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The use of audit to identify deficiencies in the management of community acquired pneumonia
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Perkins, Gavin D., Tweed, M. and Handslip, P. D. J. (2000) The use of audit to identify deficiencies in the management of community acquired pneumonia. Thorax, 55 (SUPPL. 3). ISSN 0040-6376.
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Abstract
Background: Guidelines for the management of community acquired pneumonia (CAP) were developed by the British Thoracic Society in 1993. This audit sought to identify current practice at a district general hospital and to establish the current knowledge and understanding of the CAP guidelines amongst junior medical staff prior to the launch of revised guidelines from the BTS. Methods: 60 sets of notes were retrospectively reviewed from patients admitted with a diagnosis of CAP between January -May 2000. 26 cases were excluded on the basis of age (<16), incorrect diagnosis, advanced malignancy. Current knowledge amongst junior staff was assessed through individual structured interviews. Results: 44 cases were reviewed. 23 cases male; mean age 69.2 years (range 19-100) years. 10 cases were identified using the revised BTS rule as a severe pneumonia. These cases (6 male) were older than the uncomplicated pneumonia (66.3 vs 77.9 years). All patients had clinical and radiological evidence of pneumonia. The initial severity assessment was poorly performed: 34 (77%) had an assessment of oxygenation, ABG were not performed on 6 occasions when Sp02 was < 92%; respiratory rate was recorded in 14 cases (32%); and presence or absence of confusion was documented in only 17 (39%) cases. Antibiotic prescribing was appropriate in 7 cases, excessive in 25 cases and inadequate in 12. 14 of 16 junior medical staff were interviewed about the management of CAP. Awareness that pneumococcus was the commonest organism was good (14), but knowledge about severity assessment was poor and treatment for uncomplicated CAP was variable with 6 providing correct treatment, 7 excessive treatment and 1 inadequate treatment. Conclusion: The current guidelines have been poorly integrated into clinical practice at this hospital. In addition to developing new CAP guidelines, resources should be directed towards improving the awareness of guidelines amongst junior medical staff.
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > R Medicine (General) | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Thorax | ||||||
| Publisher: | BMJ | ||||||
| ISSN: | 0040-6376 | ||||||
| Official Date: | 2000 | ||||||
| Dates: |
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| Volume: | 55 | ||||||
| Number: | SUPPL. 3 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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