Date of Award
5-2024
Degree Type
DNP Project
Degree Name
Doctor of Nursing (ND)
Department
Nursing
Chair
Karim Singh
Abstract
Background: Chronic obstructive pulmonary disease (COPD) remains the fifth leading cause of disease-related deaths worldwide, resulting in an annual cost of $3.5 billion in the United States due to COPD exacerbations. COPD treatment necessitates a multifaceted approach that includes collecting complex, subjective, and objective patient information. A ten-day patient assessment log was completed in an outpatient pulmonary clinic to evaluate any shortcomings in the current practice, revealing that the current evaluation of breathlessness involved gathering subjective reporting with binary yes/no responses, leading to variability in diagnosis and treatment.
Methods/Aims: The binary evaluation fell short of the recommendations of the Global Initiative for Obstructive Lung Disease (GOLD) 2023 clinical practice guidelines, which suggest the utilization of either the modified Medical Research Council Dyspnea Scale (mMRC) or the COPD Assessment Tool (CAT). A literature review indicated that the mMRC is an affordable, low-cost tool best recommended for use in an outpatient setting for stratifying functional breathlessness. Upon the initial intake appointment, patients completed the mMRC. Additional standard intake procedures for the differential diagnosis of COPD, , including a pulmonary function test, were ordered. At follow-up appointments, an additional mMRC score was obtained. The goal of this project was to optimize appropriate individualized diagnosis, clarification, and treatment management using the GOLD 2023 ABE treatment algorithm in new patients presenting with breathlessness.
Results/Conclusion: During the two-week intake period, 11 new patients who presented to the outpatient clinic with chief complaints of breathlessness and suspected COPD and met the inclusion and exclusion criteria were identified. Among these 11 patients, two were rescheduled outside of the timeframe of the quality improvement project, three canceled follow-up appointments without rescheduling, and six completed the necessary intake testing, including a pulmonary function test. The mMRC provided additional information for applying the GOLD 2023 Clinical Practice Guidelines (CPG). Additionally, after continued utilization, the mMRC facilitated organic conversations, improving provider assessment and interviewing beyond the five binary questions of the mMRC. It was noted that utilizing the mMRC dyspnea tool led to an improvement in identification utilizing the GOLD 2023 CPG, yielding the optimization of individualized treatment plans for all six patients, as none had previously received maintenance medications.
Implication for practice: The mMRC is an affordable, brief, and simplified tool that can be easily incorporated during intake and follow-up visits. This improves classification and provides more individualized treatment options. The mMRC can also be utilized in patients with COPD and asthma.
Recommended Citation
Flores, Martha, "Reaching GOLD: Diagnosing and Individualizing Care Using GOLD ABE Guidelines" (2024). Cohort XII. 6.
https://scholarworks.utep.edu/cohort_12/6
PowerPoint Presentation
Flores_Poster.pdf (934 kB)
Poster Presentation