PDSA Cycle 1 (1 September 2013–31 August 2014) | PDSA Cycle 2 (1 September 2014–31 August 2015) | PDSA Cycle 3 (1 September 2015–31 August 2016) | Combined baseline audits | PDSA Cycle 4 (1 September 2016–31 August 2017) | |||||
Initial baseline audit (n=57) | Pharmacist clinics (n=51) | Baseline audit new site (n=58) | Pharmacist clinics* (n=194) | Baseline audit new site (n=76) | Baseline audit new site (n=64) | Pharmacist clinics* (n=454) | Baseline audit all sites (n=255) | Pharmacist clinics* (n=885) | |
Hospitals | 1, 2 | 1, 2 | 3 | 1, 2, 3, 4† | 5 | 6 | 1, 2, 3, 4†, 5, 6 | 1, 2, 3, 5, 6 | 1, 2, 3, 4†, 5, 6, 7‡ |
Semiquantitative LVSD grading range | Moderate–severe | Moderate–severe | Mild–severe | Mild–severe | Mild–severe | Mild–severe | Mild–severe | Mild–severe | Mild–severe |
Age | 67.1 | 60.4 | 67.5 | 62.6 | 61.4 | 62.2 | 62.1 | 64.3 | 62.1 |
Baseline blood pressure, mm Hg (mean)§ | 119/68 | 123/77 | 125/69 | 122/74 | 118/69 | 135/80 | 123/73 | 124/72 | 123/72 |
Baseline pulse, beats per minute (mean)§ | 68 | 68 | 69 | 67 | 66 | 67 | 67 | 67 | 66 |
Number of pharmacist reviews (mean) | N/A | 4.6 | N/A | 4.2 | N/A | N/A | 4.2 | N/A | 4.1 |
ACEI (or ARB) dosing, n (% patients) | |||||||||
0% of target dose | 6 (11) | 3 (6) | 5 (9) | 9 (5) | 9 (12) | 2 (3) | 14 (3) | 22 (9) | 29 (3) |
1%–24% of target dose | 3 (5) | 1 (2) | 9 (16) | 5 (3) | 6 (8) | 3 (5) | 11 (2) | 21 (8) | 35 (4) |
25%–49% of target dose | 23 (40) | 8 (16) | 14 (24) | 25 (13) | 29 (38) | 15 (23) | 41 (9) | 81 (32) | 86 (10) |
50%–74% of target dose | 13 (23) | 9 (18) | 14 (24) | 26 (13) | 18 (24) | 19 (30) | 72 (16) | 64 (25) | 124 (14) |
75%–99% of target dose | 0 (0) | 1 (2) | 2 (3) | 3 (2) | 0 (0) | 1 (2) | 9 (2) | 3 (1) | 26 (3) |
100% of target dose | 12 (21) | 29 (57) | 14 (24) | 126 (65) | 14 (18) | 24 (38) | 307 (68) | 64 (25) | 585 (66) |
Mean percentage of target ACEI/ARB dose | 44% | 72% | 48% | 77% | 42% | 61% | 80% | 48% | 79% |
Beta-blocker dosing, n (% patients) | |||||||||
0% of target dose | 10 (18) | 2 (4) | 5 (9) | 14 (7) | 9 (12) | 7 (11) | 38 (8) | 31 (12) | 72 (8) |
1%–24% of target dose | 9 (16) | 5 (10) | 8 (14) | 17 (9) | 20 (26) | 8 (13) | 46 (10) | 45 (18) | 111 (13) |
25%–49% of target dose | 19 (33) | 12 (24) | 29 (50) | 57 (29) | 30 (39) | 17 (27) | 130(29) | 95 (37) | 262 (30) |
50%–74% of target dose | 14 (25) | 13 (25) | 11 (19) | 43 (22) | 11 (14) | 20 (31) | 83 (18) | 56 (22) | 166 (19) |
75%–99% of target dose | 1 (2) | 4 (8) | 1 (2) | 9 (5) | 4 (5) | 5 (8) | 27 (6) | 11 (4) | 56 (6) |
100% of target dose | 4 (7) | 15 (29) | 4 (7) | 54 (28) | 2 (3) | 7 (11) | 130 (29) | 17 (7) | 218 (25) |
Mean percentage of target beta-blocker dose | 31% | 56% | 33% | 52% | 28% | 41% | 51% | 33% | 48% |
1=Royal Alexandra Hospital, 2=Vale of Leven Hospital, 3=Glasgow Royal Infirmary, 4=West Glasgow Ambulatory Care Centre, 5=New Victoria Hospital, 6=Queen Elizabeth University Hospital, 7=Inverclyde Royal Hospital.
*Running tota.
†Baseline data not available for site four due to original hospital site closing during time period.
‡Baseline data not available for site four due to lack of cardiac rehabilitation database.
§Result taken from first cardiac rehab or first pharmacist review postdischarge.
.ACEI, ACE inhibitor; ARB, angiotensin receptor blocker;LVSD, left ventricular systolic dysfunction; N/A, not applicable; PDSA, Plan–Do–Study–Act.