#PhysioTalk Transcript

Healthcare social media transcript of the #PhysioTalk hashtag.
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Janet Thomas @JanetThomas47
Sorry not to be able to join you tonight as would be really interested in how frailty impact respiratory management. Lots of cross over with our usual work with frail older adults I suspect! A consideration might be about being frail but NOT old? #physiotalk
physiotalk @physiotalk
Hello everyone, and welcome to #physiotalk! Tonight, we’re discussing Respiratory Management of the Frail Patient with @ACPRC - Association of Chartered Physiotherapists in Respiratory Care https://t.co/o20EkVkAyv #physiotalk
Sara Bolton 🌈💙 @southernscampi
RT @physiotalk: Your one hour warning! #physiotalk is at 8.30pm BST with @TheACPRC Respiratory Management of the Frail Patient https:/…
physiotalk @physiotalk
We're looking forward to hearing your thoughts about how all physiotherapists can best manage respiratory conditions in our frail patients #physiotalk
ACPRC @TheACPRC
Welcome everyone! #Physiotalk
physiotalk @physiotalk
Have you had a chance to look at our pre-chat info? 🧐 https://t.co/QYXKpBfisl #physiotalk
Sara Bolton 🌈💙 @southernscampi
@physiotalk @acprc Hello! 🤓 from Oxford #physiotalk
physiotalk @physiotalk
So, who is joining us tonight? Say hello and let us know where you’re tweeting from! #physiotalk
Ellena @ellena_farrow
@physiotalk Hello I’m lurking in Preston 🙋🏼‍♀️ Looking forward to this one #physiotalk
Nicola Lauchlan @NicolaLauchlan
@physiotalk Hello from Paisley :-) #physiotalk
Sara Bolton 🌈💙 @southernscampi
@physiotalk @acprc Yikes... are we alone? #physiotalk 🧐
Cath Edwards @cathedwards_1
@southernscampi @physiotalk @acprc Hi 👋 it’s Cath from Wigan #physiotalk
ema swingwood @emaroids1
@TheACPRC Hello! Ema from Bristol here- very much looking forward to this! #physiotalk
ACPRC @TheACPRC
@physiotalk Hello everyone! We’ll be tweeting tonight, looking forward to hearing about how you’re managing frailty in all your different specialisms! #physiotalk
Victoria @VictoriaHatha
@physiotalk Hello from Wigan! 👋 #physiotalk
Sara Bolton 🌈💙 @southernscampi
RT @cathedwards_1: @southernscampi @physiotalk @acprc Hi 👋 it’s Cath from Wigan #physiotalk
Cath Edwards @cathedwards_1
@southernscampi @physiotalk @acprc This is a great topic btw 👍 😊#physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk #physiotalk, apologies.
physiotalk @physiotalk
@PamKHphysio @TheACPRC Evening Pam, how are you getting on - do you mean you can't access the tweetdeck site at all? #physiotalk
Pamela Kipps Hansford @PamKHphysio
@physiotalk Pam Hansford greetings to all from Cape Town #physiotalk
Becca Adams @Asqbecca
Hello from @NHSGGCsouthAHP. I am based in acute receiving, member of the frailty team and specialist interest in resp conditions. Excited to hear whats going on #physiotalk
Fiona Bowe @FionaBowe3
@physiotalk Evening from Middlesbrough.. listening in and looking forward to the content. #physiotalk
physiotalk @physiotalk
@acprc Whoops - the correct handle is @TheACPRC! Sorry about that #physiotalk #factcheck
Dr. Sibyl Edward @pasl_pt
Hi Everyone! Lurking from St. Lucia in the Caribbean. Interesting topic #physiotalk
Sara Bolton 🌈💙 @southernscampi
@physiotalk #oxford #physiotalk👋🏻
physiotalk @physiotalk
Welcome to any first-timers and lurkers out there, feel free to introduce yourselves and get involved with the chat #physiotalk
ThePhysioBack @physio_back
@physiotalk Hi. David. Physio student, 1st year. On a Respiratory placement. Looking forward to learning lots. #physiotalk
Kate Hills @KH_Physio
Looking forward to the @TheACPRC #physiotalk this evening! Tweeting from the far from sunny South coast in Chichester!
physiotalk @physiotalk
A little reminder: please use the #physiotalk hashtag in all your tweets – this way, everyone can follow the conversation and we can all hear what you’ve got to say #physiotalk #physiotalk #physiotalk
Becca Adams @Asqbecca
.I think often on non-resp wards the physio is often the one with the most experience and up to date in respiratory management. Its important to be an advocate for your patient and assist and advise in the management of their symptoms #physiotalk
physiotalk @physiotalk
Ok let’s get rolling! #physiotalk
physiotalk @physiotalk
Q1: What red flags can we look for that might highlight a frail patient to us? #physiotalk
Pearlene @Pearlene4
@physiotalk @acprc #physiotalk hello from Brum!
