Title: Breathing Space COPD Audit 200607
1Breathing Space COPD Audit 2006/07
- Practice Level Audit 36 practices
- Patient Level Audit 34 practices
- Audit process is still underway in 4 practices
2- BREATHING SPACE PRIMARY CARE STANDARDS
- By March 2009 we aim to achieve
- We will have maximised the number of patients
with COPD in Rotherham who have been accurately
diagnosed by the active use of spirometry - All patients diagnosed with COPD will be
accurately categorised into the NICE definitions
of mild, moderate and severe airways obstruction. - There will be a continuing reduction in the
number of COPD patients who smoke. - Pulmonary rehabilitation, to the standard
provided within the Breathing Space Programme, to
be offered to all patients with COPD. - Information required for audit will be
electronically recorded using standard COPD
templates. - All exacerbations of COPD will be Read Coded.
- All patients with COPD will have been given an
individualised self-management plan - Self management plans for all patients with
moderate and severe airways obstruction will
include standby antibiotics and steroids. - Medicine usage will be appropriate to patients
NICE airways obstruction severity category. - All patients with moderate or severe airways
obstruction who have 2 or more exacerbations in
any year should be prescribed inhaled steroids - All patients with moderate or severe airways
obstruction will have been assessed for oxygen
using pulse oximetry.
3Baseline practice visit records audit August
2006 March 2007
Repeat audit 2008
Feedback to practices November 2006 April 2007
- Quest Audits - Training
4Practice Level Audit Results from 36 Practices
5(No Transcript)
6(No Transcript)
7Question not answered by auditor 4
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9Patient Level Audit Results from 34
practicesSample 2985 patients
10Range 23 - 100
11Range 19 - 90
Spirometry not recorded for 4 patients
12Range 0 - 100
Results for 20 spirometry were not found
13Range 0 - 80
14Range 0 - 72
15Classification of COPD
1100/2458 spirometry records had the correct
combination of 2 criteria recorded as specified
by NICE. Of these 795 were categorised by
practices 526 (270 185 71) were compliant
with NICE
16Range 84 - 100
17Current Smoking Status n 2985
Range 23 - 60
18Range 52 - 100
19Part 2 Audit of 1 in 5 sample of patients on
COPD Register
- This section reports detailed results of an audit
carried out by a clinician on 617 patients
randomly selected.
20Range 5 - 100
21Range 0 - 95
22Range 0 - 70
23Has a reversibility test been undertaken? (n
687)
Range 0 - 85
24Range 0 - 100
25Range 0 - 100
26COPD Exacerbations Patient Contacts
- 687 COPD patients had a total of 5350 contacts
with General Practices last year (7.8 per patient
per year). - By looking at the electronic and manual records
it was possible to detect - a total of 1.2 recorded exacerbations per patient
per year - A total of 0.12 respiratory admissions per
patient in the last year. - Only 117 out of 789 exacerbations were recorded
using the NICE recommended Read Codes for
exacerbations which would make it difficult to
search electronically for the number of
exacerbations the practice manages.
27Range 0 - 100
28Range 0 - 100
29Medication
- By March 2009 the aim will be to achieve
- Medicine usage will be appropriate to patients
NICE airways obstruction severity category. - Patients with moderate or severe airways
obstruction who have 2 or more exacerbations in
any year should be prescribed inhaled steroids. - Results
- 70 patients were categorised as moderate or
severe who had 2 or more exacerbations in last 12
months. Of these 56 patients were prescribed
inhaled steroids. - 131 patients categorised as mild and 106 moderate
or severe patients who had not had 2 or more
exacerbations in last 12 months were prescribed
inhaled steroids.
30Medication - continued
31Treatment of Exacerbations
32Antibiotic Choice
- Rotherham COPD Prescribing Guidelines recommend
that the first line choice of antibiotics for
COPD exacerbations should be Amoxicillin 500mg
tds or Oxytetracycline 500mg qds, this audit
gives baseline concordance with this guidance. - 201 prescriptions were concordant with the above
guidance - 453 prescriptions were not concordant
- Non-concordant prescriptions included Amoxycillin
250mg and a wide range of other antibiotics)
33Steroid Use
- Rotherham COPD Prescribing Guidelines recommends
the use of Prednisolone 30mg od for 10 days when
required for exacerbations. - 74 prescriptions were concordant with the above
guidance - 73 prescriptions were not concordant
- Non-concordant prescriptions include a wide range
of different dosage regimes