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Manuela Velázquez Prieto
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Volume 19 - Issue 3, May-June 2017
ORIGINAL
STUDY OF MEDICAL OXYGEN USE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE ACCORDING TO TRACER METHODOLOGY OF JOINT COMMISSION
QUINTERO PICHARDO ESPERANZA


Background: Chronic obstructive pulmonary disease (COPD) is a common, preventable, progressive disease, characterized by chronic airflow obstruction. So far, there is no cure, but there are complementary measures to relieve symptoms and slow progression of disease: health education, pharmacologic and non-pharmacologic
treatment. Within the pharmacological treatment, and depending on the stage of the disease, these patients are treated with medical oxygen at different times.

Objective: To study the therapeutic use of medical oxygen in patients with COPD at hospital admission and at home by the verification of the criteria compliance of its medical management, and establishing improvement strategies.

Method: We conducted a longitudinal descriptive retrospective study on the use of medical oxygen by a Quality Audit with available data in the medical records of an overall population of patients with COPD treated with oxygen at both inpatient and outpatient care levels (continuous home oxygen therapy (COT)). We used the tracer methodology of the Joint Commission International, being oxygen the system tracer. The study period lasted 18 months. We selected 10 optimal criteria related to the use of oxygen at hospital and COT care levels, all based on the recommendations of the Integrated Care Processes (PAI) for COPD and recommendations of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). The sample was obtained from the Minimum Basic Data Set of the hospital and from the home oxygen supplying company. The number of patients diagnosed with COPD was 67. Data collection was performed from the physical medical record and Diraya of specialized Care. With respect to the sequence of the tracer management, it was mainly focused on the prescribing, dispensing, administration and monitoring. The audited units were Pneumology, Internal Medicine, and emergency room.

Results: Of the 67 audited records, fifty-five patients were treated with oxygen. We observed a total compliance (100%) of the demographic data, confirmation of diagnosis, allergies, and Adverse Drug Reactions (ADR), as well as related aspects to health education (smoking cessation). Remaining criteria: home therapy assessment (3.64%); Prescription as medication (63.64%); preparation and planning of treatment (32.73%) dispensing and administration (14.55%); monitoring (41.82%); specifications in COT (67.27%).

Conclusions: The Tracer methodology allows to identify concerns that require an additional intervention. Endorses the work done by the medical prescribers in clinical aspects, but so far, such precision is not observed in pharmacological aspects, probably because oxygen as a drug remains poorly understood and therefore
inadequately practiced by most of the health professionals, regardless of the information shared by the hospital pharmacists. Despite the unpursued goal in some of the optimal criteria selected for the audit, we perceived an improvement in the compliance of these criteria, we should focus efforts and establish improvement strategies mainly focused on health education, increase of reviews and adherence to treatment, involving the health professionals concerned with clinical management. It is appropriate to establish a multidisciplinary team aiming to address the integrated management of medical oxygen in patients with COPD, bearing in mind the negative impact resulting from the poor control of the disease.

AUDIT – CHRONIC OBSTRUCTIVE PULMONARY DISEASE – INDIVIDUAL TRACER AND SYSTEM TRACER – OXYGEN



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