physiotalk @physiotalk
RT @TheACPRC: @physiotalk Hello everyone! We’ll be tweeting tonight, looking forward to hearing about how you’re managing frailty in all yo…
physiotalk @physiotalk
@physio_back Welcome, David! #physiotalk
Nicola Lauchlan @NicolaLauchlan
@physiotalk Sarcopenia, reducing mobility, social isolation, difficulty completing everyday tasks, polypharmacy, multiple doctor appts/hospital admissions and probably lots more I'm forgetting! #physiotalk
ACPRC @TheACPRC
@physiotalk Altered cognition, polypharmacy, falls, poor mobility, poor nutrition…#physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk For me I look for a lot of factors, including number of admissions, history from ambulance crew. Obvious long term conditions, concordance with treatment, social isolation. Presentations ed with non-specific problems. Countless more I’m sure #physiotalk
Ellena @ellena_farrow
@physiotalk Recurrent hospital admissions, polypharmacy, recurrent falls whether they cause an admission or not #physiotalk
physiotalk @physiotalk
@ellena_farrow Hi Ellena and welcome! Please feel free to get involved throughout the chat :-) #physiotalk
Pamela Kipps Hansford @PamKHphysio
@physiotalk Yes, very impressed by the resources on offer - evidence based research at its best integrated into a framework through inclusive collaborative process in conjunction with a wide range of participants #physiotalk
Pearlene @Pearlene4
@NicolaLauchlan @physiotalk #physiotalk really like that social isolation is mentioned here.
Sara Bolton 🌈💙 @southernscampi
@physiotalk #physiotalk 🤦🏼‍♀️
ema swingwood @emaroids1
@physiotalk Difficult when there’s not an agreed definition of frailty. Age, BMI (risk of malnutrition), mobility status (falls hx), meds. I also think long term resp condition should be a marker of frailty! #physiotalk
physiotalk @physiotalk
RT @TheACPRC: @physiotalk Altered cognition, polypharmacy, falls, poor mobility, poor nutrition…#physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk I think ownership of medical conditions is important too. I don’t really like the term self neglect but people who don’t take ownership of their own conditions and put themselves at greater risk of other complications. #physiotalk
Cath Edwards @cathedwards_1
#physiotalk
Sara Bolton 🌈💙 @southernscampi
RT @ellena_farrow: @physiotalk Recurrent hospital admissions, polypharmacy, recurrent falls whether they cause an admission or not #physiot
Sara Bolton 🌈💙 @southernscampi
RT @IanTyrrell5: @physiotalk For me I look for a lot of factors, including number of admissions, history from ambulance crew. Obvious long…
physiotalk @physiotalk
@cathedwards_1 Whoops, don't forget the #physiotalk ;-)
Ian Tyrrell @IanTyrrell5
@cathedwards_1 @physiotalk Helps if you can access electronic records of ambulances or previous ed admissions, gives you more to go on then pidgeon holing people. #physiotalk
ACPRC @TheACPRC
@physiotalk Interesting lots of these red flags put these patients at risk of respiratory complications, even with no pre-morbid respiratory problem #physiotalk
Becca Adams @Asqbecca
I think it is important to consider frailty independent of age alongside all the other factors mentioned. A lot of the standardised frailty tools talk about older patients - younger, sicker patients can also be frail #physiotalk
physiotalk @physiotalk
#physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk Oh yea and alcohol or other substance abuse and mental health problems. Can accelerate #frailty in younger persons. #physiotalk
Nicola Lauchlan @NicolaLauchlan
@TheACPRC @physiotalk Absolutely- many of the frail patients I see are admitted with 'general debility/loss of mobility' and turn out to have a chest infection even without a background of respiratory disease #physiotalk
physiotalk @physiotalk
RT @Asqbecca: I think it is important to consider frailty independent of age alongside all the other factors mentioned. A lot of the standa…
ema swingwood @emaroids1
@Asqbecca Good point! And it’s more difficult to set up support for this middle aged group #Physiotalk
ACPRC @TheACPRC
@Asqbecca Yes definitely! Lots of work happening right now around frailty in paediatrics and in transplant patients…frailty isn’t just in the elderly! #physiotalk
Sara Bolton 🌈💙 @southernscampi
@Asqbecca Agree ... many people think LTC without ⬆️ age is just a LTC ... but actually is #frailty #physiotalk
Nicola Lauchlan @NicolaLauchlan
@BreathePhysio This is a great point #physiotalk
ACPRC @TheACPRC
@IanTyrrell5 @physiotalk That’s a really good point…these patients often slip through the net for this reason too! #physiotalk
Becca Adams @Asqbecca
RT @TheACPRC: @Asqbecca Yes definitely! Lots of work happening right now around frailty in paediatrics and in transplant patients…frailty i…
Action Potential🇳🇵🇳🇵 @DNApolymers
RT @NicolaLauchlan: @physiotalk Sarcopenia, reducing mobility, social isolation, difficulty completing everyday tasks, polypharmacy, multip…
physiotalk @physiotalk
Lots of interesting discussion around red flags! Get ready now, question 2 is coming up... #physiotalk
physiotalk @physiotalk
Q2: Should we routinely assess for frailty in respiratory services, and what assessment tools can we use? #physiotalk
Nicola Lauchlan @NicolaLauchlan
@physiotalk I think frailty is everyone's business and should be routinely assessed in every service #physiotalk
Sara Bolton 🌈💙 @southernscampi
RT @physiotalk: Lots of interesting discussion around red flags! Get ready now, question 2 is coming up... #physiotalk
physiotalk @physiotalk
RT @TheACPRC: @Asqbecca Yes definitely! Lots of work happening right now around frailty in paediatrics and in transplant patients…frailty i…
Becca Adams @Asqbecca
@emaroids1 Agreed - there is nowhere near the same resources and younger patients who are 'frail' I find can be more reluctant to accept help due to the stigma attached of needed extra support #physiotalk
physiotalk @physiotalk
RT @TheACPRC: @physiotalk Interesting lots of these red flags put these patients at risk of respiratory complications, even with no pre-mor…
Ian Tyrrell @IanTyrrell5
@physiotalk It depends on what you’re going to do with the information. If you’re just screening as a tick box then no, if you are going to make onward referrals recommendations then yes. #physiotalk
