For Cardiopulmonary placement, i was allocated to an outpatient COPD linkage program. Whereby the service provided additional pulmonary rehabilitation and maintenance classes. The program consisted of clinics whereby the clients were initially assessed to see if they are appropriate for enrollment into the exercise class; then the actual ex classes followed by 6 weekly reassessments.
During a clinic session, a patient will usually have 30 minutes with the COPD nurse, the physio and the respiratory physician in no particular order. between each session there is a quick hand over between us so there is no crossing over. For one patient that i handed over to the doctar, he asked me many questions about the patient's performance in the 6 minute walk test. Noting that he desaturated to 89% from 95% during the test. The doctar then asked me if i think he needed oxygen supplement during exercise. I replied "I don't think so", but i wasn't sure on oxygen prescription requirements and i thought it was the respiratory physician who prescribs the oxygen. It became clear to me then, that as a physio we can have more input, as ultimately we are the ones exercising these people and need to be aware, even if the docs do the official prescription.
That day i was informed of the indications for oxygen prescription for exercise. If the patient desaturates below 90% during the 6MWT on RA, 2L of oxygen via NP is trialled (that is what i preceeded to do for this patient) while performing the 6MWT. Prescription is then dependent on their exercise capacity, not their saturations. If the patient is able to walk significantly further (i.e. extra 30m) with oxygen, then it is prescribed. There is poor evidence regarding oxygen therapy and exercise, so even if the sats improve greatly but there is no improvement in exercise capacity, oxygen isn't prescribed as no benefits have been proven.
I now feel confident in my ability to give an informed opinion on a patient with regards to oxygen use in addition to assessing their exercise capacity. I have also learnt the importance of communicating with other health professions and the benefits of multiple input to get the best solution for each patient. i thought this information would be helpful for everyone as not everyone would get to experience the outpatient setting for their cardio placement.
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Thanks for that! I vaguely remember this been touched on during lectures! They said we would learn this on prac. I agree it is important to know that other health professional’s collaboration can provide the best solution for the patients, but for this issues your right the physio is the one to go to.
Thanks for that input, definitely very useful to those of us who might not have the opportunity to experience working in your setting. I believe it is things like these that make us more confident when communicating with other health professionals. In this case i suppose the doctor was assuming that he would get an answer from us. Having an appropriate answer for the doctor would increase the trust in the abilities of us students. So, thanks for reminding us about oxygen prescription there!
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