Required Information: 2 x HbA1C results
- Insulin initiation/GLP 1
- Recurrent Hypoglycaemia on insulin
- Poor glycaemic control on insulin
- High steroid with hyperglycaemia
- Terminal illness and blood glucose levels unstable
||Level 3 Continence Care:
- Refer for advice or support of complex or high risk patients as required following generic continence assessment, working diagnosis and appropriate care planning in place for Levels 1 & 2 interventions.
||Tissue Viability Specialist:
- Complex wound management/advice required
||Parkinson’s Disease Specialist Nurse:
- Individuals aged 16years and over with a confirmed diagnosis of Parkinson Disease by a Consultant with a special interest or Consultant Neurologist.
- Variants of the disease - Multi system Atrophy , Vascular Parkinson , Progressive Supranuclear Palsy, Corticobasal degeneration and Lewy body Dementia who are taking Parkinson Medication
Copy of echocardiogram, angiogram or MRI scan results required.
- Worsening signs / symptoms of heart failure
- Objective evidence to support diagnosis
– echocardiography / angiography/ MRI Scan results
|Macmillan/ Palliative Care Services
||Macmillan/ Palliative Care Services: Referral to Palliative Care Specialist for one of the following reasons
- Assessment and advice on complex physical symptoms not responding to first line management
- Advanced psychological, emotional and spiritual support for patients/ carers
- Provision and clarification of specialist information on disease treatment and palliative care.
- Acute Myocardial Infarction
- Percutaneous Cardiac Intervention
- Recent cardiac surgery including bypass graft (CABG) , valves, ventricular assist device or heart transplant
- Implantation of cardiac defibrillator
- Implantation of device for cardiac resynchronisation therapy not related to acute coronary syndrome or heart failure
- Stable Angina patients who have had two condition-related emergency admissions to hospital within a six month period.
- Heart Failure (stable 6/52 with reduced functional ability due to hf symptoms)
|Respiratory Response Services
||Acute Respiratory Assessment Service
Significant co-morbidities stable
- Confirmed diagnosis of COPD (please enclose most recent spirometry)
- Able to cope at home
- Suitable social circumstances
Early Assisted Discharge
Complex Case Management
- Via established pathway –inreach, outreach and RAPA
AND at least three of the following criteria:
- Confirmed diagnosis of chronic obstructive pulmonary disease with a spirometric FEV1 measurement of <50% of predicted.
- Two or more hospital admissions in the last 12 months with the primary diagnosis being exacerbation of COPD.
- Two or more A & E attendances in the last 12 months with the primary diagnosis being exacerbation of COPD.
- A hospital admission in the last 12 months of 4 weeks or more with the primary diagnosis being exacerbation of COPD.
- Four or more visits to their GP practice in the last 12 months with needs relating to COPD.
- An MRC dyspnoea score of 4 or 5
- Are functionally disabled by their condition.
- Receiving oxygen therapy.
- 3 or more co-morbidities
- Have a confirmed diagnosis of COPD (hard copy of spirometry must be attached to the referral).
- Optimal medical management and a period of stability for a recommended 8 weeks prior to the assessment.
- A resting SpO2 of ≤ 92% breathing air or a fall in SpO2 of 4% to below 90% on
exertion or a resting SpO2 of ≤ 94% with evidence of peripheral oedema,
polycythaemia (haematocrit ≥55%) or pulmonary hypertension.
- Be in receipt of oxygen therapy without ever having been formally assessed or currently receive oxygen therapy but do not require follow up in Secondary Care.
- Have a confirmed diagnosis of COPD (Chronic Bronchitis / Emphysema / Chronic Asthma) and self-reported exercise / functional limitation (MRC Dyspnoea Score 3-5)
- Have functional limitation due to other chronic respiratory disease or condition such as Bronchiectasis, Interstitial Lung Disease, Asthma, Chest Wall Disease, Pre and Post Thoracic Surgery, e.g. LVRS, Lung transplant, Lung resection for cancer
- Patients with an MRC Dyspnoea Score of 2 who are symptomatic and consider themselves disabled by their condition, and who require a health care professional assessment and supervision of exercise training, rather than simple advice on lifestyle changes
- Have had all Pharmacotherapy evaluated and optimised, particularly Respiratory, Cardiac and Pain Medication / Management.
- Be willing to be an active participant and motivated to attend
- Be able to provide own transport (unless logistically this is impossible)
Confirmed Diagnosis of COPD
- Difficulty with clearing secretions / excessive coughing / extreme sputum production
- Poor management of breathlessness with COPD as primary cause