Koira 4Rukahukahu MODEL OF CARE - Lungs 4Life - Starship
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Koira4Rukahukahu
Lungs4Life
MODEL OF CARE
CONTENTS
Main Document
Introduction ........................................................................................................................................... 3
Model of Care Design Principles ..................................................................................................... 3
Key Messaging ..................................................................................................................................... 4
Inclusion Criteria ................................................................................................................................. 4
Inpatient Process ................................................................................................................................. 4
Community Process ........................................................................................................................... 5
Partnerships.......................................................................................................................................... 5
Medical Framework ............................................................................................................................. 5
Data Collection ..................................................................................................................................... 6
Whānau Voice ....................................................................................................................................... 6
References ............................................................................................................................................ 6
Appendix Documents
Primary Care Letter ............................................................................................................................. 7
Chest Physiotherapy Referral Pathway ......................................................................................... 9
SLT Referral Pathway ....................................................................................................................... 12
Data Collection ................................................................................................................................... 14
Guide to Clinical Assessment ........................................................................................................ 15
Community Clinical Assessment Form ....................................................................................... 19
Whānau Voice Survey ...................................................................................................................... 22
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9 August 2021 2
“Cough free the way to be”
INTRODUCTION
The Koira4Rukahukahu:Lungs4Life project began it’s life in Counties Manukau as a Health
Equity project in Ko Awatea in 2017. The aim of the first project was the early identification
and subsequent intervention for tamariki / children at higher risk of developing respiratory
diseases particularly Bronchiectasis. This research has now demonstrated that this cohort of
tamariki have high rates of other preventable disease including eczema or skin infections
1
(43%) and dental caries (17%) . This work continues to progress the original study’s
aspirations, and broadens the scope to consider the wider wellbeing of tamariki and
preventable disease.
MODEL OF CARE DESIGN PRINCIPLES
The Model of Care details the agreed Northern Region standards for clinical follow up of
tamariki participating in the Koira4Rukahukahu:Lungs4Life programme. These tamariki are
identified by having had an inpatient respiratory admission during the first two years of life.
Aim: To reduce inequity in respiratory health outcomes for tamariki across the Northern
region.
Māori and Pasifika tamariki are disproportionately affected by Bronchiectasis and are also
2-6
diagnosed later and with more severe disease than other international indigenous groups .
New Zealand research suggests that Koira4Rukahukahu:Lungs4Life tamariki have higher
1
rates of other preventable disease and should be prioritised along with their siblings and
whānau to ensure they have access to all universal health services: primary, as well as
secondary and tertiary care when required.
The standardised health care pathway will integrate regional and local community Whānau
Ora providers who have the greatest ability to support the wider determinants of health.
Surveillance will deliberately not rely on the ‘traditional Paediatric clinic attendance’ model or
the primary health ‘symptomatic presentation’ model. The follow up care plan is designed to
prioritise nurse led, relationship-based, patient-centred care with flexibility in delivery.
Health care specialists will utilise a hub-and-spoke network of health professionals and
Koira4Rukahukahu:Lungs4Life champions. Regional consistency of branding and
socialisation of the concept is central to successful public uptake and will have resource
funding implications. Additional workforce resources will be required to factor in deprivation
index, population and rural spread of the population.
The whānau voice is valued and central to the development and continuous improvement of
the model of care. Opportunities for whānau to feedback will be accessible, safe and user-
friendly.
Key messages aim to reverse the normalisation of poor respiratory health and improve
recognition of chronic cough. Consistent messaging will be delivered across health,
education and NGO related settings.
