How to do the Audit
Title: PCRS-UK audit of patients diagnosed in primary care with chest infection
To register and do your baseline audit:
- This audit can be done by both full time, practice based and also part time sessional health professionals treating patients with chest infections:
- Full-time practice-based doctors and nurses: please download and complete this form to provide baseline demographic information about your practice.
- Part-time and sessional health professionals: please download and complete this form to provide baseline demographic information about your practice.
- Send the completed form to Dr Mark Levy at firstname.lastname@example.org.
- You will then receive log-on details to enter your audit results online.
Identify patients for inclusion in this audit:
Audit at least 10 patients with diagnosed 'chest infection' (ie LRTI, Acute Bronchitis, Community acquired pneumonia, bronchopneumonia, lobar pneumonia, flu or flu-like illness)
To audit individual patients:
- As you diagnose patients with chest infections, list them on the audit summary sheet (click to download) and please create an anonymous identity code for each (you might wish to use your practice computer code for this purpose). We suggest simply renumbering each patient from 1 upwards and that you use these numbers online as the patient identifier, but also keep a record of the patients' computer numbers on your system, so you can identify patients later if necessary. Of course, you could use your own practice computer number on the audit sheet, as this will not be identifiable to any outsider.
- This will ensure that NO CONFIDENTIAL INFORMATION about your patients is loaded onto the online audit database.
- Then use the individual patient data sheets (click to download) to enter individual patient data.
After receiving your online log on details
- Your practice baseline data will already be loaded online.
- Then log on to the PCRS-UK Chest Infection Audit and enter the information on each patient audited. This can be done at the time of consultation, or later from the details recorded onto the individual patient data sheets.
- After entering baseline and patient data, you will be able to see your audit data, compared with other practices in the UK and abroad.
- Info from summary and report button. This report, available once 10 patients have been entered will be helpful in evaluating whether the clinician needs to take any action regarding care for patients diagnosed with chest infections.
- The summary report, will also be useful as a record of audit performed for your annual personal development plan, and also will serve as evidence of audit for use in appraisal interviews.
In those patients diagnosed with Community Acquired Pneumonia (CAP) the CRB-65 and Abbreviated Mental Health Test Scores may be of help.
In patients diagnosed with CAP, the CRB-65 score (Bauer, T.T., et al., CRB-65 predicts death from community-acquired pneumonia. Journal of Internal Medicine, 2006. 260(1): p. 93-101.) is helpful in deciding whether to admit patients to hospital.
The CRB-65 score
This CRB-65 score is calculated by allocating one point for each of the following:
Source: Bauer, T.T., et al., CRB-65 predicts death from community-acquired pneumonia. Journal of Internal Medicine, 2006.
- Confusion - New mental confusion, defined as an Abbreviated Mental Test Score of 8 or less (See below for details)
- Respiratory rate - Raised ≥30/minute
- Blood pressure - Low Blood Pressure (systolic <90 mmHg and/or diastolic ≤60 mmHg)
- Age ≥65 years
Mental Health Test
(each question scores 1 mark,
total 10 marks)
Source: Wei Shen Lim et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009 Thorax, Oct 2009; 64: iii1 - iii55.
- Date of birth
- Time (to nearest hour)
- Surgery name
- Recognition of two persons
(eg. doctor, nurse)
- Recall address
(eg. 42 West Street)
- Date of First World War
- Name of Monarch
- Count backwards
20 to 1
- M.L. Levy, M. Fletcher, D.B. Price, T. Hausen, R.J. Halbert, B.P. Yawn. Diagnosis of respiratory diseases in primary care . Prim Care Resp J 2006; 15(1):20-34. Available online at http://dx.doi.org/10.1016/j.pcrj.2005.10.004
- J Macfarlane, W Holmes, P Gard, R Macfarlane, D Rose, V Weston, M Leinonen, P Saikku and S Myint.Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax 2001;56;109-114
- Feldman, C. Appropriate management of lower respiratory tract infections in primary care (2004) Primary Care Respiratory Journal, 13 (3), pp. 159-166. http://dx.doi.org/10.1016/j.pcrj.2004.02.006
- Nice 69
- Bauer, T.T., et al., CRB-65 predicts death from community-acquired pneumonia. Journal of Internal Medicine, 2006. 260(1): p. 93-101.)
- Woodhead, M.A., et al., The value of routine microbial investigation in community-acquired pneumonia. Respir Med, 1991. 85(4): p. 313-7.
- BTS CAP guideline – GP summary (Levy ML et al Prim Care Resp J 2010;19(1):21-27. http://dx.doi.org/10.4104/pcrj.2010.00014