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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 August 2008
Results
| 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 % |
Comments
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.