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9 August 2021 3
“Cough free the way to be”
KEY MESSAGING
Koira4Rukahukahu:Lungs4Life Key Messages
I’m a lungs 4 life child
Cough free the way to be
Be wise immunise
INCLUSION CRITERIA
Screen tamariki under the age of 2 years who have been admitted to hospital with a lower
respiratory tract infection (bronchiolitis, bronchopneumonia, pneumonia and including
pertussis) and review against the criteria below:
Criteria needed to be designated as ‘Koira4Rukahukahu:Lungs4Life’
• 3 or more admissions to the ward with lower respiratory tract infections (LRTI)
• High clinical risk as determined by senior medical officer (SMO)
Note that broadening of the inclusion criteria can be considered in the future as more
evidence emerges for other at risk groups of tamariki.
FIRST INPATIENT PROCESS
1) Child identified as ‘Koira4Rukahukahu:Lungs4Life’ 0–2years with follow up until 5years old
2) Patient Alert and Letter to Primary Care
3) Patient Information Sheet
4) Inpatient Process
- Healthy Housing (all eligible tamariki)
- Dysphagia screen and SLT pathway
- Smoking cessation-Incentive programme (if available)
- Safe sleep
- Special Immunisations
- Chest physiotherapy referral for persistent symptoms
- Medical investigation as required
- Review child’s universal health services
(NCHIP form or equivalent for Counties Manukau Health)
Includes: GP enrolment, new born hearing, immunisations, dental and well
child tamariki ora.
5) Medical discharge plan including Koira4Rukahukahu:Lungs4Life follow up
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“Cough free the way to be”COMMUNITY PROCESS
D AY 0 = REFERRAL TO KOIRA4RUKAHUKAHU:LUNGS4LIFE
Day 0 = entry to programme
1) Acute follow up on discharge if arranged by ward team
2) Home visit 30 days:
- Respiratory outreach nursing checklist
- Chest physiotherapy pathway / referral for persistent symptoms
3) Minimum Koira4Rukahukahu:Lungs4Life follow up:
Clinic or Home – telehealth technologies will be used to support follow up
- 3 months post day 0
- 1 year post day 0
- 2 years post day 0
- At 5 years old - discharge unless on-going requirement for secondary or tertiary care
At every community review ensure complete resolution of the child’s symptoms. If the child is
found to be symptomatic at any point appropriate intervention will be started and constant
surveillance will be continued until symptom free.
At any time during the programme Paediatrician advice or review can be arranged for
any general paediatric concerns including all tamariki with persistent respiratory
symptoms and tamariki thought to have established bronchiectasis.
PARTNERSHIPS
L AUNCH AND SOCIALISATION: NETWORKING AND EDUCATION
- Primary health care providers
- Secondary care providers
- Community / Whānau Ora providers
- Healthy housing providers
- Emergency Department and Emergency Care providers
- Early Childhood Education and Kohanga Reo
- Tertiary Paediatric Respiratory Service including Starship
MEDICAL FRAMEWORK
- Chronic Cough Guidelines
Starship Guideline
- Asthma Guidelines
Starship Guideline
Asthma Foundation Guideline
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“Cough free the way to be”DATA COLLECTION
Data will be collected to monitor the process and evaluate the health outcomes. See
appendix for further details on the data to be collected.
WHĀNAU VOICE
Whānau voice is central to the development and continuous improvement of the model of
care. Opportunities for whānau to feedback should be accessible and user-friendly. The
following are suggested avenues for whānau to feedback:
- Electronic copy of survey for whānau to complete at clinical assessments (at 1year, 2year
and at 5 years of age)
- Link to survey questions on The Bronchiectasis Foundation
www.bronchiectasisfoundation.org.nz and the Northland Bronchiectasis Support Page
New Zealand on Facebook
- Hard copy of the survey with a return envelope to be given out to whānau at
Bronchiectasis clinics
- Opportunity for whānau to speak with a consumer representative as part of
bronchiectasis clinic consultation.
- Koira4Rukahukahu:Lungs4Life participants - A formal qualitative study is under way in
South Auckland utilising a co-design process and will be available by 2023
REFERENCES
1. Byrnes CA, Trenholme A, Lawrence S, et al. Prospective community programme versus
parent-driven care to prevent respiratory morbidity in children following hospitalisation
with severe bronchiolitis or pneumonia. Thorax 2020;75:298-305
2. Edwards EA, Asher MI, Byrnes CA. Paediatric bronchiectasis in the twenty‐first century:
Experience of a tertiary children's hospital in New Zealand. J Paediatr Child Health
2003;39:111-7.
