Royal Hospital, Muscat, Oman.
J Infect Public Health. 2012 Jun;5(3):250-6. doi: 10.1016/j.jiph.2012.03.002. Epub 2012 Apr 20.
Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Herein, we present the findings from an audit of CAP management at a tertiary hospital in Oman. The main objective was to evaluate the quality of care given to patients and compare it with the standards in the Gulf Cooperation Council (GCC) CAP guidelines.
A retrospective case study of all patients admitted with CAP from June 2006 to September 2008 examined the adherence to standards for the diagnosis, investigation, and management of CAP, including the documentation of illness severity.
The case notes of 342 patients were reviewed. Of these, 170 patients were excluded from the study, and 172 patients met the diagnostic criteria for inclusion. A CURB-65 severity score was documented for only 4 (2.3%) patients, and a smoking history was documented for 56 (32.6%) patients. Although 17 different antibiotic regimens were used, 115 (67%) patients received co-amoxiclav and clarithromycin, which is the standard of care. Additionally, 139 (81%) patients received their first dose of antibiotics within four hours of hospital admission. There was no documentation of offering influenza or pneumococcal vaccine to high risk patients.
The clinical coding of CAP diagnosis was poor. There was very poor adherence to the CAP severity assessment and the provision of preventive measures upon hospital discharge. The development and implementation of a local hospital-based integrated care pathway may lead to more successful implementation of the guidelines.
社区获得性肺炎（CAP）是全球发病率和死亡率的主要原因。在此，我们报告了在阿曼一家三级医院进行的 CAP 管理审核结果。主要目的是评估患者所接受的护理质量，并将其与海湾合作委员会（GCC）CAP 指南的标准进行比较。
对 2006 年 6 月至 2008 年 9 月期间因 CAP 住院的所有患者进行回顾性病例研究，以评估诊断、检查和 CAP 管理标准的依从性，包括疾病严重程度的记录。
共审查了 342 例患者的病历。其中，170 例患者被排除在研究之外，172 例符合纳入标准。仅有 4 例（2.3%）患者记录了 CURB-65 严重程度评分，56 例（32.6%）患者记录了吸烟史。尽管使用了 17 种不同的抗生素方案，但 115 例（67%）患者接受了复方阿莫西林克拉维酸钾和克拉霉素治疗，这是标准治疗方法。此外，139 例（81%）患者在入院后 4 小时内接受了第一剂抗生素。没有记录向高危患者提供流感或肺炎球菌疫苗。
CAP 诊断的临床编码较差。对 CAP 严重程度评估和出院时提供预防措施的依从性非常差。制定和实施基于医院的综合护理途径可能会导致更成功地实施指南。
