EPIC Case Study. Sidney is an 85-year old gentleman. He suffers from very severe COPD and myelodysplasia leading to chronic anaemia. He had been admitted to hospital 12 times in the past 2 years due to exacerbations of his COPD or due to symptomatic anaemia. The EPIC Nurse prioritised him on her caseload and visited him as one of the first patients seen by the service in the area. The Nurse was able to make a full assessment including physical examination of Sidney’s needs and negotiate a management plan with him. The nurse then worked to educate Sidney about his disease helping him to understand and recognise the early signs of exacerbation of his chronic diseases. Sidney was visited regularly, but was also given the nurses contact number to ring if he experienced any signs of deterioration. A few weeks later Sidney rang to say that he was more breathless and had increased sputum. The EPIC Nurse visited and made an assessment which led to diagnosis of an exacerbation of his COPD. She contacted the GP and arranged an urgent prescription for antibiotics and steroids. She then arranged for the Rapid Assessment Team to give an intensive short term care package including night sitting until the exacerbation was resolving. This enabled Sidney to be managed at home which was his dearest wish. A few weeks later another exacerbation was managed in the same way. Later that month Sidney contacted the EPIC Nurse to say that he had experienced a prolonged episode of chest pain which had eventually resolved. The Nurse made an assessment on the telephone and decided that Sidney was safe to remain at home until she could visit 2 hours later, but gave advice on ringing 999 if symptoms recurred. The nurse visited later, took a full history, carried out a physical examination and recorded an ECG. She then took this back to the surgery and discussed with his doctor. Sidney was given advice and support, but continued to experience chest pain over the next few days. Previously, Sidney had been admitted with angina brought on by anaemia. The nurse followed up his latest blood results and found that he was now profoundly anaemic again. She arranged for a blood transfusion to be carried out as a day case at the local community hospital 2 days later. The nurse referred directly to the Doctor at the Day Hospital and cross matched the blood in preparation for the transfusion. Several weeks later, Sidney’s chest pain and weakness reoccurred. A blood test showed that he was very anaemic again, but on questioning the nurse found that he had experienced some malaena over the week preceding this. She was able to liaise with the GP to arrange an urgent referral for investigations. She then arranged for a further transfusion to be carried out in the patient’s home by the local Acute Care at Home Team. These interventions over a two-month period prevented four admissions to hospital. It is Sidney’s wish to remain at home and EPIC enabled him to do that safely, but also to ensure his chronic disease is monitored and treated appropriately.
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