3. Telfar-Barnard L, Zhang J. The impact of respiratory disease in New Zealand Update
2018. Pages 1-157. Publisher; Asthma and Respiratory Foundation of New Zealand
2018, Wellington. University of Otago, New Zealand.
4. Singleton RJ, Valery PC, Morris P, Byrnes CA, Grimwood K, Redding G, Torzillo PJ,
McCallum G, Chikoyak L, Mobberley C, Holman RC, Chang AB. Indigenous children from
three countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis.
Pediatric Pulmonology 2014; 49: 189-200 (UI:23401398)
5. Munro KA, Reed PW, Joyce H, Perry D, Twiss J, Byrnes CA, Edwards EA. Do New
Zealand children with non-cystic fibrosis bronchiectasis show disease progression?
Pediatric Pulmonology 2011; 46:131-138. (UI:20717910)
6. Twiss J, Metcalfe R, Edwards E, Byrnes C. New Zealand national incidence of
bronchiectasis “too high” for a developed country. Archives of Disease in Childhood 2005;
90 (7): 737-740. (UI: 15871981)
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“Cough free the way to be”PRIMARY CARE LETTER
Dear (GP details),
This child has been identified as a “Koira4Rukahukahu:Lungs4Life” child at risk of developing
Bronchiectasis in the future (approximately 5-10% chance) and requires consideration of this
at all medical contacts until the age of 5 years.
The overall aim is to provide monitoring and proactive medical care to prevent preschool
wheeze, recurrent infections and / or diagnose bronchiectasis as early as possible which we
believe will improve long term respiratory outcomes. New Zealand research suggests that
Koira4Rukahukahu:Lungs4Life tamariki have higher rates of other preventable disease
including eczema, skin infections and dental caries. We will be prioritising these tamariki
along with their siblings and whānau to ensure they have access to all universal health
services, primary care along with secondary and tertiary care when required.
I’m a lungs 4 life child
Cough free the way to be
Be wise immunise
Tamariki will remain under the Koira4Rukahukahu:Lungs4Life
programme until they are five
The process
• Tamariki (children) admitted with respiratory infection are screened and identified as
Koira4Rukahukahu:Lungs4Life if they meet the criteria. (see below)
• Koira4Rukahukahu:Lungs4Life tamariki are referred on discharge from hospital for
follow-up 30 days post initial screening and connect with primary care if required for
on-going problems.
• Further review will occur at 3 months, one year and two years as a minimum with
additional reviews as needed.
• Tamariki are remotely case reviewed at age 5 years by the
Koira4Rukahukahu:Lungs4Life team for on-going risk factors such as abnormal
Chest Xray or frequent antibiotic use.
If this child is seen in Emergency care, urgent care or general practice-
• Consider at least 2 weeks of high dose antibiotics if the child presents with LRTI and
wet cough.
• Review the child 30 days after each antibiotic course if possible to ensure resolution.
• Please contact your local Lungs4Life team if symptoms persist
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“Cough free the way to be”• For further information please see links for Persistent Wet Cough in Children
community health pathway (Auckland Region) and the Starship guideline for chronic
cough.
Other actions to consider
• Follow up Chest XRay as clinically indicated.
• 3 monthly review at GP during winter
• Recall for annual free influenza immunisation
• Please consider the Child Disability Allowance if eligible (i.e. if they develop
clinical or HRCT bronchiectasis). Please refer to the Work and Income
website for guidance.
We greatly appreciate your support in the care of the Koira4Rukahukahu:Lungs4Life tamariki.
If you have any questions, please contact the Koira4Rukahukahu:Lungs4Life team.
