Document Detail

Emergency department management of exacerbation of chronic obstructive pulmonary disease: audit of compliance with evidence-based guidelines.
MedLine Citation:
PMID:  19811556     Owner:  NLM     Status:  In-Data-Review    
Background: Emergency departments (ED) play a key role in management of exacerbation of chronic obstructive airways disease (COPD). Current guidelines for management of exacerbation of COPD showed highest levels of evidence (Level A and B) were related to use of medications and non-invasive positive pressure ventilation (NIPPV). Aims: The aim of this study was to examine compliance with high level evidence for management of exacerbation of COPD during the first 4 h of ED care. Methods: A retrospective medical record audit was conducted at four public and one private ED in Melbourne, Australia. Participants were adult patients with COPD presenting to the ED with a primary complaint of shortness of breath from July 2006 to July 2007. Outcome measures were compliance with evidence-based recommendations regarding use of bronchodilators, methylxanthines, steroids and NIPPV. Results: Of 273 patients in this study, 72.4% received short-acting beta-agonist bronchodilators, 37.8% received an inhaled short-acting anticholinergic medication and 56.6% received systemic steroid therapy. NIPPV was used in 21 patients, 15 of whom had documentation of acidosis and/or hypercapnia). Conclusions: There was variation in the use of high level evidence for the ED management of exacerbation of COPD. The highest rate of compliance was non-use of methylxanthines and the greatest deficit was poor compliance with evidence related to NIPPV. There was also scope for improvement in the use of bronchodilators and systemic steroids.
J Considine; M Botti; S Thomas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Internal medicine journal     Volume:  41     ISSN:  1445-5994     ISO Abbreviation:  Intern Med J     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  48-54     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.
School of Nursing, Deakin University-Northern Health Clinical Partnership, Melbourne, and School of Primary Health Care, Monash University, Melbourne, Victoria, Australia.
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