Case Study 3: Louise Barnes

Louise Barnes Pharmacy Case Study 315pxWho does the spirometry in your practice?

We have five nurses in our designated nurse clinic and we all do spirometry.

How much spirometry do you do in the practice?

On average we do 6-8 per week and it is full spirometry – pre and post.

We try to do spirometry on every patient with asthma and also try to opportunistically catch all smokers and ex-smokers. When taking a patients’ history we identify those at risk and suggest spirometry.  Doctors within the practice refer patients to us too.

We have introduced something new in our practice: self-referral facilities for patients.  Posters on the walls in our reception encourage patients to ask for a lung health check or heart check.  The nurses do the check at the request of the patient and the doctor gives the patient the results.

Who interprets the spirometry?

The computer program gives some information but the doctor that ordered the spirometry does the interpretation of results.

What do you see as the advantages to doing spirometry in the practice?

I see it as a good opportunity to do education with patients.  It also demonstrates continuity of care and enables us to screen at-risk patients in the practice.

What do you see as the challenges in offering a spirometry service?

The biggest challenge is patient related because some people are unable to do the technique correctly and it is difficult to get repeatable results.  The age of the patient and fatigue can be contributing factors.  The results are not always a clear cut perfect read, so we follow up with the doctor to decide whether the patient should come back to do spirometry again.

Spirometry is also time-consuming and we tend to devote one afternoon of our clinic time per week for respiratory appointments which include spirometry.

Which spirometer do you use?

We use the Minispir® which was purchased by one of the doctors after learning about it a GP Conference.  The ongoing costs include disposable turbines ($4 each) and the nurses’ time.

What training did you (and others) undertake to learn how to deliver spirometry?

I originally did a spirometry course through the Division of General Practice many moons ago and have kept up to date since then through my own personal education.  There are now recommended accredited courses by the Thoracic Society (TSANZ).  I have subsequently trained other nurses who hadn’t received formal education in-house. Most of the RNs have now attended more formal training which we see as very important.

How does your practice finance the delivery of this service?

We used to bulk bill spirometry but we currently charge patients a fee on top of receiving the Medicare rebate.

Do you have any advice for a practice considering undertaking spirometry?

  1. Make sure your spirometer has good software which is computer compatible and that does not required frequent calibration
  2. Allow adequate time for the appointments
  3. Training is very important for confidence and good technique
  4. Have good procedures and protocols in place
  5. Good reception staff are invaluable as they need to advise anyone making an appointment to withhold preventers on the morning of the test and relievers for four hours prior (unless in distress). This avoids wasted appointment time. Booking morning appointments alleviates some of these issues.