Asthma management at Christchurch Hospital: compliance with guidelines.
OBJECTIVE
To audit compliance with guidelines for the assessment and management of adult patients admitted to Christchurch Hospital with acute asthma.


METHODS
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.


RESULTS
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%.


CONCLUSIONS
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.
McLeod
S J
SJ
Department of Medicine, Christchurch School of Medicine, New Zealand.
Pearce
M J
MJ
Rigby
S A
SA
Begg
E J
EJ
Beard
M E
ME
Martin
I R
IR
Drennan
C J
CJ
Town
G I
GI
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000628:therapy*; D005260:Female; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D010351:Patient Discharge; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome