Documentation & accuracy of smoking status – An educational need?

Introduction: A comprehensive admission assessment includes an accurate smoking history (SH). There are ∼3 million people in the UK with Chronic Obstructive Pulmonary Disease (COPD), of which ∼2/3rd remain undiagnosed [1]. Without an accurate SH prompting spirometry & appropriate referral (smoking cessation advice (SCA) services) this statistic will not improve & delays early preventative treatment. NICE (UK) encourages all healthcare professionals (HCP) to refer to SCA services [2]. Our study conducted at a large UK university hospital evaluates the pattern & accuracy of documentation, with a view to targeted HCP education. Method: Cross-sectional case note audit during admission to a respiratory ward in January 2011 (current and ex-smokers). We compared the documentation of pack year (PY) SH at hospital admission to SH taken by a respiratory physician. The initial documentation of PYs was deemed accurate if within ±5 PYs of that determined by the physician. Results: N=81 (43% male). Mean age 72 (SD 14) yrs. Smoking status (SS) was documented on admission in 89% (45% smokers, 55% ex-smokers). Accuracy of calculation of PYs -40%. Documentation was by junior (79%), middle grade doctors (21%). Conclusion: Recognising undiagnosed COPD earlier is vital, & an accurate SH helps to enable this. Although nearly 90% of patients had some documentation of their SS, less than half were accurate when calculating PYs. A regular targeted education programme surrounding the issues of SH documentation & its importance in COPD diagnosis is being arranged for all HCPs. References: 1 Healthcare Commission. Clearing the air: Healthcare Commission, 2006. 2 Brief interventions and referral for smoking cessation in primary care and other settings, NICE, March 2006.