An audit of acute asthma admissions to a respiratory unit

A criterion based audit was performed on 90 admissions with acute asthma to a specialist respiratory unit using the guidelines set by the British Thoracic Society. Three main areas were audited including: documentation of severity markers in the case notes on admission, acute treatment given on admission, and further investigations performed. Case notes were found to be deficient in documentation of objective severity markers such as peak expiratory flow rate (52% recorded) and blood gases (72% recorded), as well as subjective markers such as speech (27%), air entry (58%) and exhaustion (4%). Of the total 90 admissions, 78% were identified as having at least three out of five objective markers for acute severe asthma. Most of these severe cases (93%) were given corticosteroids but none were prescribed greater than 35% concentration of inspired oxygen. The majority of admissions had a chest radiograph (87%), and 56% had measurement of serum potassium. These results show that even in a specialised respiratory unit, guidelines such as those produced by the British Thoracic Society are not in general being adhered to. It also indicates that assessment of severity is inadequate, particularly for peak flow measurement, and that management is deficient in established treatments such as the use of high flow oxygen. As a result of the audit, a severity marker stamp for the case notes along with guidelines for treatment have been implemented in order to improve the quality of care delivered to patients admitted with acute asthma.