Allowing you to achieve incremental and measurable changes to make a real difference to patients
The Asthma Diagnostic Review (Project TWO of TWO)
QI projects are built as a TWO-PART component
Part 1 | |
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Setup Here you set up and understand the project, ensuring you have everything in place to start your project |
Part 2 | |
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Project Here you have all the tools and resources to keep track of your progress towards completing the project successfully |
Better setup, better success
Getting started
Data collected from GP practices across Wales suggest that only 76.3% adult patients and 67.4% children and young adult patients on the Asthma registers have evidence of any tests results that can be used to support their diagnosis.
This QI project will ensure that the Asthma register is coded correctly, and every patient who has no evidence of a diagnostic test is invited in for a diagnostic review.
Good data entry directly improves patient care, which will also help you identify gaps or errors in the patient record or diagnosis.
On completion of this QI project, you will also get a certificate for your work. You will also be able to use this QI project as evidence towards CPD and professional revalidation.
This QI project is aimed at primary care teams who have a register of Asthma patients (adult and paediatric).
The aim of this Quality Improvement Project is to record evidence and code appropriately objective variability for 80% or more of people diagnosed with asthma, as demonstrated by at least one of the following:
This is the second of two projects, which involves inviting patients in for a review of the Asthma diagnosis if they don’t have any record of any diagnostic tests.
This project should be completed after the first project, which focuses on reviewing the Asthma register.
Start by working through the set-up phase of this project, setting yourself a goal according to the time you have available to dedicate to this project, ensuring your team are aware of the project and you have been given the authorisation from your practice manager to complete the project.
Progress through the Set-up phase of your QI project before moving down to the Project phase.
Readiness
Make sure you have the knowledge and expertise to undertake this project successfully.
If you are confident you have the skills and knowledge to make an accurate diagnosis of Asthma, mark this section as complete using the button below.
If you want to check your level of understanding, or need a refresher, check out the associated learning and assessments for this QI project, in line with the All Wales approach.
Making a diagnosis of AsthmaNot Started
Making a diagnosis of Asthma0% Complete
Your capacity
Capacity is the most important aspect for the successful completion of any project – ensure you have the capacity, time and ability to complete your project in a suitable timeframe.
Start by outlining how much time you have to commit to this project.
For example: Over the next six weeks, I will commit one 4-hour clinic (Wednesday afternoon) to completing this project.
And use the calculator provided to work out how many patients you can review in this time.
It is estimated that each patient action for this QI project will take 30 minutes, but adapt locally.
When estimating the time for each patient action on this QI project, think about how long it takes to review a patient’s diagnosis and enter the correct code into the patient’s notes.
When will my project start:
When will my project be completed by:
How much time do I have to dedicate to my project each week
Each patient action for the project will take 30 minutes
Recommended time is 30 minutes per patient.
EditPlease complete form to calculate capacity
Communication pack
It’s important that your colleagues know about the project.
You may want to include colleagues in the project, and they may need to know about other demands on your time. Let them know that you are focusing on QI with these useful resources.
Milestone Map
Keep track of your set-up progress and make sure you are on track to getting started with your project with the timeframe you have added in your capacity calculator.
Your Progress
Getting started
Readiness
Your capacity
Alignment
Communication pack
Milestone Map
Start Date
Not Set
End Date
Not Set
Project overview
The aim is to ensure all patients on the COPD register have an accurate diagnosis of COPD using post-bronchodilator spirometry and the correct SNOMED code.
This is the first of two projects, which involves a review of the COPD register; identifying patients who definitely have COPD and have the appropriate evidence for that diagnosis in their notes, patients who may have COPD but need further confirmatory testing, and those who do not have COPD and should be removed from the register.
This project should be completed before the second project, which focuses on getting patients in for a diagnostic review if they do not have the evidence in their notes to support their diagnosis.
Data collected from GP practices across Wales suggest that only 11.5% patients on the COPD registers have evidence of both:
This QI project will ensure that the COPD register is coded correctly, and every patient who does not have all the evidence they need is lined up for a diagnostic review.
Good data entry directly improves patient care, which will also help you identify gaps or errors in the patient record or diagnosis.
On completion of this QI project, you will also get a certificate for your work. You will also be able to use this QI project as evidence towards CPD and professional revalidation.
Instructions
Perform a test to support the patient’s asthma diagnosis or continue investigations and code appropriately.
Step 1 – Invite patients for a diagnostic review
Ensure you have completed the first QI project in this series ‘Fixing the Asthma register’. From this first project, you should have a list of patients who need a review of their Asthma diagnosis:
Step 2 – Perform a test to support the patient’s diagnosis
Start by undertaking a structured clinical assessment to assess the probability of asthma. This should be based on:
The next step is to ask the patient to complete a two week Peak Flow Diary, taking one measurement in the morning and one measurement in the evening, and recording the results. This record can be a paper diary, or you can advise your patient to download the Asthmahub or Asthmahub for parents app, with an in-built peak flow diary.
Once the patient returns the PEF diary, record these results in the patient’s notes with the correct code for a peak flow diary:
Check the Peak Flow Diary for evidence of “dips”; if there are “dips” in the peak flow measurement of more than 20%, the diagnosis of Asthma has been confirmed. Make sure the diagnostic code reflects this:
For those patients who did not experience significant “dips” in their Peak Flow measurement, try an alternative diagnostic test:
Of course, some patients will be stable on their medication and will not show evidence of objective variability for this reason. Click through the scenarios below for more details.
If you there is a high probability of Asthma following a structured clinical review and the patient demonstrates variable airflow obstruction, you have confirmed the diagnosis of Asthma and should continue managing their asthma.
Make sure the diagnostic code reflects this:
If you there is a high probability of Asthma following a structured clinical review but the patient does not demonstrate variable airflow obstruction, continue managing the patient according to the Asthma Management Plan.
Remember, tests influence the probability of asthma but do not prove a diagnosis.
If there is a low probability of asthma and/or an alternative diagnosis is more likely, investigate for the alternative diagnosis, reconsidering asthma if the clinical picture changes or an alternative diagnosis is not confirmed. If reconsidering asthma, undertake or refer for further tests to investigate for a diagnosis of asthma.
Resources
Progress
Add the number of patients that you have addressed according to this project.
You should see your progress bars increase as you get closer to your goal.
Please complete form to calculate capacity
Click on the chevrons for more information on your progress
Project data not set. Please complete your project's capacity settings.
Project data not set. Please complete your project's capacity settings.
Certificate
Your dynamic certificate can be found below. You can generate a certificate at any point during your QI project, and the certificate will be updated when you make further progress.
This QI project can be signed off by yourself.
Please sign off by clicking the button below. This will make your certificate available.
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