PDSA Cycle 3
STUDY: 76 patients with any grade of LVSD post-MI were identified in the baseline New Victoria Infirmary audit and 64 patients were identified in the Southern General Hospital audit. 88% (n=67/76) of New Victoria Infirmary patients and 97% (n=62/64) of Southern General Hospital were prescribed an ACEI (or ARB). The mean percentage of ACEI (or ARB) target dose was 42% for New Victoria Infirmary and 61% for Southern General Hospital, with 18% (n=14/76) of patients achieving the full target dose at New Victoria Infirmary and 38% (n=24/64) at Southern General Hospital. Eighty-eight per cent (n=67/76) of New Victoria Infirmary patients and 89% (n=57/64) of Southern General Hospital were prescribed beta-blockers. The mean percentage of beta-blocker target dose was 28% at New Victoria Infirmary and 41% at Southern General Hospital, with 3% (n=2/76) of New Victoria Infirmary patients and 11% (n=7/64) of Southern General Hospital patients achieving the full target dose. Baseline medication optimisation in the Southern General Hospital was higher than other sites, potentially due to the baseline consultant cardiologist-led post-MI clinic.
A further 260 patients were reviewed at the pharmacist-led clinics during the third year of the project, making the running total 454 patients. The use of ACEI (or ARB) was 97% (n=440/454). The mean percentage of ACEI (or ARB) target dose increased from 77% in PDSA Cycle 2 to 80%, with 68% (n=307/454) patients achieving the full ACEI (or ARB) target dose. The use of beta-blockers was 92% (n=416/454). The mean percentage of beta-blocker target dose was 51%, with 29% (n=130/454) patients achieving the full beta-blocker target dose.
ACT: The service steering group endorsed the plan to continue sequential roll-out to the final hospital site.