A Welsh Local Health Board needed our support to identify COPD patients who could potentially benefit from a pulmonary rehabilitation service.
In order to plan their service provision, the pulmonary rehabilitation service needed to assess the number of patients who might be referred to them, however information was not being recorded at this point in time.
To overcome the challenge, we were commissioned to develop and implement a clinical audit programme across three primary care sites.
The audit needed to capture spirometry readings and an up to date breathlessness scale score for each patient on the COPD register.
Although each of the primary care sites in the audit programme had a list of patients with COPD, only 18% of the patients had breathlessness score recorded.
Outcomes:
- After nine months, 80% of patients were categorised as having mild, moderate or severe COPD – compared to 50% at the start of the programme. This categorisation led to appropriate therapy management according to the agreed treatment protocol.
- The audit process showed a need for practice nurses to be trained on the interpretation and recording of spirometry results.
- All three practices continued to actively review patients and work through those with missing or out of date readings.
- The programme significantly contributed towards the practices’ QOF achievement in a number of areas.
- The pulmonary service could plan for referrals
After our involvement, practice staff reported a better understanding of COPD in relation to QOF and NICE guidelines, as well as greater confidence in identifying the correct medication for each patient and in which format.
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