Hannetjie Easton @HanniLowe
@physiotalk Already receiving lots of care at home/residence #physiotalk
Sam Targett @sam_targett
@NicolaLauchlan @physiotalk Absolutely! #physiotalk
Cath Edwards @cathedwards_1
@BreathePhysio Good concept as if a patient is frail little reserves & vulnerable #physiotalk
Sam Targett @sam_targett
RT @TheACPRC: @Asqbecca Yes definitely! Lots of work happening right now around frailty in paediatrics and in transplant patients…frailty i…
physiotalk @physiotalk
@Physio_myRehab Evening Hari! Don't forget the #physiotalk in each message
ema swingwood @emaroids1
@physiotalk Everyone should consider it- you don’t have to be on an Okder Persons Ward to fulfill a Frailty description! Many resp pts are frail!! #Physiotalk
Sara Bolton 🌈💙 @southernscampi
RT @emaroids1: @physiotalk Everyone should consider it- you don’t have to be on an Okder Persons Ward to fulfill a Frailty description! Man…
ACPRC @TheACPRC
@physiotalk Something like the Clinical Frailty Scale can be done really quickly for patients you see with those red flags we just discussed! #physiotalk https://t.co/1zpY7TfO1H
Cath Edwards @cathedwards_1
@physiotalk Yes deffo should consider frailty & assess ✅ but need to refer onward. Frailty a risk factor in #COPD #physiotalk
Pearlene @Pearlene4
@physiotalk #physiotalk Yes it should be assessed we all need to take responsibility. Clinical frailty score is a quick one to use. I am interested to see what others are used.
ema swingwood @emaroids1
RT @TheACPRC: @physiotalk Something like the Clinical Frailty Scale can be done really quickly for patients you see with those red flags we…
Ellena @ellena_farrow
@physiotalk Yes. Frailty may affect risk of developing respiratory complications, treatment options and scope for recovery. Only tool I’ve previously used is the Rockwood frailty scale. #physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk In terms of tools, lots out there but again needs to be specific. Rockwood is a simple screening tool but difficult to assign properly in my opinion. Also need something to be specific and easy to use! #physiotalk
physiotalk @physiotalk
Any other frailty measures in use out there? Or that you would like to see in use? #physiotalk
Nicola Lauchlan @NicolaLauchlan
@IanTyrrell5 @physiotalk I agree- I feel these tools are very subjective and prone to misinterpretation #physiotalk
Sam Targett @sam_targett
RT @TheACPRC: @physiotalk Something like the Clinical Frailty Scale can be done really quickly for patients you see with those red flags we…
Ian Tyrrell @IanTyrrell5
@NicolaLauchlan @physiotalk Especially if not done in detail! #physiotalk
Sara Bolton 🌈💙 @southernscampi
@ellena_farrow @physiotalk I think rockwood is good, visual and quick... #physiotalk
Action Potential🇳🇵🇳🇵 @DNApolymers
RT @TheACPRC: @physiotalk Interesting lots of these red flags put these patients at risk of respiratory complications, even with no pre-mor…
Cath Edwards @cathedwards_1
@physiotalk I’m most familiar with the Rockwood Frailty Scale but know about Edmonton Frail Scale #physiotalk
physiotalk @physiotalk
@r_vineeth Hi Vineeth and welcome :-) Don't forget to add #physiotalk hashtag into each message
Action Potential🇳🇵🇳🇵 @DNApolymers
RT @TheACPRC: @Asqbecca Yes definitely! Lots of work happening right now around frailty in paediatrics and in transplant patients…frailty i…
Fiona Bowe @FionaBowe3
@IanTyrrell5 @physiotalk Agree completely. I always think we should be including frailty assessments for many elective surgeries.. (my area is cardiothoracics) and having greater PT/OT input in a pre-emptive rather than reactive manner would be great. Taking action beyond a tick #physiotalk
physiotalk @physiotalk
Question 3 is on its way.. #physiotalk
Sam Targett @sam_targett
@r_vineeth @physiotalk Yes have seen the same, also quick and easy to assess with appropriate patients #physiotalk
Ian Tyrrell @IanTyrrell5
@TheACPRC @physiotalk This is only a brief tool and should indicate a referral on for CGA, but who is going to do that? #physiotalk
ACPRC @TheACPRC
@IanTyrrell5 @NicolaLauchlan @physiotalk Totally agree, we should be using it to identify the ‘at risk’ patient and make specialist referral. If we want/need to provide intervention, are there more detailed tools that can be used? #physiotalk
physiotalk @physiotalk
Q3: How can respiratory/acute medicine teams work collaboratively to deliver best practice for both respiratory and frailty-related problems? #physiotalk
Ian Tyrrell @IanTyrrell5
@FionaBowe3 @physiotalk Exactly, what we’re talking about is the need for CGA, which is not a quick tick box, needs that whole MDT approach, just need to make sure those services are available. #physiotalk
Becca Adams @Asqbecca
@FionaBowe3 @IanTyrrell5 @physiotalk Prevention is better than cure!!! #physiotalk
ACPRC @TheACPRC
@IanTyrrell5 @physiotalk Who can make that referral? Is it consultant to consultant, or should physios be taking this on? #physiotalk
Dr. Sibyl Edward @pasl_pt
Still on Q2. sorry. Some research has shown that the usefulness of certain frailty assessment tools has not been properly assessed #physiotalk
Vineeth Ravindran @r_vineeth
@physiotalk Could we use 6MWT regularly on COPD patients during each hospital admissions as an outcome measure of progress? #physiotalk
Nicola Lauchlan @NicolaLauchlan
@physiotalk This is the million dollar question especially when we still work in specialist silos- perhaps an across-board AHP approach to frailty which encompasses all co-morbidities is required? How to do this is the difficulty though #physiotalk
Becca Adams @Asqbecca
@physiotalk I think the important thing is MDT communication. As i said earlier, its everyones job to be their patients advocate - if something isnt right. Flag it up #physiotalk
Ellena @ellena_farrow
@physiotalk In service training between teams, open door policy to allow staff to easily gain advice from more experienced colleagues, shadowing/opportunities to spend time within different teams to expand skills and learn from each other. #physiotalk
Ian Tyrrell @IanTyrrell5
@TheACPRC @physiotalk Depends on where you work, both acute and community. Doesn’t need to be medically led as it’s an MDT approach to the whole patient! #physiotalk mainly used in frailty teams.
