Breathing Space COPD Audit 200607

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Breathing Space COPD Audit 2006/07

• Practice Level Audit 36 practices
• Patient Level Audit 34 practices
• Audit process is still underway in 4 practices

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• 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.

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Baseline practice visit records audit August
2006 March 2007
Repeat audit 2008
Feedback to practices November 2006 April 2007
- Quest Audits - Training
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Practice Level Audit Results from 36 Practices

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Question not answered by auditor 4
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Patient Level Audit Results from 34
practicesSample 2985 patients
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Range 23 - 100
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Range 19 - 90
Spirometry not recorded for 4 patients
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Range 0 - 100
Results for 20 spirometry were not found
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Range 0 - 80
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Range 0 - 72
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Classification 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
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Range 84 - 100
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Current Smoking Status n 2985
Range 23 - 60
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Range 52 - 100
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Part 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.

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Range 5 - 100
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Range 0 - 95
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Range 0 - 70
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Has a reversibility test been undertaken? (n
687)
Range 0 - 85
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Range 0 - 100
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Range 0 - 100
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COPD 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.

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Range 0 - 100
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Range 0 - 100
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Medication

• 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.

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Medication - continued
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Treatment of Exacerbations
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Antibiotic 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)

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Steroid 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