1. Capstone Project Topic Selection and Approval.
Capstone Project Topic Selection and Approval. Capstone Project Topic Selection and
ApprovalTopic: Use of GOLD guidelines for patients with Chronic obstructive pulmonary
disease (COPD) in an acute care setting to reduce the readmission rate.Capstone Project
Topic Selection and Approval.ORDER A PLAGIARISM-FREE PAPER HEREIntroductionCOPD
is a chronic lung disease that is typified by difficult breathing, repetitive respiratory
symptoms, as well as airflow limitations due to the abnormalities of the airway/alveolar
(Zha et al., 2019). A COPD exacerbation is marked by symptom escalation and significantly
contributes to the worsening of lung function, reduced quality of life, need for
hospitalization or urgent care, and increased the cost of care (Augustin et al., 2018). COPD
affects about 24 million individuals and is among the leading causes of mortality and
morbidity within America(Biener et al., 2019).Capstone Project Topic Selection and
Approval. Biener et al (2019) explain that COPD is not only the third leading cause of deaths
within the USA but also causes about 800,000 hospitalizations every year in America.
Statistics show that 1 in 4 patients admitted for COPD isreadmittedwithin 30 days post-
discharge. Healthcare costs allied to COPD total to about $32–40 billion annually(Biener et
al., 2019). Therefore, there is a need to research more on the interventions and strategies
that can reduce the rate of patients with acute exacerbations in COPD and the readmission
rates for this population.Global Initiatives for Chronic Obstructive Lung Disease (GOLD)
guidelines have been demonstrated to improve outcomes of COPD patients and prevent
acute exacerbations.Capstone Project Topic Selection and Approval.PICOTIn patients with
COPD exacerbations requiring hospitalization (P), can implementation of a GOLD guidelines
criteria care bundle (I) when compared to no care bundle (C) reduce exacerbation requiring
hospitalization (O) within the first 60 days after discharge?Capstone Project Topic Selection
and Approval.SettingThis proposed capstone project will be implemented in the acute care
setting where the readmission rate of COPD patients will be examined to examine if the
implementation of GOLD guidelines during care of COPD patients reduces the risk of future
exacerbations and thus the readmission rate.Significance of the ProblemEven though COPD
is preventable and treatable, it is the third leading cause of death globally. The GOLD
guidelines present the “best practices” for assessment, diagnosis, and treatment of COPD.
The majority of patients hospitalized with acute exacerbations in COPD do not receive the
required treatment and the appropriate follow-up treatment after discharge (Criner& Jean,
2015). This significantly contributes to the readmission of acute exacerbations within 30
days post-discharge.Capstone Project Topic Selection and Approval. The use of the Gold
2. guidelines can significantly reduce the high costs and reimbursement penalties associated
with rehospitalizations of patients with acute exacerbation of COPD. Nonetheless, the GOLD
guidelines are underutilized during the care of patients with COPD. Utilization of GOLD
guidelines results in better patient outcomes by reducing the acute exacerbations for
patients with COPD, which worsens the flow of air and increases mortality (Franssen et al.,
2019). The use of the GOLD guidelines also reduces hyperinflation for patients with COPD
and also improves their ability to exercise (Patel et al., 2019). Therefore, appropriate
utilization of the GOLD guidelines can be effective in reducing the readmission rate for
patients with acute exacerbations in COPD.Capstone Project Topic Selection and
Approval.Global Obstructive Lung Disease (GOLD) GuidelinesFor the assessment and
diagnosis of COPD, the GOLD guidelines recommend that COPD should be considered for
patients with chronic cough/sputum, dyspnea, history of exposure to risk factors of COPD,
and a history of persistent lower respiratory infections. Spirometry is needed to confirm a
COPD diagnosis and COPD assessment should aim to establish the level of airflow limitation,
how the disease impacts the health status of the patient, and the risk for future acute
exacerbations (Patel et al., 2019). The ABCD assessment tool is used to grade the severity of
airflow limitation.Capstone Project Topic Selection and Approval.For the prevention and
maintenance treatment, smoking cessation is prioritized. Pharmacological treatment can
lessen symptoms, reduce the severity and frequency of exacerbations, and generally
improve exercise tolerance and health status(Singh et al., 2019). The pharmacological
therapy should be personalized and directed by the symptom severity, risk of future
exacerbations, side effects, availability of medications and costs, comorbidities, response to
treatment, and the ability of the patient to utilize various medication delivery devices. The
GOLD guidelines also recommend that regular assessment of the inhaler technique(Singh et
al., 2019). Influenza and pneumococcal vaccinations lower the rate of lower tract infections
while pulmonary rehabilitation significantly improves symptoms and the quality of life. For
patients having serious resting chronic hypoxemia, long-term oxygen therapy has been
shown to improve the survival rate. Long term non-invasive ventilation is suggested for
patients having severe chronic hypercapnia and a history of respiratory failure. Medications
for COPD include bronchodilators, inhaled corticosteroids, and Anti-cholinergic meter
dosed inhaler (Singh et al., 2019).Capstone Project Topic Selection and
Approval.ReferencesAugustin IML, Spruit MA, Houben-Wilke S, et al. (2018). The
respiratory physiome: clustering based on a comprehensive lung function assessment in
patients with COPD. PLoS One, 13(9): e0201.Biener A, Decker S & Rohde F. (2019).
Prevalence and Treatment of Chronic Obstructive Pulmonary Disease (COPD) in the United
States. JAMA, 322(7), 602.Criner G & Jean B. (2015). Prevention of Acute Exacerbations of
COPD. Chest, 147(4), 894–942.Franssen F, Peter A, Bar N, Birke J, Lurato S, Majer D, Spruit
M, Claus V, Wouters E & Bernd S. (2019). Personalized medicine for patients with COPD:
where are we? Int J Chron Obstruct Pulmon Dis, 14(1), 1465–1484.Patel A, Patel A, Signh S,
Singh S & Imran K. (2019). Global Initiative for Chronic Obstructive Lung Disease: The
Changes Made. Cureus, 11(6), e4985.Singh D, Agusti A, Anzueto A, Barnes P, Bourbeau J,
Celli B, Criner G et al. (2019). Global Strategy for the Diagnosis, Management, and
Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019.
3. ur Respir J, 53(5).Zha, Z., Leng, R., Xu, W. et al. (2019). Prevalence and risk factors of chronic
obstructive pulmonary disease in Anhui Province, China: a population-based survey. BMC
Pulm Med, 19(102).Global strategy for the diagnosis, management, and prevention of COPD:
global initiative for chronic obstructive lung disease (GOLD)
