Confirm exacerbation and categorise severity | “Unless confused or comatose, even the sickest of patients can perform an FEV1 manoeuvre” [p. 61] FEV1 performed this admission/patients admitted | 45/198 (22.7%) | 1/65 (1.5%) | 0/5 (0%) | 2/38 (5.3%) | 33/62 (53.2%) | 9/28 (32.1%) | <0.001 |
“Arterial blood gas levels should be measured if the FEV1 is less than 1.0 L or less than 40% predicted” [p. 61] ABG or VBG taken/patients with any documented FEV1 <1 L | 86/106 (81.1%) | 23/31 (74.1%) | 3/3 (100%) | 8/13(61.5%) | 43/46(93.5%) | 9/13(69.2%) | 0.017 |
“Chest x-ray…helps to identify alternative diagnoses and complications” [p. 61] Chest radiography performed/patients admitted | 203/204 (99.5%) | 65/65 (100%) | 7/8 (87.5%) | 39/39 (100%) | 62/62 (100%) | 30/30 (100%) | 0.039 |
Optimise treatment | “Oral corticosteroids hasten resolution and reduce the likelihood of relapse” [p. 61] Prescribed corticosteroids/patients admitted | 195/205 (95.1%) | 65/65 (100%) | 7/7 (100%) | 37/39 (94.2%) | 59/64 (92.2%) | 27/30 (90%) | 0.085 |
“Antibiotics are given for purulent sputum to cover for typical and atypical organisms” [p. 61] Antibiotics prescribed/patients with change in sputum colour | 95/100 (95.0%) | 30/32 (93.8%) | 2/3 (66.7%) | 14/15 (93.3%) | 35/35 (100%) | 14/15 (93.3%) | 0.085 |
“Oxygen therapy…indicated in patients with hypoxia… minimise excessive oxygen administration” [p. 61] All patients who were administered oxygen therapy/patients admitted | 180/202 (89.1%) | 52/65 (80.0%) | 8/8 (100%) | 32/36 (88.9%) | 61/63 (96.8%) | 27/30 (90.0%) | 0.034 |
“Oxygen therapy…indicated in patients with hypoxia… minimise excessive oxygen administration” [p. 61] Patients who were administered oxygen therapy when PaO2 <80 mmHg and ABG taken on air this admission/all patients who had PaO2 <80 mmHg when ABG taken on air this admission | 25/27 (92.6%) | 5/7 (71.4%) | 0/0 (0%) | 1/1 (100%) | 13/13 (100%) | 6/6 (100%) | 0.177 |
“Ventilatory assistance… indicated for increasing hypercapnia and acidosis” [p. 61] Received ventilatory assistance/those with pH <7.35 | 21/32 (65.6%) | 6/8 (75%) | 0/2 (0%) | 4/6 (66.7%) | 9/14 (64.3%) | 2/2 (100%) | 0.429 |
Refer appropriately to prevent further deterioration | “Pulmonary rehabilitation…can be initiated immediately following an acute exacerbation” [p. 66] Referred to pulmonary rehabilitation/patients admitted | 60/185 (32.4%) | 33/46 (71.7%) | 3/8 (37.5%) | 4/39 (10.3%) | 14/64 (21.9%) | 6/28 (21.4%) | <0.001 |
“It is recommended that the first review after a hospital admission should be by the GP and within seven days of discharge” [p. 67] Referred to GP/patients admitted | 136/177 (76.8%) | 43/47 (91.5%) | 1/6 (16.7%) | 23/34 (67.7%) | 39/60 (65.0%) | 30/30 (100%) | <0.001 |