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Project steps
Step 1
Invite all patients without evidence of diagnostic testing on the COPD register (gathered in part one).
Step 2
Provide all patients with a test (post-bronchodilator spirometry) for COPD diagnosis to confirm or disprove diagnosis.
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Step 1 - Invite patients for a diagnostic review
Ensure you have completed the first QI project in this series 'Fixing the COPD register'. From this project, you should have a list of patients who need a review of their COPD diagnosis:
- Those who have no record of spirometry
- Those who have a record of spirometry which is not post-bronchodilator
- Those who have a record of poor quality spirometry
In the resources section of this project, you will find some examples of template letters to use to invite a patient in for a review of their diagnosis.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row el_class="qitaskouterrow"][vc_column][vc_row_inner el_class="qigrey"][vc_column_inner][vc_column_text]
Step 2 - Perform a post-bronchodilator spirometry measurement
Ensure your patient has taken their inhaler at least 20-minutes before testing and perform spirometry.
Remember,
post-bronchodilator spirometry, or spirometry performed after administration of a reliever inhaler, is the test needed to
confirm a diagnosis of COPD.
Once you have achieved good quality spirometry results, record this results in the patient's notes with the correct code for post-bronchodilator spirometry:
- Read Code: 339m
- Or SNOMED code: 407603001
AND record the FEV1/FVC ratio. This should be a decimal number, not a percentage.
- For example, 0.65
- NOT 65%
- To convert a percentage to a ratio, divide by 100.
At this stage, you will have confirmed or refuted the patient's diagnosis. Click through the dropdown menu below for more details.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_tta_accordion active_section="0" collapsible_all="true"][vc_tta_section title="Scenario 1: Diagnosis is confirmed" tab_id="1614005719562-799eea7b-bf9e"][vc_column_text]For those patients who now have evidence of a post-bronchodilator spirometry with a FEV1/FVC ratio
less than 0.7, confirm the diagnosis and continue managing their COPD.[/vc_column_text][/vc_tta_section][vc_tta_section title="Scenario 2: Diagnosis is refuted" tab_id="1614007801075-37b13c21-2c13"][vc_column_text]For those patients who have evidence of a post-bronchodilator spirometry with a FEV1/FVC ratio
greater than 0.7, remove them from the COPD register and consider a differential diagnosis.[/vc_column_text][/vc_tta_section][/vc_tta_accordion][/vc_column][/vc_row][vc_row el_class="qitaskouterrow"][vc_column][vc_row_inner el_class="qiaqua"][vc_column_inner][vc_column_text]
Recording your progress
For every patient who you review, whether you find evidence to confirm or refute their diagnosis, be sure to record this in the 'Progress' section of the QI platform.
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