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Chronic Obstructive Pulmonary Disease Audit (COPD) Context Page

The National Asthma and COPD Audit Programme (NACAP) for England, Scotland and Wales is delivered by the Royal College of Physicians and aims to improve the quality of care, services and clinical outcomes for patients with asthma (adult and paediatric) and chronic obstructive pulmonary disease (COPD). Spanning the entire patient care pathway the programme comprises six key workstreams including a COPD continuous clinical audit of people admitted to hospital in England, Scotland (from late 2018) and Wales with COPD exacerbations. Participation in the secondary care workstreams of the National Asthma and COPD Audit Programme (NACAP) is a requisite of trust quality accounts.

To view the full audit data set visit www.nacap.org.uk

Metrics:

Case ascertainment

  • Rationale: This metric shows the proportion of eligible cases within the hospital that were submitted to the audit. The comparison is made against Hospital Episode Statistics data. This can sometimes be higher than 100% due to inconsistencies in local coding methodologies.
  • Guideline/mapping: Trusts are required to participate and report on all National Clinical Audit and Patient Outcomes Programme projects as part of their NHS Standard contract.
  • Graph/relative performance: Not available for this reporting period.
  • Quality improvement prompt question: Not available for this reporting period.

Percentage of patients seen by a member of the respiratory team within 24hrs of admission date

  • Rationale: Specialist review of patients within 24 hours of admission had an impact on oxygen prescription, smoking cessation pharmacotherapy, use of NIV and discharge processes.
  • Guideline/mapping: This metric maps to Nice Quality standard 10, statements for use at local level (https://www.nice.org.uk/guidance/qs10/chapter/List-of-quality-statements) “People admitted to hospital with an exacerbation of COPD are cared for by a respiratory team, and have access to a specialist early supported‑discharge scheme with appropriate community support.” This metric all forms part of the best practice tariff for COPD.
  • Graph/relative performance: Comparison to national aggregate
  • Quality improvement prompt question: If worse than the national aggregate this should prompt questions about what action can be taken to improve the percentage of COPD patients being seen by a member of the respiratory team with 24 hours.

Percentage of patients receiving oxygen in which this was prescribed to a stipulated target oxygen saturation (SpO2) range (of 88-92% or 94-98%)

Percentage of patients receiving non invasive ventilation (NIV) within the first 24 hours of arrival who do so within 3 hours of arrival

  • Rationale: Non-invasive ventilation (NIV) is the use of airway support administered through a face (nasal) mask instead of an endotracheal tube. Evidence suggests that approximately 20% of admissions may be acidotic on arrival, thus indicated for treatment with NIV. Only 10.9% of admissions received acute treatment with NIV. Improvement in timing of NIV leads to better patient outcomes. Prompt application of acute NIV substantially reduces the risk of death in appropriately selected patients with acute hypoxemic respiratory failure (AHRF).
  • Guideline/mapping: NICE Clinical Guideline 101 Chronic obstructive pulmonary disease in over 16s: diagnosis and management-1.3.7.1 NIV should be used as the treatment of choice for persistent hypercapnic ventilatory failure during exacerbations despite optimal medical therapy.
  • Graph/relative performance: Comparison to national aggregate
  • Quality improvement prompt question: If worse than the national aggregate this should prompt questions about what action can be taken to improve the early identification of COPD patients requiring NIV and ensuring they receive it promptly.

Percentage of documented current smokers prescribed smoking-cessation pharmacotherapy

  • Rationale: Identification of current smokers and prescribing of smoking cessation pharmacotherapy is poor. Smoking cessation is a therapy for COPD. Improving quit rates reduces readmissions and improves other outcomes.
  • Guideline/mapping: NICE Clinical Guideline 101 Chronic obstructive pulmonary disease in over 16s: diagnosis and management 1.2.1.3 Unless contraindicated, offer NRT, varenicline or bupropion, as appropriate, to people who are planning to stop smoking combined with an appropriate support programme to optimise smoking quit rates for people with COPD
  • Graph/relative performance: Comparison to national aggregate
  • Quality improvement prompt question:  If worse than the national aggregate this should prompt questions about what action can be taken to improve the percentage of current smokers prescribed smoking-cessation pharmacotherapy

Percentage of patients for whom a British Thoracic Society, or equivalent, discharge bundle was completed for the admission

  • Rationale: Hospital discharge care bundles are designed to ensure that every person leaving hospital receives the best care. They emphasise the key interventions in the management pathway, including details of settings for care and treatment. There are several elements of ongoing care that an adult with COPD should start before discharge from hospital, which can improve their outcome.
  • Guideline/mapping:  This metric maps to Nice Quality standard 10, quality statement 8: Hospital discharge care bundle (https://www.nice.org.uk/guidance/qs10/chapter/List-of-quality-statements)
  • Graph/relative performance: Comparison to national aggregate
  • Quality improvement prompt question: If worse than the national aggregate this should prompt questions about what action can be taken to improve the percentage of patients who have a completed discharge bundle

Percentage of patients with spirometry confirming FEV1/FVC ratio <0.7 recorded in case file

  • Rationale: COPD can only be diagnosed in the presence of a risk factor, symptoms and confirmatory spirometry (and possibly further lung function tests or a CT scan).Spirometry is issued to measure airflow obstruction. Spirometry measures the volume of air that the patient is able to exhale in the first second of forced expiration (FEV1) and the total volume of air that the patient can forcibly exhale in one breath (FVC). If the ratio of FEV1 to FVC is 0.7 (70%) or less this is indicative of airway obstruction. all patients over the age of 35 who present with symptoms of COPD should have a spirometry test to confirm their diagnosis. This will not be required on every admission but could be from a previous test.
  • Guideline/mapping: NICE Clinical Guideline 101 Chronic obstructive pulmonary disease in over 16s: diagnosis and management 1.2.2 Spirometry(https://www.nice.org.uk/guidance/cg101).
  • Graph/relative performance: Comparison to national aggregate
  • Quality improvement prompt question: If worse than the national aggregate this should prompt questions about what action can be taken to improve the percentage of patients with spirometry confirming FEV1/FVC ratio <0.7 recorded in case file
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