Article type
Year
Abstract
Introduction/Objective: To achieve good adherence to the 'British Thoracic Society Guidelines for the Management of Asthma in Adults'.
Methods: Over the last six years there have been audits of patients treated for asthma at this University Hospital to assess adherence to the BTS guideline. Different strategies have been used to improve guideline adherence.
Results: 1991/92. Two audits showed good emergency treatment with virtually all patients having satisfactory clinical assessment, blood gases, chest x-rays and regular peak flow recordings. However, treatment of the recovering asthmatic was not as complete; documentation of cause of attack was poor; many patients were not equipped with personal treatment plans; inhaler technique was infrequently checked.
Strategy 1 - 1995. At their induction day Junior Doctors were given the guideline on a laminated card. They received a lecture on the guideline. Audits over the next twelve months still showed poor adherence in similar areas.
Strategy 2 - 1996. A Patient Specific Reminder (PSR) was introduced to act as a prompt to junior medical staff. PSR forms were placed in casualty for all emergency admissions for completion throughout patient episode and would provide audit information. Doctors did not complete the forms.
Strategy 3 - 1997. Junior Doctors regularly present audits of their own patients to peers and senior lecturer; teaching and discussion about guideline adherence is based around the audit result. This strategy addresses the problem of constantly changing junior medical staff.
Discussion: We hope that by using Strategy 3 Clinical Audit will be a routine activity for doctors; consequently there will be on-going education and continuous monitoring; and hopefully improved adherence to guidelines results in improvement in patient care. This will be re-audited at 2 years.
Methods: Over the last six years there have been audits of patients treated for asthma at this University Hospital to assess adherence to the BTS guideline. Different strategies have been used to improve guideline adherence.
Results: 1991/92. Two audits showed good emergency treatment with virtually all patients having satisfactory clinical assessment, blood gases, chest x-rays and regular peak flow recordings. However, treatment of the recovering asthmatic was not as complete; documentation of cause of attack was poor; many patients were not equipped with personal treatment plans; inhaler technique was infrequently checked.
Strategy 1 - 1995. At their induction day Junior Doctors were given the guideline on a laminated card. They received a lecture on the guideline. Audits over the next twelve months still showed poor adherence in similar areas.
Strategy 2 - 1996. A Patient Specific Reminder (PSR) was introduced to act as a prompt to junior medical staff. PSR forms were placed in casualty for all emergency admissions for completion throughout patient episode and would provide audit information. Doctors did not complete the forms.
Strategy 3 - 1997. Junior Doctors regularly present audits of their own patients to peers and senior lecturer; teaching and discussion about guideline adherence is based around the audit result. This strategy addresses the problem of constantly changing junior medical staff.
Discussion: We hope that by using Strategy 3 Clinical Audit will be a routine activity for doctors; consequently there will be on-going education and continuous monitoring; and hopefully improved adherence to guidelines results in improvement in patient care. This will be re-audited at 2 years.