Sam Targett @sam_targett
This!!!!! #physiotalk
ACPRC @TheACPRC
@FionaBowe3 @IanTyrrell5 @physiotalk Are there any prehab services out there that screen for frailty pre-surgery? #physiotalk
Louise Brennan @Louise_Brennan_
@sam_targett @r_vineeth @physiotalk I've seen this too - I wonder how widely this is used, and what/if other measure are used alongside. Seems very useful! #physiotalk
Ian Tyrrell @IanTyrrell5
@physio_back @TheACPRC @physiotalk Comprehensive Geriatric Assessment. Looks at the whole patient rather than just specifics, usually carried out on frailty units. #physiotalk
ACPRC @TheACPRC
RT @ellena_farrow: @physiotalk In service training between teams, open door policy to allow staff to easily gain advice from more experienc…
Becca Adams @Asqbecca
@IanTyrrell5 @TheACPRC @physiotalk Our CGA is carried out by ECANs or the therapy staff, rarely by the medical staff. They are often led by us to plans for DC and ongoing therapy/social needs #physiotalk
physiotalk @physiotalk
RT @NicolaLauchlan: @physiotalk This is the million dollar question especially when we still work in specialist silos- perhaps an across-bo…
Nicola Lauchlan @NicolaLauchlan
@IanTyrrell5 @physio_back @TheACPRC @physiotalk I wonder why CGA is only used on frailty units? Could it be more widely utilised? #physiotalk
Ian Tyrrell @IanTyrrell5
@TheACPRC @FionaBowe3 @physiotalk Lots of surgery schools popping up! Unsure whether or not they screen for frailty, but they probably should. #physiotalk
physiotalk @physiotalk
RT @ellena_farrow: @physiotalk In service training between teams, open door policy to allow staff to easily gain advice from more experienc…
Sam Targett @sam_targett
@Louise_Brennan_ @r_vineeth @physiotalk Its part of the CPAx assessment isn't it so already in use on ITU environments #physiotalk
physiotalk @physiotalk
RT @TheACPRC: @FionaBowe3 @IanTyrrell5 @physiotalk Are there any prehab services out there that screen for frailty pre-surgery? #physiotalk
Ian Tyrrell @IanTyrrell5
@NicolaLauchlan @physio_back @TheACPRC @physiotalk Massively! Because lots of younger frail respiratory patients don’t meet the criteria for frailty units so just go resp/gen med. #physiotalk
ema swingwood @emaroids1
@physiotalk Need to share knowledge and experiences- DON’T work in silo’s. Not just relevant for Physio but whole MDT. We have CGA @UHBristolNHS #Physiotalk
physiotalk @physiotalk
RT @IanTyrrell5: @physio_back @TheACPRC @physiotalk Comprehensive Geriatric Assessment. Looks at the whole patient rather than just specifi…
Dr. Sibyl Edward @pasl_pt
So true!
