Background: Several studies attest the effectiveness of physician order set, also known as Power Plan (PP) in standardizing patient care and improving outcomes. In general, PP use is suboptimal. We hypothesized that PP use in patients admitted with Chronic Obstructive Pulmonary Disease (COPD) assists in standardization and appropriateness of inpatient management.
Methods: We conducted a retrospective chart review of 60 patient encounters admitted with primary diagnosis of COPD exacerbation to a university hospital over a 2-month period. With the help of data warehouse personnel, we selected consecutive 30 patients from each group: (a) encounters with PP use (called PP+); (b) encounters without PP use (called PP-). 9 patients were excluded due to incorrect diagnosis or incomplete information. Various management metrics were compared between the two groups (n=26 and 25 respectively)
Table shows that the proportion of patients receiving 1) arterial blood gas (ABG) within 12 hours of arrival, 2) standard steroid dose and 3) appropriate antibiotic therapy were superior in PP+ group compared to PP- group. Importantly, though Bundle management (all three criteria) use was overall low but twice as high in PP+ group compared to PP- group.
Table 1: Comparison of treatment metrics
(n = 26)
(n = 25)
|ABG within 12 hours of arrival||17 (66%)||11 (40%)|
|Steroid use||25 (96%)||24 (96%)|
|Standard steroid dose ∏||17 (65%)||12 (48%)|
|Antibiotic use||22 (85%)||22 (88%)|
|Appropriate antibiotic choice †||23 (88%)||18 (72%)|
|Nebulized B-agonist||23 (88%)||21 (84%)|
|Bundle management *||7 (27%)||3 (12%)|
∏ As per GOLD guidelines/REDUCE trial: Prednisone 40 mg daily
† One of the following per GOLD guidelines: doxycycline, aminopenicillin, azithromycin or levofloxacin
* As described above in Results section
COPD power plan use resulted in greater adherence to several management metrics in accordance with guidelines and institutional recommendations, along with superior standardization.