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BTS Audit 2010+2011+ Quality standards

BTS Audit 2010+2011+ Quality standards. Dr Adam Hill Royal Infirmary and University of Edinburgh. Audits. 2010 Audit. 2011 Audit. Secondary care audit 1 Oct 2010-31 Nov 2010 1,501 Records 60% Female Mean age 66 + 15 years.

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BTS Audit 2010+2011+ Quality standards

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  1. BTS Audit 2010+2011+ Quality standards Dr Adam Hill Royal Infirmary and University of Edinburgh

  2. Audits 2010 Audit 2011 Audit • Secondary care audit 1 Oct 2010-31 Nov 2010 • 1,501 Records • 60% Female • Mean age 66 + 15 years • Secondary care audit 1Oct 2011-31 Nov 2011 • 2,404 • 62% Female • Mean age 64 + 16 years

  3. Patients should have the Dx confirmed with CT

  4. Patients should see a chest physiotherapist

  5. Patients should have record of cough, sputum purulence, estimated or measured 24hr sputum volume and breathlessness when clinically stable 2010 2011 %

  6. Patients should have treatable causes excluded 2010 2011 %

  7. Patients should have spirometryAnnual spirometry if attending secondary careSpirometry before and after IV antibiotic therapy and LT antibiotic therapy 2010 2011 • 60% spirometry on day appt [others 6m (3-13)] • 16% IV Abs past year • Of which 22% had spirometry pre and post IVs • 10% long term Neb Abs • Of which 63% had spirometry pre and post • 55% spirometry on day appt [others 6m (3-13)] • 17% IV Abs past year • Of which 22% had spirometry pre and post IVs • 10% long term Neb Abs • Of which 61% had spirometry pre and post

  8. Long term treatments 2010 2011 • 66% SA B2 agonist and 11% SA anticholinergic • 65% SA B2 agonist and 29% SA anticholinergic • 81% ICS [median dose 1252 (70) BDP] • 27% Carbocysteine and 6% Neb saline (38% 0.9% saline) • No mannitol or DNAse • 27% LT oral Abs and 9% Neb Abs (76% colomycin) • 67% SA B2 agonist and 9% SA anticholinergic • 62% SA B2 agonist and 30% SA anticholinergic • 78% ICS [median dose 1094 (679) BDP] • 30% Carbocysteine and 8% Neb saline (37% 0.9% saline) • 0.4% mannitol + 0.2% DNAse • 33% LT oral Abs and 10% Neb Abs (76% colomycin)

  9. Patients with an exacerbation should have a sputum sample sent for microbiological culture prior to empirical AbTx

  10. Pulmonary rehab should be offered if dyspnoea affecting ADL 2010 2011 • 54% Not applicable • 13% No data • 12% Referred • 17% Not referred • 5% Unable to participate • 52% Not applicable • 16% No data • 15% Referred • 13% Not referred • 5% Unable to participate

  11. BTS Guidelines Thorax 2010;65(1):1-58Quality standards for clinically significant Bx in adults. July 201211 Quality Standards • Ensuring diagnostic accuracy with confirmation of a clinical diagnosis of Bx with a CT of the chest using 1mm slices. • Why important ? Population poorly defined in primary care; Underdiagnosis in primary + secondary care e.g. Severe asthma and COPD. • To investigate for specific treatable causes (ABPA, CVID and cystic fibrosis) • Why important ? These have specific treatments that differ from standard bronchiectasis management, which may alter the prognosis . • Regular chest clearance techniques to be taught by a specialist respiratory physiotherapist and advised of the frequency and duration with which these should be carried out. • Why important ? This is a key treatment to alleviate symptoms and may reduce chest infections.

  12. BTS Guidelines Thorax 2010;65(1):1-58Quality standards for clinically significant Bx in adults. July 2012 • Pulmonary rehabilitation to be provided in those with significant breathlessness. • Why important ? To improve patients exercise capacity and health status. • To monitor sputum bacteriology both in stability and exacerbations. • Why important ? Guide antibiotic therapy and management and improve the assessment and follow up. • Assess patients before and after intravenous antibiotic therapy. • Why important ? Allow the patient and clinicians to objectively assess the response and may guide long term management.

  13. BTS Guidelines Thorax 2010;65(1):1-58Quality standards for clinically significant Bx in adults. July 2012 • Suitable patients to have an available inhaled antibiotic service. • Why important ? Long term prophylactic treatment may improve symptoms and reduce the number of chest infections. • Domiciliary intravenous antibiotic treatment made available for chest infections in selected patients to reduce the need for hospitalisation. • Why important ? This will reduce hospital bed days and the risk of hospital acquired infection and promote people centred care allowing delivery of intravenous treatment safely at home.

  14. BTS Guidelines Thorax 2010;65(1):1-58Quality standards for clinically significant Bx in adults. July 2012 • All patients should have a self-management plan. • Why important ? This will allow people with bronchiectasis to manage their condition and to recognise, respond to and reduce the occurrence of chest infections; • Secondary care follow up as per British Thoracic Society national guidelines. • Why important ? The clinical course and management in such people is complicated and management would be better under a multidisciplinary team led by a Respiratory physician.

  15. BTS Audit 2012 • In progress • Based on Quality Standards • BTS Guidelines Thorax 2010;65(1):1-58 • BTS Audit Thorax. 2012 Oct;67(10):928-930. • Self management plan + BTS QS- BTS website

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