rachael moses @rachaelmoses
@physiotalk In old days of resp medicine this wasn’t an issue as PT were ‘allowed’ to treat the whole patient. Now with cuts/specialist boundaries more difficult I loved the model @StGeorgesTrust where a PT/OT front door team assess & Rx entire pt only refer to resp if needed #physiotalk
physiotalk @physiotalk
@joshpoole Hi Joshua! don't forget the #physiotalk in each tweet ;-)
Ian Tyrrell @IanTyrrell5
@physiotalk Communication, learning from each other, learning from patient stories. Adding more strings to our bows and embrace the challenge of new skills rather than working with one hat on! #physiotalk
ema swingwood @emaroids1
@IanTyrrell5 @NicolaLauchlan @physio_back @TheACPRC @physiotalk This is why resp conditions should also be a marker of frailty #Physiotalk
Joshua Poole @joshpoole
@physiotalk Many apologies, normally well behaved! #physiotalk
Action Potential🇳🇵🇳🇵 @DNApolymers
RT @ellena_farrow: @physiotalk In service training between teams, open door policy to allow staff to easily gain advice from more experienc…
Action Potential🇳🇵🇳🇵 @DNApolymers
RT @IanTyrrell5: @physiotalk Communication, learning from each other, learning from patient stories. Adding more strings to our bows and em…
physiotalk @physiotalk
Doing great tonight on the hashtagging everyone! Just a brief reminder to use #physiotalk in every tweet so you're included in the chat 👍👍👍 #physiotalk
Ian Tyrrell @IanTyrrell5
@emaroids1 @NicolaLauchlan @physio_back @TheACPRC @physiotalk But will a respiratory consultant see it that way or will they just want to treat the respiratory condition. #physiotalk
ACPRC @TheACPRC
@physiotalk Communication! Resp teams identifying frailty and communicating with frailty/medicine teams, and vice versa when frail patients come in with new or pre-existing resp conditions #physiotalk
physiotalk @physiotalk
@joshpoole I don't doubt that for a minute! :-) #physiotalk
Vineeth Ravindran @r_vineeth
@TheACPRC @physiotalk @FionaBowe3 @IanTyrrell5 We were discussing about using clinical frailty scale to predict LoS in our critical care unit #physiotalk
Robyn Stiger @RobynStiger
@IanTyrrell5 @TheACPRC @FionaBowe3 @physiotalk I think currently prehab is perhaps too undefined to answer this question yet. The patients referred to prehab are often on a surgical list which means they are probably considered fit for surgery prior to referral. Prehab could definitely help this patient group. #physiotalk
Becca Adams @Asqbecca
@IanTyrrell5 @emaroids1 @NicolaLauchlan @physio_back @TheACPRC @physiotalk I think we need to adopt a culture of change and educate the importance of it as well. Easier said than done I know! #physiotalk
ACPRC @TheACPRC
@physiotalk Loving the ideas around shared IST…how many services have IST that crosses specialities? #physiotalk
Robyn Stiger @RobynStiger
@IanTyrrell5 @TheACPRC @FionaBowe3 @physiotalk Lots of work to be down through service evaluation / research. #physiotalk
physiotalk @physiotalk
Ready for Q4? #physiotalk
Sam Targett @sam_targett
RT @TheACPRC: @physiotalk Loving the ideas around shared IST…how many services have IST that crosses specialities? #physiotalk
physiotalk @physiotalk
Q4: How can we support frail patients with respiratory disease admitted to non-respiratory specialty areas? How do we support the staff working in these areas? #physiotalk
ema swingwood @emaroids1
@TheACPRC @physiotalk Yep. We have one massive IST timetable for all specialities and disciplines- everyone welcome. We have some amazing discussions and I think our pt approach is better as a result #Physiotalk
Pearlene @Pearlene4
@physiotalk #physiotalk front door services are key but also sharing best practices and effective communication in the team!
Fiona Bowe @FionaBowe3
@r_vineeth @physiotalk #physiotalk 4 metre gait speed test too is reportedly a good clinical indicator for Fraility and certainly sometimes easier to perform in busy clinical environments for practicalities.
physiotalk @physiotalk
RT @TheACPRC: @physiotalk Loving the ideas around shared IST…how many services have IST that crosses specialities? #physiotalk
Pamela Kipps Hansford @PamKHphysio
@TheACPRC @physiotalk #physiotalk Often rel 2 polypharm+adverse drugs reactionsinteractions Drugs R prescribed 2 Rx symptoms, underlying problems not investigated Given BetaBlockers 4 arythmia @37 for 2y. Heart enlarged & breathless when hiking. Underlying problem too much caffeine, too little sleep
Nicola Lauchlan @NicolaLauchlan
@physiotalk I usually find if they are admitted to non-respiratory specialties it's because this is not their main complaint. Holistic assessment is essential, as is understanding the patient's own expertise in managing their LTC. #physiotalk
ema swingwood @emaroids1
@physiotalk Make IST sessions for everyone, peer review/supervision across teams not just within your current rotation. We also do some non specialist resp IST sessions. #physiotalk
Ian Tyrrell @IanTyrrell5
@TheACPRC @physiotalk Struggle with the idea of frailty/medicine teams not managing their own respiratory patients. May just be me! #physiotalk
Nicola Lauchlan @NicolaLauchlan
@physiotalk I also think we need to be more ready to contact the 'experts' in other silos- picking up the phone to our colleagues in other specialisms for advice where needed #physiotalk
Becca Adams @Asqbecca
@physiotalk Treat and assess holistically. Coming from a resp BG if someone was SOB/productive/anxious etc I would try and address that as well regardless of what I was treating them for. Important to educate our newer staff not to get pigeonholed in on assessment #physiotalk
Laura McGarrigle @TxPhysio
#physiotalk
Nicola Lauchlan @NicolaLauchlan
@Asqbecca @physiotalk This too! #physiotalk
Shakila Devi Perumal @SdPerumal
