Appendix 2: Data Collection Template - Review the need for ICS / LABA inhaler in COPD patients with an FEV1≥50% Number of patients and Practice ………………… reviewed…………Audit carried out between …/…/2014 …/…/2014 Audit lead ……………………… Patient Medication Indication for ICS COPD review FEV1 % value and Inhaler technique Any side effects reported (e.g. Action Plan ID details /LABA inhaler in in the last 12 date recorded. check documented? symptoms of adrenal for individual patient notes? months Yes or No suppression, low bone mineral patient density, glaucoma, diabetes) ICS Dose COPD COPD/ Yes No FEV1 Date Yes No /LABA Asthma % recorded inhaler
Appendix 2: Data Collection Template - Review the need for ICS / LABA inhaler in COPD patients with an FEV1≥50% Practice ………………… Number of patients reviewed…………Audit carried out between …/…/2014 and …/…/2014 Audit lead ……………………… Patient ID Medication details Indication for ICS /LABA inhaler in patient notes? COPD review in the last 12 months FEV1 % value and date recorded. Inhaler technique check documented? Yes or No Any side effects reported (e.g. symptoms of adrenal suppression, low bone mineral density, glaucoma, diabetes) Action Plan for individual patient ICS /LABA inhaler Dose COPD COPD/ Asthma Yes No FEV1 % Date recorded Yes No
3_ReviewOfICS_LABA_InhalersInCOPD_PatientsVer2.docx