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A Simple, Color-Coded, Illustrated COPD Action Plan Simplifies Symptom Care

EXECUTIVE SUMMARY

A simple, color-coded action plan can help patients with COPD remember warning signs and symptoms.

  • The American Lung Association created a one-page green, yellow, red plan.
  • Patricia Conley of the Research Medical Center created a similar plan that also includes illustrations of a sunny day, cloudy day, and a tornado. These further show patients when to be concerned with symptoms.
  • The action plan uses simplified wording and can fit on the refrigerator.

Case managers working with COPD patients could benefit from sharing a simplified, color-coded action plan.

For example, the American Lung Association created a two-page action plan that breaks down symptoms into three categories: the green zone, yellow zone, and red zone. It includes bullet points in simple language that tell patients which category they are in and what they need to do.1

This action plan is useful and publicly available, but organizations can create their own versions. For instance, one new plan is designed to fit on one page, easily posted on a refrigerator. It includes symbols as well as color codes, and explains symptom management, the proper use of rescue inhalers or nebulizer treatment, and relevant comorbidities to consider, including diabetes, heart failure, anxiety, depression, and kidney disease.2

The plan uses simple wording. A description of a green zone day reads, “A Good Day for You: Your usual breathing and activity level.”2 This new plan is more accessible in its language and design, says Patricia Conley, PhD, RN, PCCN, clinical nurse coordinator in the progressive care unit at the Research Medical Center in Kansas City, MO. Conley has been working with COVID-19 patients since the pandemic began.

“Our [plan] has garnered a lot of attention,” Conley says.

The COPD action plan is colorful, illustrated, and fits on a single page. Unlike educational booklets, this new resource leaves out many words, succinctly explaining the key points.

“When people hand patients booklets of information, patients sometimes leave them on the bedside stand,” Conley notes. “It tells me they didn’t really value that.”

The one-page action plan Conley designed garnered positive comments from participants in the study. “I gave them a magnet and said to put it on their refrigerator,” she adds. “Every day, they can do a little self-assessment.”

The American Lung Association’s action plan is one page front and back. The reverse side includes discharge information for physicians to complete. But Conley did not believe that was necessary since physicians complete instructions and paperwork electronically and rarely have time to add one more task to their patient visits.

Patients like the color-coded part in the American Lung Association’s COPD action plan, so Conley kept that in her self-check plan.

“[Their plan] is a good action plan, but I wanted to do one of my own,” Conley says. “I consulted with pulmonary doctors, and I researched healthcare literacy.”

Too often, Conley found educational materials given to patients use words common to physicians and nurses, but not by lay people. Patients want to understand the content without having to read through long explanations because they often are so sick, they want just the highlights. They want simple answers to their questions, such as “If I have these symptoms and I’m more breathless today, what do I need to do?” she adds.

Conley borrowed the idea of using green, yellow, and red to signify when patients are doing well (green zone), when they are having a bad day or a COPD flare-up (yellow zone), and when they need urgent medical care (red zone). But she also added symbols to further show the difference between the three categories. For the green zone, the symbol is a sun, which means a good day. The yellow zone uses clouds to indicate someone is not feeling well and is getting in trouble medically. The red zone has a tornado, meaning the patient needs to call 911 immediately or go to the ED.

The illustrations of the sun, clouds, and tornado are to the left of the descriptions of symptoms and necessary actions. Together, these take up three-quarters of the page.

Conley also assessed the plan’s reading level to ensure it is in the range of fifth or sixth grade with no parts higher than eighth-grade reading level.

Action plans can help reduce severity of COPD by reinforcing effective self-management behavior, such as using inhalers and calling providers as soon as indicated, research shows.3

The next step is to study how patients use the action plan and whether it helps them improve their COPD care self-management.

“Because of COVID, I couldn’t bring papers into patients’ rooms, so we haven’t been able to do a study yet,” Conley says. “But we have to do a study to gain evidence that it’s a reliable and valid tool. My goal is to improve patient care, decrease hospitalization, and improve their quality of life.”

REFERENCES

  1. American Lung Association. My COPD Action Plan. 2015.
  2. Conley P. Using COPD action plans to support outcomes after discharge. Nursing 2021;51:41-46.
  3. Conley P, Kelechi TJ, Nemeth LS, Mueller M. Chronic obstructive pulmonary disease discharge education and quality of life evaluation: A feasibility study. Res Theory Nurs Pract 2019;32:328-348.