Resp /acute medicine team can screen patients vulnerable for frailty with a CGA and get the communication to med team in the hosp and the intergarted community care so the decision on ceilings of end of life care and other mangement can be smoothly targeted on time #physiotalk
Becca Adams @Asqbecca
YES - its never too late to learn #physiotalk
Louise Brennan @Louise_Brennan_
@emaroids1 @TheACPRC @physiotalk Sounds fantastic - this kind of shared interdisciplinary learning must really help pt management! #physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk By not forgetting our key skills no matter what speciality we are in. Treating holistically and being patient centred. And asking for support when needed. #physiotalk
physiotalk @physiotalk
RT @emaroids1: @TheACPRC @physiotalk Yep. We have one massive IST timetable for all specialities and disciplines- everyone welcome. We have…
Barnsley Hospital AHPs @AhpsBarnsley
RT @IanTyrrell5: @physio_back @TheACPRC @physiotalk Comprehensive Geriatric Assessment. Looks at the whole patient rather than just specifi…
Vineeth Ravindran @r_vineeth
@physiotalk By sharing good practice case study presentations/inservice? #physiotalk
Carlos Llorca @LlorcaCarlos
RT @physiotalk: Q2: Should we routinely assess for frailty in respiratory services, and what assessment tools can we use? #physiotalk
physiotalk @physiotalk
RT @Asqbecca: @physiotalk Treat and assess holistically. Coming from a resp BG if someone was SOB/productive/anxious etc I would try and ad…
ema swingwood @emaroids1
@IanTyrrell5 @TheACPRC @physiotalk Agree but it’s so easy to get immersed in your own bubble. For resp pts it’s the subtle signs and symptoms that specialists may recognise and the knowledge of meds etc. #physiotalk
Ellena @ellena_farrow
@physiotalk Responsibility of all staff to keep themselves competent in resp however best works for them. But can be supported with good resp competency training days, supportive seniors to bounce ideas off and opportunities to spend time working with other teams. #physiotalk
ACPRC @TheACPRC
@NicolaLauchlan @physiotalk If it’s not the main complaint, but they have a respiratory issue (new or long-term), should resp teams in-reach? Provide arms length support? Some specialist centres won’t take respiratory patients with high frailty scores…so a LRTI may be managed on a medical ward #physiotalk
physiotalk @physiotalk
@carolinewrighty Hi Caroline! Don't forget the #physiotalk in each tweet :-)
Sam Targett @sam_targett
@emaroids1 @TheACPRC @physiotalk Brilliant, what a fantastic idea, this must really help collaborative working too! #physiotalk
physiotalk @physiotalk
RT @TheACPRC: @NicolaLauchlan @physiotalk If it’s not the main complaint, but they have a respiratory issue (new or long-term), should resp…
exerciseCOPD @exerciseCOPD
RT @TheACPRC: @physiotalk Communication! Resp teams identifying frailty and communicating with frailty/medicine teams, and vice versa when…
Laura McGarrigle @TxPhysio
@r_vineeth @physiotalk the Fried Frailty score includes grip strength (among other measures). #physiotalk
Pamela Kipps Hansford @PamKHphysio
@TheACPRC @physiotalk @FionaBowe3 @IanTyrrell5 #physiotalk check resources: Frailty Framework
Ian Tyrrell @IanTyrrell5
@emaroids1 @TheACPRC @physiotalk But then would a respiratory physio miss the signs of someone advancing frailty syndrome. Massive grey area but we need to be better at doing more, in my opinion. But need the education, support and exposure to be able to do it well. #physiotalk
exerciseCOPD @exerciseCOPD
RT @rachaelmoses: @physiotalk In old days of resp medicine this wasn’t an issue as PT were ‘allowed’ to treat the whole patient. Now with c…
Nicola Lauchlan @NicolaLauchlan
@TheACPRC @physiotalk I worked in older people's rehab unit recently-my PT colleagues were highly skilled in managing respiratory issues due to their participation in on-call rotation. I was in awe as I have been a community specialist for some time. I think it's part of the toolbox 1/2 #physiotalk
ACPRC @TheACPRC
@IanTyrrell5 @physiotalk Also, some teams won’t treat respiratory issues…not saying it’s right but it definitely happens! Are there issues around maintaining competence? What about ensuring the evidence-base/guidance/standards/etc? #physiotalk
Lynsey MacD-Ferguson @lynseyferguson6
RT @TheACPRC: @Asqbecca Yes definitely! Lots of work happening right now around frailty in paediatrics and in transplant patients…frailty i…
ema swingwood @emaroids1
@IanTyrrell5 @TheACPRC @physiotalk Yes I think we do sometimes especially on the fast paced admission wards. We all need to take a step back sometimes to ensure we have covered everything #physiotalk
Nicola Lauchlan @NicolaLauchlan
@TheACPRC @physiotalk 2/2 this said, I think when expertise is required, other colleagues are generally very receptive and accessible to providing increased/specialist support. #physiotalk
physiotalk @physiotalk
Final question coming up now #physiotalk
Caroline Abbott @carolinewrighty
@IanTyrrell5 @emaroids1 @TheACPRC @physiotalk Can the CFS not help here? It’s a quick easy tool that can be embebbed into an initial assessment alongside gathering social history. #physiotalk
Pearlene @Pearlene4
@physiotalk #physiotalk I think having a good understanding of anxiety and breathlessness and simple methods to address this such as fan therapy and breathing re-education is a simple but effective rx modality
physiotalk @physiotalk
Q5: How can we support frail patients with their respiratory symptoms and treatment plans? #physiotalk
Shakila Devi Perumal @SdPerumal
Patients unfortunately get into "Fraility syndrome" which means vulnerability to multiple disorders of body functions due to a disease proces- immobility, dementia , incontience.. I beleive APH should be trained to deal and support this care irrespective of speciality #physiotalk
victoriadenny @vickydenny
In the community the 'whole patient' is treated routinely. That is why I prefer working in the community.
