The Impact of Interprofessional Monitoring and Education on the Usage of Systemic Glucocorticoids in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Retrospective, Medication Use Review

Abstract

BackgroundSystemic corticosteroid therapy for chronic obstructive pulmonary disease (COPD) exacerbations is routine in clinical practice, however, dosing is variable. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) panel recommends a short course of systemic corticosteroids for acute COPD exacerbation treatment. Despite these recommendations, institutions continue to use higher doses and longer durations of systemic corticosteroid therapies.MethodsThis single-center, retrospective, cohort study evaluated systemic corticosteroid use in inpatient treatment of COPD exacerbations. Data were collected on patients with a diagnosis of COPD exacerbation from October 2017 to February 2018 in both the control and education groups. An interprofessional, learner-centric, quality improvement, educational seminar was performed. Providers were given accompanying pocket reference material for improved adherence to GOLD guidelines for the management of acute COPD exacerbations.ResultsOf the 137 charts reviewed in the control group, 130 of 137 patients (94.9%) received systemic corticosteroid doses exceeding GOLD guideline recommendations. These patients received an average daily dose of 147.5 mg of prednisone equivalents. These patients also experienced more adverse drug reactions as compared to their post-intervention counterparts. The 105 charts examined post-educational intervention revealed 47 of 105 patients (44.8%) received GOLD guideline-directed doses of systemic corticosteroids. This was an improvement from 2.9% (4 of 137) in the control group (p-value < 0.001). The average daily dose decreased to 58 mg daily (p-value < 0.001), and the number of doses over the recommended 40 mg of prednisone equivalents (54 of 105) was a 43.5% reduction (p-value < 0.001). Length of stay also decreased in the education group from 6.1 +/- 4.1 to 4.7 +/- 2.8 days (p-value 0.009). The 30-day readmission rate, however, was not statistically different between the two groups, 31.4% pre- and 21.0% post-educational intervention (p-value 0.098).ConclusionsThe interprofessional education seminar and pocket reference sheet realigned clinical practice with guideline-based therapy in this tertiary care, community hospital. These data validate that learner-centric innovation will benefit patient outcomes and improve the educational potential of the interdisciplinary rounding team.

The relationship between magnesium levels and mortality in the respiratory intensive care unit

“…[ 13 ] It has been shown that COPD is a systemic inflammatory illness that not only affects the respiratory system but also other organ systems, and has a significant effect on health care expenditures. [ 14 , 15 ] This study, which mostly included COPD patients, was designed based on the hypothesis that chronic systemic inflammatory stress is associated with low magnesium levels and affects the prognosis. However, contrary to this hypothesis, it was found that the patient group followed in the ICU was predominantly normomagnesemic, and the effect of magnesium levels of patients with COPD on mortality could not be confirmed.…”