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 SafetyCulture analytics, audit leads can instantly collect and analyze data the moment this clinical audit questionnaire is completed.
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Title Page
Department/Division
Healthcare Facility
Data Collector
Conducted on
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
SafetyCulture Staff
Clinical Audit Questionnaire
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 SafetyCulture analytics, audit leads can instantly collect and analyze data the moment this clinical audit questionnaire is completed.
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.
The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction.
You should independently determine whether the template is suitable for your circumstances.
