Respiratory & COPD Risk Assessment (QMS-F055) RESPIRATORY & COPD RISK ASSESSMENT (QMS-F055) Subscribe Document Ref: QMS-F055 (Respiratory & COPD Risk) Version: 1.0 Confidentiality Level: HIGH (Medical Records) CQC Alignment: Safe (Mitigating Risk) Service User Full NameService User ID NumberOperating Local Authority- Select -HaringeyIslingtonWaltham ForestBarnetOtherCare Funding & Financial Arrangements- Select -Local Authority Managed (Direct Commissioning)NHS Funded (Continuing Healthcare - CHC)Direct Payments (Personal Budgets)Self-Funded (Full Cost)OtherSECTION 1 - Diagnostic Baseline & Exertion LimitsPrimary Respiratory Diagnosis- Select -COPD (Chronic Obstructive Pulmonary Disease)AsthmaEmphysemaChronic BronchitisPulmonary FibrosisNo formal diagnosis / Shortness of breath onlyBreathlessness & Exertion Baseline- Select -Breathless at rest (Requires constant support)Breathless washing/dressing (Requires slow-paced care)Breathless walking short distances indoorsBreathless on stairs or inclines onlyNo significant breathlessness during daily activitiesDoes the service user experience frequent chest infections?- Select -Yes (High risk of sudden deterioration)NoSECTION 2 - Inhalers & NebulisersPrescribed Respiratory Medication Types: Preventer Inhaler (Usually brown/red) Reliever Inhaler (Usually blue) Spacers used with inhalers Nebuliser Machine Oral Steroids (e.g., Prednisolone) None prescribedMandatory Nebuliser Scope of Practice- Select -I confirm that care workers will NOT set up or administer the nebuliser without formal, documented competency training signed off in their staff file.Nebuliser / Inhaler Support InstructionsIs Home Oxygen Therapy prescribed and present in the property?- Select -YesNoOxygen Equipment Type Oxygen Concentrator Machine Ambulatory Oxygen Cylinders Liquid OxygenOxygen Flow Rate (Litres per minute)- Select -1 - 2 L/min3 - 4 L/min5+ L/minVariable (As directed by Respiratory Team)Mandatory Oxygen Fire Safety Declarations (Check to confirm) Fire Service has been notified of oxygen in the property NO SMOKING signs are clearly displayed Service User and family instructed NOT to smoke near oxygen Oxygen equipment is kept away from open flames / gas cookers Risk of petroleum-based creams (e.g., Vaseline) explained to staffSECTION 4 - Emergency Protocol & Sign-offExacerbation & Emergency Action PlanAssessor NameDate of AssessmentSave Respiratory Risk