Regional Contact Details
Kidz First Hospital: lungs4life@middlemore.co.nz
Waitakere Hospital: lungs4life@waitematadhb.govt.nz
Whangarei Hospital: lungs4life@northlanddhb.org.nz
Starship Hospital: lungs4life@adhb.govt.nz
The Koira4Rukahukahu:Lungs4Life team includes paediatricians, physiotherapists,
nurses, speech and language therapists and social workers.
Further information about the Koira4Rukahukahu:Lungs4Life programme can be found
using this link to the Starship Clinical Guidelines
Inclusion Criteria
Under the age of 2 years and has been admitted to hospital with a lower respiratory tract
infection (bronchiolitis, bronchopneumonia, pneumonia and including pertussis)
Criteria needed to be designated as ‘Koira4Rukahukahu:Lungs4Life’
• 3 or more admissions to the ward with lower respiratory tract infections (LRTI)
• High clinical risk as determined by senior medical officer (SMO)
Note that broadening of the inclusion criteria can be considered in the future as more
evidence emerges for other at risk groups of tamariki.
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“Cough free the way to be”CHEST PHYSIOTHERAPY REFERRAL P ATHWAY
Physiotherapy Guideline:
Referral Pathway for Tamariki with Chronic Cough Identified
in the Koira4Rukahukahu:Lungs4Life Programme
Purpose:
This guideline aims to provide a standardised referral pathway to support medical teams
referring Koira4Rukahukahu:Lungs4Life tamariki to physiotherapy services for chronic cough
management. The guideline has been collaboratively developed by physiotherapists within
the Northland Regional District Health Boards.
The guideline is a bench mark for Physiotherapy services / District Health Boards to strive
towards when establishing their Koira4Rukahukahu:Lungs4Life services locally.
Disclaimer:
This guideline is for referral processes only. It does not provide recommendations for
physiotherapy management or replace current inpatient and outpatient physiotherapy
services or protocols.
Roles / Responsibilities:
Referrer: Responsible for referring tamariki who fulfil the physiotherapy criteria to the
appropriate inpatient or outpatient services in a timely manner using the identified pathways.
Physiotherapist: Responsible for assessing the child within the stipulated time frames and
providing appropriate input if deemed clinically appropriate. The physiotherapist is responsible
for ensuring they are practicing within their scope of practice and clinical skill set.
Pathway:
Chest Physiotherapy Referral Pathway for Koira4Rukahukahu:Lungs4Life Algorithms.
1. Inpatient Pathway – See Figure 1.
2. Outpatient Pathway – See Figure 2.
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“Cough free the way to be”Figure 1 - Inpatient Pathway
Criteria:
Physiotherapist will see tamariki if they have:
1. Difficulty clearing their secretions independently
OR
2. Chronic x-ray changes with concerns for future lung disease
Physiotherapist will not see tamariki if they have:
1. Viral induced wheeze (i.e. bronchiolitis, bronchopneumonia, pertussis)
OR
2. Dry or non-productive cough
Yes Criteria Met:
Please call the physiotherapy team.
Monday to Friday 0730 to 1600hours on …………….… (insert number here) ……………………..
* A physiotherapist will assess +/- treat the child within 1-2 working days and provide a clear
physiotherapy plan for the admission
Weekends and after hours on …………….… (insert number here) …………………………………
* Tamariki will be prioritised as per the weekend / oncall criteria and reviewed as appropriate
* If discharged prior to review please send the referral to:
…………………………………………………………………………………………………………………
……………… (insert DHB referral pathway links here / or write details) ……………………….….
…………………………………………………………………………………………………………………
*Ensure Lungs4Life is clearly documented on the referral
On Discharge:
If treatment is required, the physiotherapist will teach the whānau airway clearance and organise
an outpatient follow up appointment within 4-6 weeks.
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“Cough free the way to be”Figure 2 - Outpatient Pathway
Koira4Rukahukahu:Lungs4Life tamariki can be referred to
physiotherapy outpatients from either:
Community Nurse Review Outpatient Paediatrician /Nurse Specialist
(anytime during 5 year follow-up)
If at 30 days the child is still
experiencing: Update If the child is experiencing:
1. Persistent wet cough Request Plan 1. Persistent or recurrent wet cough not
2. Crackles on auscultation resolved by antibiotics
2. Persistent chest x-ray changes
Refer to Outpatient Physiotherapy for Assessment
Send referral to Physiotherapy Outpatient Service via:
………………………………………………………………………………………………
……………… (insert DHB referral pathway links here / or write details) ………….
………………………………………………………………………………………………
* Ensure Lungs4Life is clearly documented on the referral
Note: Physiotherapy appointments aim to be completed within 14 - 28 days. If the child
needs to be reviewed sooner please contact the physiotherapy team on
………..………………………… (insert number here)……………………………………
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“Cough free the way to be”Affix Patient Label Here
SLT REFERRAL PATHWAY Name: NHI:
Address:
DOB: Age: Telephone No.:
Paediatric Dysphagia Screening Form for Koira4Rukahukahu:Lungs4Life
This is a screening tool for use with children enrolled in Koira4Rukahukahu:Lungs4Life.
It is important to recognize the different signs and symptoms of dysphagia (eating, drinking
and swallowing difficulty) early in order to exclude aspiration of food and liquid as contributing
factors to respiratory symptoms. If any of the following signs or symptoms are observed or
reported, please refer to the Paediatric Speech Language Therapy Team (details over page).
Referral Criteria
Clinical signs / symptoms of dysphagia (please tick)
Coughing or choking episodes during or after feeding
Gurgly (wet) voice quality after feeding
Changes to breathing during or after feeding, e.g.
• Rattly breathing
• Wheeze
• Stridor
• Snuffliness
• Increased Work of breathing
• Apnoea/Colour change
Prolonged (i.e. longer than 30 minutes)/ fussy feeding times
If referring to SLT please complete the additional information to support this referral
Does the child have any additional risk factors for dysphagia?
Neurological
Disability
Complex medical presentation
Is there any spilling of milk out of the mouth during feeding?
Are there parental concerns about feeding?
If yes, please describe:
Is there a history of feeding difficulties?
If yes, please describe:
Additional Comments:
Sometimes children will silently aspirate and will not show any of the signs outlined on this
screening tool. If there is no other explanation for the child’s respiratory symptoms and/or
lung condition please refer to SLT for assessment and consideration of Videofluoroscopy.
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“Cough free the way to be”Inpatient - refer to inpatient Speech Language Therapy by phoning 021 195 2989
CMH Community - refer via email to CDTreferrals.generic@middlemore.co.nz
Inpatient – Rangatira - referral to SLT via electronic whiteboard, and phone call to
covering SLT (indicated on Allied Health availability board to the left of the
electronic whiteboard)
WDHB
Community – referral via e-referrals on clinical portal to “Paediatric Allied Health –
Speech Language Therapy” or email to
childhealthreferrals@waitematadhb.govt.nz
Inpatients – clinical care provided between 7.30am and 4pm Monday-Friday.
Phone SLT – Louise Bax 0211951941, leave voicemail if outside of hours.
ADHB Community- referrals via e-referrals on Regional Clinical Portal to “Starship
Community - Speech and Language Therapy”
Inpatient – please scan and send the completed screening form to the Child
Health Centre SLT Shared Mailbox Paediatric.SLTReferrals@northlanddhb.org.nz.
NDHB You can alert us to the referral via phone call on extension 8030 (Child Health
Centre Reception).
