Breathing room – spirometry with a practice nurse
Practice Nurse Maysel Wright has been in her current job since the start of 2016 and can see up to four patients a day for spirometry. Maysel commented on how the surgery where she is employed overcomes some of the challenges of doing spirometry in general practice.
How do you make spirometry testing efficient and not too time-consuming?
The word that comes to mind is ‘flow’. The practice has a dedicated room fully set up for the practice nurses to undertake a range of activities. If any of the GPs have a consultation with a patient whom they think should be tested, the door is open for them to bring the patient straight through for testing, provided they fit the criteria.
After testing has been done I can call the GP back in to the room to talk to the patient about what the test has found. Some of them can then go into the room next to mine for an ECG if one is needed. It’s all about flow.
The patients love it – they really appreciate being able to do it all in one place and sometimes in one go. It saves them time and inconvenience and we don’t lose them to testing when they walk out the door.
What other factors contribute to the ‘flow’ and making spirometry an efficient procedure in the practice?
Our spirometer is really easy to use. The practice uses a spirometer that sits here in the nurse’s room. It plugs into the computer so the results from each patient are downloaded straight into the practice software and the patient’s file. Once I have done the spirometry, the GP comes in and can view the results on the screen.
The spirometer and the disposable mouthpieces are pre-calibrated so you don’t have to spend time doing calibration. (The software does allow for calibration checks with a 3 L syringe.) The mouthpieces are disposable so no time needs to be spent on sterilisation.
Who interprets the spirometry?
The spirometer software provides a full list of measurements and results but the doctor who ordered the spirometry does the interpreting. (The spirometer has a feature that lets you turn off interpretation, turn the lung age on and off, and add comments.)
What are the advantages of the way spirometry is done here?
Most patients already know me from having other procedures done here, so there can be a level of trust and familiarity that already exists. Having the nurse do the spirometry is efficient because I do them regularly, I know the routine and how to get the best out of the patients without them getting tense and creating anxiety. I give them a short demonstration of exactly how I want them to do it. Once I get the first good breath from a patient, it can be easy to get them to do it again.
Being a nurse, part of my job is chronic disease management – we have patients of all ages but as many of them are smokers, I understand the issues.
What contributes to the success of the practice?
The doctors and nurses have an excellent supportive working relationship. This makes everyone feel at ease – both the staff and the patients. The doctors also provide mentoring for the nurses to make sure that the spirometry is done well. It really makes a difference to my confidence and the joy I get from my work here. Being responsible for performing the spirometry improves my skills and makes me feel like I have an important role to play.
How does your practice finance the delivery of this service?
Patients are bulk billed for spirometry. There is no extra fee.