An audit of the assessment and management of adults admitted to Christchurch Hospital with community acquired pneumonia.
OBJECTIVE
To audit the management of adult patients admitted with community acquired pneumonia including the standards of clinical assessment, use of modified British Thoracic Society prognostic criteria and antibiotic therapy.


METHODS
A prospective, 16 week, study of consecutive patients admitted to Christchurch Hospital with community acquired pneumonia.


RESULTS
Ninety-six patients met the inclusion criteria. The median age was 70 years. A pathogen was identified in 28 (26%) patients. Forty two patients fulfilled the modified British Thoracic Society criteria for severe disease and all 9 deaths occurred in that subgroup. The management guidelines were followed without exception in only 15% of cases. Documentation of the prognostic criteria was often incomplete and therefore only 33% of those patients with severe disease were correctly identified. Seventy one percent of those with severe disease were treated with only one antibiotic and there was significant delay in administering the first dose in 44% of cases. A follow up chest radiograph was performed in 43 (51%) of those discharged.


CONCLUSIONS
There was poor compliance with the management guidelines. There was a lack of awareness of the severity criteria leading to inadequate treatment in many cases. Further educational initiatives are indicated.
Meyer
R J
RJ
Canterbury Respiratory Research Group, Christchurch School of Medicine.
Town
G I
GI
Harrè
E
E
Koning
M
M
Hurrell
M
M
Beard
M E
ME
Chambers
S T
ST
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000628:therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D008485:Medical Audit; D009520:New Zealand / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000628:therapy; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D000900:Anti-Bacterial Agents