Community – as above or please complete an e-referral via RMS to Paediatrics,
Speech Language Therapy and attach the completed screening form
Adapted from Northland District Health Board Paediatric Dysphagia Screen January 2021
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“Cough free the way to be”DATA COLLECTION
Monitoring the Process:
- Total number of tamariki identified as ‘Koira4Rukahukahu:Lungs4Life’
The percentage seen at 1 month, 3 months, 12 months and at 24 months
- Physiotherapy follow up
Number of referrals, the number of referrals deemed appropriate, initial appointment
provided, total number of appointments
Outcome: Treatment on-going as part of daily management, treatment completed
(symptoms resolved) and discharged, treatment not required once assessed in clinic
therefore discharged, family declined input, family DNA appointments / unable to
engage
- Speech language therapy follow up
Number of referrals, number of referrals deemed appropriate and if VFSS was
required.
Outcome: Number confirmed aspiration and treatments instigated
- Smoke cessation
Number of assessment and number referred
- Housing assessment
Number of assessments and number referred
Health Outcomes:
At 1 month and 3 months post discharge
- Is there resolution of respiratory disease?
At 12 months, 24 months and by aged 5 years
- Respiratory Health
- Ear Health
- Skin Health
- Developmental Health
- Growth
- Immunisations
- Total courses of antibiotics
- Total admissions to hospital
- Respiratory admissions to hospital
At aged 5 years
- Diagnosis of preschool wheeze +/- asthma
- Diagnosis of bronchiectasis
- Lung function (if possible)
Environmental Outcomes:
- Housing
New housing
Housing improvements
- Smoke cessation
Member of family
Still smoke exposed
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“Cough free the way to be”GUIDE TO CLINICAL ASSESSMENT
Koira4Rukahukahu:Lungs4Life
Guide to Clinical Assessment
Use this form in conjunction with standard homecare nursing assessment forms.
At every community review ensure complete resolution of the child’s symptoms.
If the child is found to be symptomatic at any point appropriate intervention will be
started and constant surveillance will be continued until symptom free.
HISTORY OF SYMPTOMS
Has the child had persistent symptoms since their last review? Do they still have a
cough or wheeze – has this continued? Have they had any new illnesses?
Any symptoms of Cough (wet / dry / resolved), wheeze, shortness of breath, fever?
If a family is unsure about symptoms use this as an opportunity to educate the whanau about
recognition of cough
Any antibiotics since discharge / last review – indication for antibiotics?
Any hospital admissions since last review – indication? (include non-respiratory)
Parental concerns – ears, hearing, teeth, growth, development, sleep or snoring
REVIEW OF INTERVENTIONS
Smoke exposure / cessation advice – was there a referral / any reported progress
Housing – any changes since discharge / last review
Do they have a follow-up CXR planned or a clinic to attend? – most of the children will not
require these but it is an opportunity for remind the whanau of the importance of these
Do they have Speech language therapy / physiotherapy input?
GENERAL OBSERVATIONS
Temperature
Respiratory rate – ideally record the respiratory rate for a full minute to ensure accuracy
Heart rate
Oxygen saturations on air
Weight in kilograms (kg)
Patients length/height (cm)
Assess if the child has any increased work of breathing
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“Cough free the way to be”RESPIRATORY EXAMINATION
Normal: No respiratory distress was seen or anatomical clinical signs of long term respiratory
distress noted.
Stridor: is a gasping sound during inhalation resulting from a partial blockage of the throat
(pharynx), voice box (larynx), or windpipe (trachea).
Wheeze: is a continuous, coarse, whistling sound produced in the respiratory airways during
breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or
obstructed, or airflow velocity heightened.
Crackles: crepitations or rales are heard on auscultation and sound like clicking, rattling, or
crackling noises heard during inhalation.
Recession: Paediatric patients have a more compliant chest wall (not as rigid as an adults)
any increased negative pressures generated in the thorax will result in intercostal, sub-costal
or sternal recession. Greater recession = greater distress.
Cough during examination: Record if you hear the child cough during your examination
period and record the nature of the cough. Describe as wet or dry.
Nasal discharge: mucous-like material that comes out of the nose.
Clubbing: Bulbous, club like deformation of the distal portion of fingers and toes resulting
from connective-tissue proliferation.
