Abstract
Introduction: Aspiration pneumonia is a common condition, particularly in older patients, with impaired swallowing being a significant risk factor; however, it can be difficult to recognise and no specific management guidance existed nationally until the British Thoracic Society Clinical Statement was published in March 2023. In this audit, we assessed the management of patients admitted with aspiration pneumonia to Leighton Hospital, Crewe.
Methods: We retrospectively collected data from a random sample of patients ≥64 years old admitted to the Acute Medical Unit with aspiration pneumonia between September and November 2022. Data collected included length of stay, co-morbidities, presence of an EDAR (Eating and Drinking At Risk) decision, antibiotics prescribed, completion of SLT (Speech and Language Therapy) review and mortality outcome. Antibiotic prescribing practice was compared against local trust guidelines.
Results: 24 of the 28 patients were prescribed antibiotics; of these, only 12 (50%) followed Trust guidelines. Regarding nutrition, 29% of patients did not have a clear plan for EDAR or an alternative feeding method. 14% of patients were not referred to SLT when it may have been appropriate.
Conclusions: For this patient cohort, adherence to local antimicrobial guidelines was only 50%. Reasons for this divergence may include human factors such as lack of awareness of guidelines, and system factors including rotation of doctors through different trusts. Subsequently, posters have been displayed in clinical areas where patients are clerked and initially managed. Regular re-audits will be performed to evaluate whether guideline adherence has improved and to implement new changes accordingly.