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Adult Asthma CPI
Clinical scenario
Asthmatics frequently present to emergency departments in the UK. Rapid assessment and treatment is essential for optimal care of these patients. Subsequent management depends on the severity of the initial presentation.
Audit question
Is acute asthma managed appropriatey according to best practice guidelines?
Method
Retrospective audit
Sample: 30-50 Emergency Department patient records
Criteria
Inclusions: Patients (16 years or over) with asthma or SOB suspected as their primary condition.
Exclusions: Patients aged under 16 OR patients presenting with another medical condition.
Audits
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1st December 2007
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st December 2007 | Patients attending the ED with acute asthma | Management of patients according to the criteria. | Patients discharged following steroid administration followed up appropriately | 100 % | 28.5 % |
| B agonists are given to moderate/severe cases within 10 mins of arrival, if appropriate | 100 % | 20.8 % | |||
| Moderate asthma (PFR 50/70%) patients who are discharged are given oral prednisolone 40-50mg for 5 days | 100 % | 76.5 % | |||
| Oxygen sat measured on arrival | 100 % | 87.2 % | |||
| Peak flow measured on arrival | 100 % | 54 % | |||
| Respiratory rate measured on arrival | 100 % | 82 % | |||
| IV magnesium 1.2-2.0g over 20 mins if life threatening and not responding within 15 mins of arrival | 100 % | 100 % | |||
| Oxygen given on arrival | 100 % | 5.13 % |
Comments
Significant decline in patient management noted overall, with the exception of the administraion of IV magnesium, which achieves target. Of particular concern is patient follow-up, administration of B agonists, observation documentation and administration of oxygen on arrival, all of which show a significant decine in scores.
Audit Bottom Line
Overall a disappointing set of results. Significant scope for improving patient care in nearly all areas outlined by the criteria. Investigation recommended into whether this is a documentation issue.