Joshua Poole @joshpoole
@physiotalk Education to staff of all grades, not forgetting carers and relatives to support the patients recovery. Consistency in care is also important, ensuring good patient rapport to help embed the importance of their treatment and self management. #physiotalk
ACPRC @TheACPRC
@IanTyrrell5 @emaroids1 @physiotalk Yes I think plenty would! Maybe it’s just a conversation in either direction that’s needed…”I have a patient I think is frail, should I be doing anything different?” or “I have a frail patient with COPD, do I need to do anything specific for their resp management?” #physiotalk
physiotalk @physiotalk
RT @joshpoole: @physiotalk Education to staff of all grades, not forgetting carers and relatives to support the patients recovery. Consiste…
rachael moses @rachaelmoses
@physiotalk There are lots of specialists nurses and other @WeAHPs now who can (and should) Inreach eg COPD/ILD/Vent/Asthma/Bronchiectasis I know SLTs and Physiologists as well as OTs who can provide acute care & symptom management. Deffo about #MDT approach IF available #physiotalk
Action Potential🇳🇵🇳🇵 @DNApolymers
RT @joshpoole: @physiotalk Education to staff of all grades, not forgetting carers and relatives to support the patients recovery. Consiste…
Ian Tyrrell @IanTyrrell5
@TheACPRC @physiotalk Oh I know it does, whole can of worms there and I have my own opinion. Maintaining competence Is key and needs robust systems in place to achieve. Has to be a want to remain competent! #physiotalk
Nicola Lauchlan @NicolaLauchlan
@physiotalk Listen to their concerns, give them practical support, empower them to ask the questions they need to, and reassure them that they are the experts and can manage their conditions effectively with the tools they have been given #physiotalk
Pearlene @Pearlene4
@physiotalk #physiotalk I think having a good understanding of anxiety and breathlessness and simple methods to address this such as fan therapy and breathing re-education is a simple but effective rx modality
physiotalk @physiotalk
RT @rachaelmoses: @physiotalk There are lots of specialists nurses and other @WeAHPs now who can (and should) Inreach eg COPD/ILD/Vent/Asth…
Sam Targett @sam_targett
@TheACPRC @IanTyrrell5 @physiotalk Yes have definitely experienced this, teams for example, which are not part of the on-call rota tend to be the ones likely to call on others. Other time pressures get in the way of regular updates/competencies, lack of exposure to these patients etc...vicious cycle #physiotalk
ema swingwood @emaroids1
@physiotalk Include them in Rx plans so they can self manage and know when they need additional input/review. Education for patients/caters/families is key #Physiotalk
ema swingwood @emaroids1
@TheACPRC @IanTyrrell5 @physiotalk Yep totally agree #physiotalk
Becca Adams @Asqbecca
@NicolaLauchlan @TheACPRC @physiotalk Everyone in the acute hospital (excl. MSK) has oncall duties goes through training. Most teams support this and we have quarterly oncall IST as a cohort. Doesnt make everyone an expert but have enough knowledge to know if something needs to be escalated to seniors #physiotalk
Shakila Devi Perumal @SdPerumal
A collaborative approach with fraility team (if one exist in hospital) with the medical team and liaison with community team for continuity of care. Not sure whether econsult would be a way froward to go #physiotalk
Ian Tyrrell @IanTyrrell5
@carolinewrighty @emaroids1 @TheACPRC @physiotalk Potentially. I have my own thoughts on the CFS, as long as it is being used to triage and instigate CGA then it is appropriate but if just using in isolation it’s not for me. #physiotalk
Pamela Kipps Hansford @PamKHphysio
@TheACPRC @physiotalk @37 #physiotalk Why? because I was studying through UNISA & getting up @ 4am to write assignments with great enjoyment with a cup of tea/coffee at hand - finally persuaded a creative thinking pulmonologist with me: Doing uppers & downers with excessive caffeine & too little sleep
Romain Lefebvre @romainlephysio
@physiotalk Definitely keep the palliative team in mind if things are going this way and not hesitate to refer for symptom management and care planning #physiotalk
Caroline Abbott @carolinewrighty
@IanTyrrell5 @emaroids1 @TheACPRC @physiotalk Obviously to be used as a adjunct to support clinical decision making alongside a holistic assessment! #physiotalk
Becca Adams @Asqbecca
Make the patient (and their families) esp in frail patients the expert in their own management #physiotalk
Barnsley Hospital AHPs @AhpsBarnsley
RT @rachaelmoses: @physiotalk There are lots of specialists nurses and other @WeAHPs now who can (and should) Inreach eg COPD/ILD/Vent/Asth…
Kate Hills @KH_Physio
#physiotalk Better knowledge and confidence to discuss palliative care is key
ema swingwood @emaroids1
@Asqbecca @NicolaLauchlan @TheACPRC @physiotalk Sometimes with competence (especially for oncalls) it’s understanding and acknowledging where your skill/knowledge limit is. It’s ok not to know everything! #physiotalk
Pamela Kipps Hansford @PamKHphysio
@TheACPRC @physiotalk @37 #physiotalk wonder what would have happened if I hadn't refused to take meds for breathlessness & dumped betablockers?