Chest wall deformity:
Harrison’s sulcus is a groove deformity of the lower ribs at the point of attachment to the
diaphragm.
Pectus carinatum also known as “pigeon chest”, is used to describe a chest where the
sternum is prominent. It is caused by chronic childhood asthma and rickets.
Pectus excavatum: Significant sternal depression in relation to the mid clavicular rib cage.
Pharyngitis: is inflammation (redness) of the throat or pharynx.
Enlarged tonsils (Including tonsillitis):"tonsils" refer to the palatine tonsils. Acute tonsillitis
is caused by bacteria and viruses and is accompanied by ear pain when swallowing, bad
breath, drooling, sore throat and fever. The tonsil surface may be bright red or have a gray /
white coating, while neck lymph nodes may be swollen.
Tonsilitis
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“Cough free the way to be”CONDITION OF THE SKIN Normal: With no inflammation or infection seen. Impetigo: Primarily caused by Staphylococcus aureus, and sometimes by Streptococcus pyogenes. Bullous impetigo: causes painless, fluid-filled blisters usually on trunk, arms and legs. The skin around the blister is usually red and itchy but not sore. The blisters break and scab over with a yellow-colored crust, may be large or small, and may last longer than sores from other types of impetigo. Ecthyma: is a more serious form of impetigo where infection penetrates deeper into the skin's second layer, the dermis. Signs and symptoms include: Painful fluid or pus-filled sores that become deep ulcers, usually on legs and feet, a hard, thick, gray-yellow crust covering the sores, swollen lymph glands in the affected area, little holes the size of pinheads to pennies appear after crust recedes and scars that remain after the ulcers heal Boils (or Furuncle): is a deep infective folliculitis (infection of the hair follicle). It is almost always caused by infection by the bacterium Staphylococcus aureus, resulting in a painful swollen area on skin caused by an accumulation of pus and dead tissue. Insect Bites: Are there multiple insect bites for example, flea or mosquitoes. Cellulitis: a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burns and insect bites. Scabies: Caused by a tiny parasite Sarcoptes scabiei which burrows under the host's skin, causing intense allergic itching. Scabies mites prefer thin hairless skin, and for this reason concentrate on intertriginous parts of the body below the neck (e.g., between fingers and in skin folds), avoiding callused areas. Infants may be infected over any part of the body. Tinea: refers to a skin infection with a dermatophyte (ringworm) fungus. Dermatophyte infection is confirmed by microscopy and culture of skin scrapings. Eczema, or dermatitis: symptoms vary with all different forms of the condition. They range from skin rashes to bumpy rashes or including blisters. Common signs include redness of the skin, swelling, itching and skin lesions and sometimes oozing and scarring. Seborrhoeic dermatitis: in infants (
ADDITIONAL ASSESSMENTS TO CONSIDER
Examination of the ears: normal, otitis media (acute/chronic), perforation, wax
Examination of teeth: healthy, dental Caries / decay, prior fillings
Examination of the Heart:
Heart murmur: indicate if a heart murmur is heard on auscultation. A murmur is defined as
extra heart sounds that are produced as a result of turbulent blood flow that is sufficient to
produce audible noise.
Snoring: If reported snoring complete the OSA questionnaire (website access via this link)
Immunisations: If not up to date consider plan in place to support this occurring
(website access to schedule via this link)
Development:
Any concerns with hearing or vision?
Are there any parental concerns with development?
Making appropriate developmental progress?
This is an opportunity to complete an Ages and Stages Questionnaire (ASQ) or the ASQ: SE
Review child’s universal health services (NCHIP or equivalent): GP enrolment, new born
hearing, immunisations, dental and well child tamariki ora
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“Cough free the way to be”COMMUNITY CLINICAL ASSESSMENT FORM
Koira4Rukahukahu:Lungs4Life
Clinical Assessment Form
This form is to be used in conjunction with standard homecare nursing assessment forms.
