Category: Federal Forum Posters
Purpose: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) consensus guidelines is the gold standard for best practices in COPD assessment and management. Currently, the study institution does not use standardized tools for assessment and documentation of COPD, such as validated symptom assessment questionnaires like the COPD Assessment Test (CAT). The goal of this pharmacy-collaborative quality improvement project was to develop, select, and implement standardized assessment and documentation tools that integrate the most updated GOLD guideline recommendations for use by providers in a Veterans pulmonary clinic and to assess the use and impact of these tools on clinical practice.
Methods: This quality improvement project involved collaboration between the pharmacy and pulmonary services. It consisted of three phases: Phase I: pre-tool assessment of COPD clinical practices in a Veterans pulmonary clinic, Phase II: development of tools, and Phase III: post-tool assessment of COPD clinical practices in the pulmonary clinic. During Phase I, a retrospective chart review of selected clinic patients was conducted by Pharmacy Service to evaluate current COPD assessment and documentation practices pre-tool implementation. Documentation of specific GOLD-recommended assessment practices was collected, particularly use of CAT, evaluation of exacerbations, spirometry, and tobacco use. During Phase II, assessment and documentation tools were developed and selected based upon results of a chart review, input from clinic providers, and integration of the 2017 GOLD guideline recommendations. These tools consisted of a patient intake questionnaire and an electronic note template. During Phase III, the Pharmacy Service educated the clinic providers on use of the assessment and documentation tools. Following dissemination of the tools, usage of the tools by the clinic providers and patients and documentation of GOLD-recommended assessment practices pre- and post-tool implementation were collected, evaluated, and compared by the Pharmacy Service as part of a seven-week pilot assessment.
Results: A total of 14 pulmonary clinic providers received training. A total of 66 patient intake questionnaires were distributed to COPD patients, in which 51 (77 percent) were returned. Prior to implementation of the clinic patient intake questionnaire and COPD electronic note template (Phase I), a sampling of 14 clinic notes were reviewed. None of the notes (0 percent) included use of CAT score while 10 notes (77 percent) addressed exacerbations, 12 notes (92 percent) contained documentation of spirometry, and 13 (100 percent) notes included assessment on tobacco use. After implementation of Phase III, a sampling of 20 clinic notes were collected and reviewed. Eight (40 percent) notes included a CAT score while 16 (80 percent) notes included assessment of exacerbations, and 20 (100 percent) notes included spirometry results and assessment of tobacco use.
Conclusion: This pharmacist collaborative quality improvement project lead to increased documentation of specific GOLD-recommended clinical assessment measures at a Veterans pulmonary clinic. Further collaborative educational efforts between the pulmonary and pharmacy services will be conducted to enhance usage of documentation tools and assess their impact on clinical practice and COPD management.
Audrey Lee– Professor of Pharmacy Practice, University of the Pacific and VA Medical Center San Francisco, San Francisco, CA