Stage 1: Get the diagnosis right

Aim:

The aim of this first stage is to get the diagnosis right for the patients currently on the COPD register and to correctly record the diagnostic code.

Rationale:

We know from the COPD audit that the vast majority of patients on COPD registers do not have a record of the gold standard test – that is, a post-bronchodilator FEV1/FVC ratio recorded by Read code 339m. We also know that for those with the correct Read code a quarter do not have a spirometry result that is either consistent with COPD or have a valid test result. In other words, either the FEV1/FVC ratio is a value more than 0.7, or the spirometry result is of poor quality and therefore the diagnosis cannot be made.

What is involved?

Performing spirometry can be done by anyone qualified to the foundation level of ARTP spirometry. This can be any healthcare practitioner including support workers and practice nurses. Someone appropriately qualified to ARTP standards should interpret the results.

  • Perform/ repeat post-bronchodilator Spirometry
  • Record Smoking Status
  • Record MRC and/or CAT
  • Measure and record SpO2 at rest
  • Record number of exacerbations in the past 12 months
  • Record Chest X-Ray at diagnosis

How will I show improvement?

Those with COPD will not have the evidence documented to support the diagnosis. However, there will also be a group of patients that do not meet the diagnostic criteria for COPD. These patients will require further investigations and perhaps a referral to secondary care.

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