At every community review ensure complete resolution of the child’s symptoms.
If the child is found to be symptomatic at any point appropriate intervention will be started
and constant surveillance will be continued until symptom free.
Patient Label / NHI: __________________ Date of follow-up: ___________________
Follow-up Visit (time since discharge)
30 days 3 months 1 year 2 year 5 years old Additional visit
specify:
Have the following symptoms continued?
For 30 day and 3 month visit – have they continued since discharge
For all other visits – have they continued since the previous assessment
Do they have a persistent cough No Yes Unsure
If YES, Nature of cough: Dry Wet Unsure
Do they have persistent wheeze No Yes Unsure
Has the child had any new illnesses since discharge / previous assessment?
Cough No Yes Unsure
If YES, Nature of cough: Dry Wet Unsure
Wheeze No Yes Unsure
Lower respiratory infection No Yes Unsure
Upper respiratory infection No Yes Unsure
Has the child had any antibiotics since discharge / previous assessment?
No Yes
If yes; frequency and
Indication?
Has the child had any further hospital presentations / admissions
No Yes
If yes; describe
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“Cough free the way to be”General Observations
Temperature Oxygen saturations
Heart rate Height (cm)
Respiratory Rate Weight (kg)
Respiratory Examination (tick at least one)
Normal No Yes Chest recession No Yes
Stridor No Yes Chest wall deformity No Yes
Wheeze No Yes Clubbing No Yes
Crackles No Yes
Other (Specify)
Nasal discharge No Yes No Yes
Enlarged tonsils
Pharyngitis No Yes unable to examine
Cough during If YES,
No Yes Dry Wet
Examination? Nature of cough:
General Examination
Are there concerns with any of the following?
Skin No Yes Describe:
Ears No Yes
Teeth No Yes
Growth No Yes
Development No Yes
Sleep / Snoring No Yes
Vaccinations (tick if completed)
6 week 3 months 5 months 12 months 15 months 4 years Flu (this year)
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“Cough free the way to be”Have hospital discharge Interventions/Referrals been followed up?
Smoking Cessation
Progress reported by family?
AHWI Referral
Progress Reported by family
Do they Have a Follow up CXR or
Out Patient Clinic? (note: this will
not needed for a lot of our children)
Do they have physiotherapy follow-up No Yes Discharged
Do they have speech language therapy follow-up No Yes Discharged
Plan
Physiotherapy:
If; persistent wet cough, crackles, CXR changes
No Yes
Review the physio pathway: Do they need referral?
Speech Language Therapy:
No Yes
If; concerns see SLT pathway: Do they need referral?
Social Support Concerns: No Yes referral needed:
Medical:
Does the child need a GP visit and review today? No Yes
Does the child need EC review today? No Yes
Does the child need an earlier L4L review than the next scheduled? No Yes
If unwell discuss with the L4L team / paediatrician
If well continue with follow-up as per the Lungs4Life programme
Specify Plan
Outcomes: Does the child have a diagnosis of any of the following?
Preschool asthma No Yes Recurrent Infections No Yes
Preschool wheeze No Yes Bronchiectasis No Yes
Key messages to discuss with the whanau at each visit
I’m a lungs 4 life child
Cough free the way to be
Be wise immunise
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“Cough free the way to be”WHĀNAU VOICE SURVEY
Have you found the Koira4Ruakahukahu / Lungs4Life program useful
for you, your tamariki/child and whanau/family?
Yes, very useful No, not useful
5 4 3 2 1
Additional comments:
Has the program increased your knowledge about lung health?
Yes, increased No change
knowledge
5 4 3 2 1
Have you felt supported and reassured by the program, or has it
made you worry more?
Supported and Worried
Reassured
5 4 3 2 1
Have you and your whanau / family felt comfortable with the program
and the health professionals involved?
Comfortable Uncomfortable
5 4 3 2 1
Additional comments:
Thank you for taking the time to complete the questionnaire.
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9 August 2021 22
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