Children, Teenagers, and Health

Abstract

treatment was completed from the notes by us in order to see how well these factors were recorded.No major differences were found among the hospitals or the specialties.In over a third of patients there was no record of disability in relation to breathlessness or mobility, or change of breathlessness before admission; in two thirds there was no record of a history of the presence or absence of ankle oedema.In only 12% had the usual (best) peak flow been recorded.Social support was not recorded in 48% and housing details not recorded in 59%.The blood count and urea and electrolyte concentrations were usually recorded, but peak flow was not recorded in 33% and blood gas tensions on air were not recorded in 21%.In patients given oxygen, repeat measurements of blood gas tensions were commonly not recorded.Before dis- charge, peak flow/forced expiratory volume in one second, and blood gas tensions were poorly recorded.Only 15% of case notes recorded that antismoking advice had been given to those patients who smoked on admission.In 42% of patients given steroids as part of acute management it was impossible to find plans for tailing off this treatment.The use of antibiotics was almost universal in this series; 7 1% of patients received steroids (orally or intravenously), and bronchodilators were given in wide dosage, most patients receiving high dose nebulised 2 agonist and anticholinergic treatment simultaneously with no attempt to quantify responses.This study shows that the general standard of note keeping is poor.It would be impossible to measure outcomes with the data currently provided from most case notes of these patients.More careful assessment of this group of patients and a more critical approach to their treatment is required.