Ellena @ellena_farrow
@physiotalk Explain why you’re using the treatments you’re using, make sure they’re involved and find the method that works best for them, not for you. Don’t forget involving the families and carers, they can support when the patient starts to struggle with self management. #physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk Take a whole system approach, understand the symptoms that are being described, identify problems and treat accordingly from social isolation, sputum management to anxiety/dysfunctional breathing. #physiotalk
physiotalk @physiotalk
RT @ellena_farrow: @physiotalk Explain why you’re using the treatments you’re using, make sure they’re involved and find the method that wo…
Sam Targett @sam_targett
RT @ellena_farrow: @physiotalk Explain why you’re using the treatments you’re using, make sure they’re involved and find the method that wo…
Lynsey MacD-Ferguson @lynseyferguson6
@emaroids1 @TheACPRC @physiotalk This isn't something we currently do, with the exception of on call training. But I do think it would have significant merit. Rarely do our patients fit into one speciality, a broad knowledge is essential. So important to share and value each disciplines skills #Physiotalk
exerciseCOPD @exerciseCOPD
RT @ellena_farrow: @physiotalk Explain why you’re using the treatments you’re using, make sure they’re involved and find the method that wo…
physiotalk @physiotalk
Time's up...where did that hour go?! Thank you all for another great #physiotalk
Nicola Lauchlan @NicolaLauchlan
@physiotalk Thank you! Great chat! #physiotalk
physiotalk @physiotalk
Please continue to talk here, we’ll collect and share the transcript later tonight #physiotalk
University of Lincoln Physiotherapy @UoL_Physio
RT @emaroids1: @TheACPRC @physiotalk Yep. We have one massive IST timetable for all specialities and disciplines- everyone welcome. We have…
Lynsey MacD-Ferguson @lynseyferguson6
@rachaelmoses @physiotalk @WeAHPs Agree. Our main source of specialist respiratory input to medical wards come from the specialist nurse teams, they always come armed with an array of suggestions #Physiotalk
Pamela Kipps Hansford @PamKHphysio
@TheACPRC @physiotalk @37 #physiotalk @Atul_Gawande says in his book #BeingMortal that taking more than 4 prescription drugs puts a person at risk of falling. Frail patients are taking 13 or even more
Laura McGarrigle @TxPhysio
@physiotalk In the environment that’s most appropriate for them. At home if needs be or outpatient/group setting if acceptable and with a review during/after an admission. With holistic goal setting that considers the whole individual and their environment/family/disease process #physiotalk
ACPRC @TheACPRC
Thanks everyone for joining our tweet chat with #Physiotalk on Respiratory Management of the Frail Patient! What a great chat! Some great ideas to take away.
Sam Targett @sam_targett
Definitely need to integrate more with our community teams #physiotalk #frailty
physiotalk @physiotalk
And we'll see you on June 10th at 20.30 for our next chat, To Risk or Not to Risk: Managing Risk in Physiotherapy, hosted by @NicolaLauchlan 👍👍👍 #physiotalk
Vicky Johnston @greyhoundvicky
RT @physiotalk: We're looking forward to hearing your thoughts about how all physiotherapists can best manage respiratory conditions in our…
Laura McGarrigle @TxPhysio
@physiotalk Oh and with continuity of the therapist/team where possible. I find it so much better to not only build up relationship and trust but to also be more objective in assessment of decline/progress. important for frailty measures IMO. #physiotalk
Lynsey MacD-Ferguson @lynseyferguson6
RT @emaroids1: @Asqbecca @NicolaLauchlan @TheACPRC @physiotalk Sometimes with competence (especially for oncalls) it’s understanding and ac…
Lynsey MacD-Ferguson @lynseyferguson6
RT @physiotalk: And we'll see you on June 10th at 20.30 for our next chat, To Risk or Not to Risk: Managing Risk in Physiotherapy, hosted b…
Kate Hills @KH_Physio
Definite #tweetdeck fail tonight during the #physiotalk discussion but I will be sure to catch up on the bits I missed! 🤦‍♀️ Thank you @TheACPRC for hosting!
Pamela Kipps Hansford @PamKHphysio
#physiotalk @Atul_Gawande's book #BeingMortal should be required reading for all! Fascinating his grandfather in India was still riding his horse around his lands @ 102 and respected by the family but this was in strong contrast to what happens elsewhere like USA
physiotalk @physiotalk
RT @PamKHphysio: #physiotalk @Atul_Gawande's book #BeingMortal should be required reading for all! Fascinating his grandfather in India was…
Vineeth Ravindran @r_vineeth
@TheACPRC Good to resonate that fact that we all work among many specialities within our system which continues to complicate things a little bit for the person we aim to get better #physiotalk
physiotalk @physiotalk
@KH_Physio @TheACPRC Sorry to hear that, Kate. Make sure to check out the transcript which we'll post shortly #techfail #physiotalk
Pamela Kipps Hansford @PamKHphysio
#physiotalk @Atul_Gawande says in his book #BeingMortal that taking more than 4 prescription drugs puts a person at risk of falling. Frail patients are taking 13 or even more carefully prepared in blister packs (at cost) and administered by nurses in hospitals & care homes
physiotalk @physiotalk
RT @TheACPRC: Thanks everyone for joining our tweet chat with #Physiotalk on Respiratory Management of the Frail Patient! What a great chat…
physiotalk @physiotalk
And thank you to @TheACPRC for leading the chat this evening and prompting lots of fantastic discussions! #physiotalk
Pamela Kipps Hansford @PamKHphysio
#physiotalk PLEASE do your patients a favour - Google their symptoms to find out what drugs cause memory loss/ raise BP /cause agression/ sleeplessness/ irritability/ hallucinations/ anxiety/depression etc etc and then check their drugs ……
Huw Griffiths @huwgriff16
RT @physiotalk: Q1: What red flags can we look for that might highlight a frail patient to us? #physiotalk
COPD_research @COPD_research
RT @cathedwards_1: @physiotalk Yes deffo should consider frailty & assess ✅ but need to refer onward. Frailty a risk factor in #COPD #physi
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