McLeod S J, Pearce M J, Rigby S A, Begg E J, Beard M E, Martin I R, Drennan C J, Town G I
Department of Medicine, Christchurch School of Medicine, New Zealand.
N Z Med J. 1996 Apr 12;109(1019):115-8.
To audit compliance with guidelines for the assessment and management of adult patients admitted to Christchurch Hospital with acute asthma.
An asthma admission form and management guidelines, based on international consensus statements, were designed for use by resident staff at Christchurch Hospital. Compliance with these guidelines was audited during the winter of 1994 by means of retrospective case record review.
One hundred and forty three admissions were screened. The form was used in 99 patients (69%), of which 97 had records available for audit. Sixty two patients were admitted under general medical services and 35 under respiratory specialist services. The median age was 34 years (range 14-84) and 77% were female. The history including interval status was adequately documented in over 95% of cases. Peak flow rate was recorded on admission in 93 patients (96%) and spirometry in 62 (64%). During the acute phase of treatment 528 items were prescribed, of which 382 (72%) were appropriate according to the guidelines. The major area (55%) of nonguideline prescribing was the use of nebulised ipratropium in addition to salbutamol for mild or moderate asthma. Written evidence of asthma education was present in 42 (43%). In 34 patients (35%) there was specific reference to the introduction of an asthma action plan. Of the 33 smokers only 17 appeared to have been given smoking cessation advice. Discharge prescribing complied with the guidelines in 71%. The most common variation from the guidelines for discharge therapy related to the manner of prednisone dose reduction. The readmission rate at 1 month was 11%.
The introduction of an asthma admission form enhanced the quality of clinical data gathering by junior staff. Compliance with management guidelines was adequate. Specific sections pertaining to the use of chest radiographs, arterial blood gases and the prescribing of ipratropium and prednisone will be reviewed in updated guidelines.
审核克赖斯特彻奇医院收治的成年急性哮喘患者评估与管理指南的遵循情况。
基于国际共识声明设计了一份哮喘入院表格及管理指南，供克赖斯特彻奇医院住院医师使用。1994年冬季，通过回顾性病例记录审查对这些指南的遵循情况进行了审核。
筛查了143例入院病例。99例患者（69%）使用了该表格，其中97例有可供审核的记录。62例患者由普通内科服务收治，35例由呼吸专科服务收治。中位年龄为34岁（范围14 - 84岁），77%为女性。超过95%的病例中，包括发作间期状况在内的病史记录充分。93例患者（96%）入院时记录了峰流速，62例（64%）进行了肺功能测定。治疗急性期共开具了528项医嘱，其中382项（72%）符合指南。不符合指南的主要医嘱领域（55%）是在轻度或中度哮喘时，除沙丁胺醇外还使用雾化异丙托溴铵。42例（43%）有哮喘教育的书面证据。34例患者（35%）中特别提及引入了哮喘行动计划。33名吸烟者中，只有17名似乎得到了戒烟建议。出院医嘱71%符合指南。出院治疗与指南最常见的差异涉及泼尼松剂量减少的方式。1个月时的再入院率为11%。
引入哮喘入院表格提高了初级医务人员收集临床数据的质量。对管理指南的遵循情况良好。更新后的指南将对与胸部X光片使用、动脉血气以及异丙托溴铵和泼尼松处方相关的特定部分进行审查。
