Knowledge Bank

Abstract. Background: Chronic Obstructive Pulmonary Disease (COPD) is a treatable disease and exacerbations from COPD are preventable, but can require hospitalizations, that cause poor outcomes for these patients. The continued increasing costs and burdens of COPD on the current health care system are rising significantly; even though there are proven Evidence Based Practices (EBP) Global Initiatives for Chronic Obstructive Lung Disease (GOLD) guidelines that have been shown to consistently improve COPD patient outcomes and prevent exacerbations. Purpose: The purpose of this DNP quality improvement project was to evaluate the use of the adoption of Global Obstructive Lung Disease Initiative (GOLD) recommendations in an outpatient pulmonary practice (Gold Guidelines (2016 Global Initiative for Chronic Obstructive Lung Disease, 2015). Project Methods: An EBP-QI approach was used. A three year retrospective review of 120 COPD patients’ electronic health records (EHRs) provided the source of the quality process data. Results: The records accessed reported an age range of 40 to 89 with mean of 64.83 years. COPD severity included Stage II, n=70 (58.3%), Stage III, n=40 (33.3%), and Stage IV, n=10 (8.3%). The accessed records were closely divided by gender with 61 females (50.8%) and 59 males (49.2%). More than 90% of the sample was Caucasian with African-Americans making up 6.7% of the records. Smoking status was documented for all records with 61.9% of the patients as former smokers and 38.1% current smokers. All patients had smoking cessation options offered to them. GOLD recommendations for recommended pharmacological therapy were assessed, and revealed that short acting bronchodilators (SABA) were provided to 100% of patients, while long-acting anticholinergic bronchodilators (LAMA) were provided to 93.3% of patients. For OUT-PATIENT PRACTICE USE OF GOLD GUIDELINES 5 those who didn’t received this therapy, rationale was provided in the record. The use of an inhaled corticosteroid/long acting beta agonist (ICS/LABA) or separate prescriptions of just the ICS or the LABA was provided to 92.5% of patients. Pneumococcal vaccines were noted in only 55.1% of patients while influenza vaccines were administered to 63.9% of patients. It is possible that vaccinations were not given to the remainder due to previous administration and up to date status. Pulmonary rehabilitation was found to only be prescribed in 36.7% of the records. The outpatient pulmonary practice providers were able to meet overall GOLD treatment recommendations discussed within this project 80% of the time. Of the 120 patient records abstracted, 24 (20%) received all of the treatment recommendations. Conclusions and Implications: While smoking cessation and medication prescription were closely aligned with the recommendations, determination of vaccine use was limited by lack of information regarding patients’ vaccination status being current or outdated. The guideline recommendation with the lowest compliance was the referral to pulmonary rehabilitation (PR). This may be related to younger or less severely ill patients, or the structural limitations of PR such as geographical distance to program, cost (related to high co-pays), or access to programs during off-peak hours