Aims: This audit assesses COPD-X guideline adherence in geriatric inpatients during acute exacerbations, compares adherence rates across medical units and studies the influence of clinician education sessions on prescribing attitudes.
Methods: This study retrospectively audited COPD-X guideline adherence in 100 geriatric inpatients across three hospitals in Victoria (Nov 2022–Feb 2023) and included post-audit education sessions for 30 clinicians, followed by surveys to assess change in prescribing attitudes.
Results: Among 319 patient records reviewed, 100 met eligibility criteria. Patients were mostly elderly (mean age 77.8 years), predominantly male (52.0%), and ex-smokers (69.0%) with significant smoking histories (median 42 pack-years). Triple inhaler therapy was common, and a notable portion required home oxygen (16.0%). Differences across units included significantly higher discharge rates to usual accommodation in the respiratory unit (95.0%) compared to general medicine (73.9%) and geriatric medicine (85.7%). Adherence to COPD-X guidelines varied, with spirometry use notably higher in the respiratory unit (65%) compared to general medicine (30.4%) and geriatric medicine (50%). Overall adherence remained suboptimal across units, with notable deficiencies in areas such as blood gas analysis (39.0%), systemic corticosteroid use (30.0%), non-invasive ventilation (47.1%), and pulmonary rehabilitation referrals (18.0%). Post-education intervention, participant confidence in managing AECOPD increased, highlighting the potential impact of targeted education on guideline adherence and patient outcomes.
Conclusions: The study highlights significant barriers to COPD-X guideline implementation in geriatric inpatients, including resource limitations and knowledge gaps. Addressing these through education, research, and resource allocation is crucial to improve adherence and AECOPD outcomes in this vulnerable population.