An audit of inpatient management of community-acquired pneumonia in Oman: A comparison with regional clinical guidelines

SummaryObjectiveCommunity-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Herein, we present the findings from an audit of CAP management at a tertiary hospital in Oman. The main objective was to evaluate the quality of care given to patients and compare it with the standards in the Gulf Cooperation Council (GCC) CAP guidelines.MethodsA retrospective case study of all patients admitted with CAP from June 2006 to September 2008 examined the adherence to standards for the diagnosis, investigation, and management of CAP, including the documentation of illness severity.ResultsThe case notes of 342 patients were reviewed. Of these, 170 patients were excluded from the study, and 172 patients met the diagnostic criteria for inclusion. A CURB-65 severity score was documented for only 4 (2.3%) patients, and a smoking history was documented for 56 (32.6%) patients. Although 17 different antibiotic regimens were used, 115 (67%) patients received co-amoxiclav and clarithromycin, which is the standard of care. Additionally, 139 (81%) patients received their first dose of antibiotics within four hours of hospital admission. There was no documentation of offering influenza or pneumococcal vaccine to high risk patients.ConclusionThe clinical coding of CAP diagnosis was poor. There was very poor adherence to the CAP severity assessment and the provision of preventive measures upon hospital discharge. The development and implementation of a local hospital-based integrated care pathway may lead to more successful implementation of the guidelines.

► We have audited the management of community acquired pneumonia (CAP) in a tertiary care hospital in Oman. ► We evaluated the quality of care, compared with standards in the Gulf Cooperation Council (GCC) CAP guidelines. ► 172 patients were included; there was very poor adherence to CAP severity assessment and provision of preventive measures on discharge from hospital. Clinical coding for CAP diagnosis was poor. ► 17 different antibiotic regimens were used; but 115 (67%) patients received co-amoxiclav and clarithromycin, the standard of care. ► The development and implementation of a local hospital-based integrated care pathway may lead to more successful implementation of the guidelines.