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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?


Retrospective audit
Sample: 30-50 Emergency Department patient records

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.


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1st August 2007

1st December 2007

1st April 2008

1st August 2008

1st December 2008

1st April 2009

1st August 2009

1st December 2009

1st April 2010

1st August 2010

1st December 2010

1st April 2011

1st August 2011

1st December 2011

1st April 2012

1st August 2012

1st December 2012

Show Results Over Time


Date Patients Measured Results Standard Regional avg.
01st August 2008 Patients attending the ED with acute asthma Managemnt of the patients according to the criteria Patients discharged following steroid administration followed up appropriately 100 % 56.5 %
B agonists are given to moderate/severe cases within 10 mins of arrival, if appropriate 100 % 47.8 %
Moderate asthma (PFR 50/70%) patients who are discharged are given oral prednisolone 40-50mg for 5 days 100 % 50 %
Oxygen sat measured on arrival 100 % 77.5 %
Peak flow measured on arrival 100 % 42.5 %
Respiratory rate measured on arrival 100 % 75 %
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 % 58.3 %


Overall a mixed set of results. Results indicate a reduction in the quality of care. Observations on arrival score lower, discharge medications and follow-up following steriod administration scored lower. However, there is a slight improvamant in the use of B agonists when appropriate, and an apparent huge increase in the use of IV megnesium, although this may be a false results due to lack of appropriate patients. Only one of the criteria is reaching target, with the others well under, at around 40-70%, so significant scope for improvement.

Audit Bottom Line

The majority of scores are well below target, so significant scope for improvement, particularly around the use of B agonists, peak flow measurements and oxygen given on arrival, and care taken around the use of steriods at discharge, with approriate follow up.

Record created on 31st December 2005 by