MANAGEMENT OF PNEUMONIA IN

W/C/S/H OUTPATIENT DEPARTMENT

13/November/2023
# AUDIT TEAM MEMBER RESPONSIBILITY
1 Dr. Adem Muktar OPD Head
2 Dr. Rediate Ermias OPD Coordinator
3 Rewan OPD Co-Head
4 A/Rahim OPD Nurse head

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 i. Background and aim

a. Background
Pneumonia is the most common infectious disease in the world, it affects the lungs which
results in inflammation and difficulty in breathing. It can b caused by various pathogens
including bacteria, viruses and fungi. Pneumonia is a significant global health issue, causing a
substantial number of deaths and hospitalization, particularly among vulnerable populations
such as young children, older adults and individuals with weakened immune systems. Despite
advancements in health care pneumonia still possesses a considerable burden on healthcare
systems and patient outcomes.

It is the most common disease in the outpatient department of W/C/S/H. There are on average -
-- number of patients seen yearly in the department. Which shows it is has significant burden in
our hospital.

b. Aim
 The aim of this audit is to improve the quality of patient care diagnosed with community
acquired pneumonia and to improve the management and outcome of pneumonia
patients in our hospital. By implementing evidence-based practice, we intend to
enhance the efficiency and effectiveness of pneumonia care, ultimately leading to
better patient care, increased patient satisfaction and reduced health care costs.
ii. Standard
 MOH clinical audit guideline was used as standard in this clinical audit.

iii. Methodology
a. Target population
 Adult patients (age>14 years) diagnosed with community acquired pneumonia
in the medical OPDS in 4th quarter of last years (2015)
b. Sample size – A sample size of 42 charts were selected from population of study
c. Sample selection
 Sample was taken randomly from the chosen population. There was a total of
___patients seen with in the 4th quarter of last year.

d. Retrospective type of study was done.

e. Tools
 Check list was prepared from the clinical audit tool which is prepared from two
Guidelines, which are the South African CAP treatment guideline and American
Thoracic society pneumonia treatment guideline 2019.

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 iv. Result
a. Demographic data

The demographic data shows that most of the patients are between the ages of 16 and 26,
which comprises of 28.6%. The age groups with the least pneumonia illness are between 70 and
80, which is about 12 %. The data shows females are slightly more affected than males, which
are 57% and 43% respectively. Worabe woreda is where the majority of the patients are from
which is 43%, then comes silti (11%), Hulbareg(9.5), Dalocha(9.5),East Azernet (7.5%) and other
woredas such as Butajira, Halaba, Adama comprises (19% ) altogether.

Age Catagories

16-26
27-37
38-48
49-59
60-70
70-80

Table1. Shows the age categories of patients with pneumonia

PERCENT

MALES

PERCENT

FEMALES

0% 10% 20% 30% 40% 50% 60%

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 Table 2 The distribution of sex among the pneumonia patients

Address

Worabe
Silti
Hulbareg
Dalocha
East Azernet
Butajira
Halaba
Adama

b. Clinical data

Clinical data were collected from pneumonia patient charts such as history, physical
examination, Investigations, Diagnosis and treatment. The audit shows pertinent history is
complete for only 29 % of the patients. Risk factors were not accessed for all patients.

The pertinent physical examination that is expected to be done for patients with core symptoms
of pneumonia is Vital signs, chest examination, CVS and CNS. The clinical audit shows physical
examination is about 52% complete. Temperature and oxygen saturation were not done for all
patients at the triage, because there is no pulse oximetry at the triage.

# Investigations Result
1 CBC 100%
2 ESR 40%
3 Chest x-ray 100%
4 OFT 10%
5 RBS 10%

Table 1 Investigations to be done for pneumonia patients.

Appropriate diagnosis of pneumonia is done based on clinical findings and chest x-ray findings,
28.6% of the patients are inappropriately diagnosed. Appropriate antibiotics are documented

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 and given for 60% of the patients were as 40 % of them have incomplete documentation (14%),
the rest are not started with the recommended antibiotics.

Identification of the health provider is documented 100 % but advice on the illness is not given
for all patients.

v. CONCLUSION

The result of the audit shows pneumonia management in our hospital is about 44%

vi. Recommendation
a. List of Problems Identified
i. Chart incompleteness
ii. Laboratory investigations results not attached.
iii. Final diagnosis not documented.
iv. Advice is not documented.
v. System interruption
vi. Lack of pulse oximetry at triage

b. Interventions
i. High patient flow
ii. Physicians should be advised to complete charts, problems should be inquired.
iii. Incomplete charts should not be saved
iv. Investigation results should be documented
v. Network needs a solution

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