Prevailing Practice Versus Clinical Guideline: The In-Patient Assessment And Management Of Childhood Bronchopneumonia In A Malaysian District Hospital
- Author:
Jacynta Jayaram
;
Nai Ming Lai
;
Kin Wai Foong
;
Sit Zaleha Mohammad Salleh
- Publication Type:Journal Article
- Keywords:
Bronchopneumonia, children, clinical audit, hospitals, district
- From:International e-Journal of Science, Medicine and Education
2008;2(2):9-16
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Pneumonia is the most common
diagnosis made in hospitalised children. The Malaysian
Clinical Practice Guidelines on pneumonia and
respiratory tract infections provides a comprehensive
guidance in the local context. We evaluated the
documented assessment and management of children
diagnosed with pneumonia admitted to the children’s
ward, Hospital Batu Pahat against this guideline.
Methods: We performed a retrospective analysis of
hospital case notes for children admitted from January
to May 2004.
Results: Ninety six case notes were analysed. Most
patients (84%) had at least four positive clinical features
leading to the diagnosis of pneumonia. 92% met the
guideline criteria for admission. Sp02 was performed for
58% on admission, and 58% with reading below 95%
received supplemental oxygen. Throughout hospital
stay, each patient had an average of four investigations
(range: 1 – 12). Among 23 patients who had
further investigations, justifications were only recorded
in seven patients (30.4%), and changes in
management resulted in 23%. The most common
antibiotic prescribed was intravenous Penicillin (97 %).
In 17 patients who met the guideline classification for
severe pneumonia, none received the recommended
antibiotic combination. The median time to fever
resolution was 22 hours (range 2 – 268), and median
hospital stay was 3 days (range 1 – 12).
Conclusions: Although the quality of clinical
assessment and antibiotic choices were acceptable,
there was a failure to critically evaluate patients
according to disease severity and initiate corresponding
investigations and managements. Future efforts need to
be directed at promoting further guideline adherence
and the exercise of critical judgment in patient
evaluation.
- Full text:W020150928401264514092.pdf
