Originally from California. Came over to Australia to do medical school at the University of Queensland. Currently finishing up his final year as a BPT registrar at the Mater Hospital in South Brisbane and plans to pursue Oncology.
Adherence to the COPD-X Guidelines in a Regional Hospital for Patients Admitted with COPD
To assess adherence to the COPD-X guidelines when prescribing antibiotics to patients admitted to Ipswich Hospital with an Infective Exacerbation of Chronic Obstructive Pulmonary Disease (IECOPD).
A retrospective analysis of a 100 patients admitted to Ipswich Hospital with IECOPD (18 to 80 years old). These patients were randomly selected for our quality assurance audit. We looked for features associated with an increased likelihood of a bacterial infection warranting antibiotic therapy. These included: a productive cough, change in sputum amount or color, fever, evidence of consolidation on chest radiograph, increased white blood cell count and a raised C-reactive protein.
Of the 100 patients reviewed, 53 were male. The average age was 69.4 years. Four patients did not have a previous or current smoking history. COPD was confirmed with spirometry in 46 of the 100 patients. Nine patients did not exhibit any of the features listed above indicating infection. Of those 9 patients, only 2 received antibiotics. There were 14 patients who had one of the features suggestive of infection. Of those 14 patients, 9 received antibiotics. There were 27 patients who had two of the features indicating infection. Of those 27 patients, 20 were given antibiotics. As for the remainder: 20 patients had 3, 15 patients had 4 and another 15 patients had 5 of the features indicting infection respectively. All of these patients received antibiotics.
Unnecessary use of antibiotics is costly to the health system and can have potentially serious adverse effects for patients. It is therefore important to ensure that we practice in accordance to the COPD-X guidelines when treating patients with an IECOPD. In our regional hospital, our audit confirms that we are adhering to the guidelines and managing most of our patients admitted with infective exacerbations of COPD appropriately. We have also identified the need to ensure more patients undergo spirometry to confirm a COPD diagnosis on discharge.