Objective: To evaluate the quality of care of patients with acute exacerbation of COPD in our tertiary care hospital and evaluate the change in practice after educational program and recommendations.
Methodology: An initial audit from 01/12/2013 to 31/11/2014 was carried out. Standard of care was determined with inpatient mortality, length of hospital stay, accuracy of initial controlled oxygen prescription, history and clinical assessment at admission, adherence of post graduate trainees to GOLD guidelines and discharge recommendations. A re-audit was performed in July 2015 with analysis of 6 months data.
Results: A total of the 121 files were included in first audit. Though the pattern in mortality remained the same, a significant reduction in median length of hospital stay from 11 to 7 to 8 days (p=0.003) was observed. A significant improvement was seen in documentation of biomass exposure, renal failure, Anthonisen criteria, Performance status, systematic steroids, Anticoagulation (heparin), PEFR before discharge, Inhaler technique, Smoking cessation advice, vaccination advice, outpatient follow-up and oral steroid in re-audit phase of the study. Consistent practice was observed with regards to good inpatient prescription of oxygen therapy, systemic steroids and antibiotics.
Conclusion: Improvement in quality of care for AECOPD can be achieved with continuous education and monitoring of postgraduate doctors, a more systemic approach to patients, adherence to standard guidelines and intermittent audits.
Key words: COPD, AECOPD, Inpatient care.
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