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Clinical Audit Questionnaire

Chronic Obstructive Pulmonary Disease (COPD)

Is the patient being assessed for COPD?

Has the patient with COPD been asked about the presence of the following factors by the respiratory nurse?

Weight loss

Effort intolerance

Waking at night

Ankle swelling

Fatigue

Occupational hazards

Chest pain

Haemoptysis

Was the MRC dyspnoea scale used to grade breathlessness according to the level of exertion required to elicit it?

Have patients with an MRC score of 3, 4 or 5 been offered a referral to pulmonary rehabilitation?

Has pulse oximetry been recorded to assess the need for oxygen?

Is there an up to date smoking history for the patient?

Does it include smoking pack years?

If the patient is planning to stop smoking, have they been referred to smoking cessation services?

Has the patient been given a personalized care plan which includes a self-management plan for exacerbations?

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Additional Comments

Data Collector Name & Signature

Clinical Audit Questionnaire

Created by: SafetyCulture Staff | Industry: General | Downloads: 10

This clinical audit questionnaire for Chronic Obstructive Pulmonary Disease (COPD) patients can be easily customized according to the selected audit topic and relevant best practices criteria. With iAuditor analytics, audit leads can instantly collect and analyze data the moment this clinical audit questionnaire is completed.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

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Clinical Audit Questionnaire

Chronic Obstructive Pulmonary Disease (COPD)

Is the patient being assessed for COPD?

Has the patient with COPD been asked about the presence of the following factors by the respiratory nurse?

Weight loss

Effort intolerance

Waking at night

Ankle swelling

Fatigue

Occupational hazards

Chest pain

Haemoptysis

Was the MRC dyspnoea scale used to grade breathlessness according to the level of exertion required to elicit it?

Have patients with an MRC score of 3, 4 or 5 been offered a referral to pulmonary rehabilitation?

Has pulse oximetry been recorded to assess the need for oxygen?

Is there an up to date smoking history for the patient?

Does it include smoking pack years?

If the patient is planning to stop smoking, have they been referred to smoking cessation services?

Has the patient been given a personalized care plan which includes a self-management plan for exacerbations?

Sign Off

Additional Comments

Data Collector Name & Signature