THE USE OF PEFR IN

ASTHMATICS AT UHWI, A CLINICAL

AUDITPresented 23.02.16

By : Camille Rainford

Gillian BentYoleigh

GardenerPeter Soltau

Introduction

The Audit■ For the purposes of improving patient care, enhance staff

professionalism, increase resource utilization, aid continuing

education, and demonstrate accountability of the quality of clinical

services, an asthma protocol was created and distributed to the staff

members of the EMD

■ This Asthma protocol was last updated in 2011

■ The Asthma peak flow audit is a standard based audit

■ Based on the UHWI A&E Asthma Protocol 2011 peak expiratory flow measurements is one of the two components used in the evaluation of severity of an acute exacerbation

■ This measure is also used to aid in decision making regarding the disposition of patients who present with an exacerbation of asthma

Methodology■ Log books located in A/E & Casualty was reviewed for all patients with

a diagnosis of asthma

■ The docket numbers were collected and requested from the docket library

■ Dockets were reviewed for documented evidence of ;– Peak flow request– Peak flow done (Pre-treatment/Post-treatment)

■ Data collected and analyzed using Microsoft Excel 2013

Results■ Over the study period of 2 months ( October – November 2105 ), a

total of 152 asthmatics presented to the EMD UHWI for treatment of exacerbations of bronchial asthma

■ Of 152 dockets requested :– 104 were obtained (62.8%)– 13 contained no asthma notes (0.08%)– 91 were reviewed (59.8%)– Of the 91 reviewed (3 were omitted – 1 resolved, 2 peak flow not

required age < 3)– Leaving 88 patients (57.9%) to be audited

Dockets Not FoundNo Asthma Data In Docket

Dockets Reviewed

0102030405060708090

100

48

13

91

Total Number Of Patients

Total Number of Patients

65%

35%

% Peak Flow Requested

Peak Flow RequestedPeak Flow Not Requested

64%

36%

Pre- Treatment Peak Flow Doc-umentation %

Pre-Treatment Peak Flow DonePre-Treatment Peak Flow Not Done

81%

19%

Post-Treatment Peak Flow Documentation %

Post-Treatment Peak Flow DonePost-Treatment Peak Flow Not Done

99.03%

Expected Peak Flow Documented

Expected Peak Flow Documented Expected Peak Flow Not Documented

Limitations

■Inability to locate dockets (31%)

■Patient unable to perform peak flow at time of presentation

■Small sample size

■No documentation indicating reason for no peak flow being done in majority of cases

Recommendations ■Emergency Asthma Treatment Charts

■Peak Flow Charts

■Asthma Education (Monday/Wednesday meetings)

■Asthma Training

Conclusion

■Adherence to the asthma policy needs improvement by all members of staff

■Continued asthma education and training is needed to improve adherence

Thank You

■ Of the 88 patients audited:– 58 patients had a peak flow requested by the attending physician

(65%)– 57 patients had a pre treatment peak flow documented (64%)– 72 patients had a post treatment peak flow documented (81%)– 7 patients had a expected peak flow documented (0.07%)