Transcript Audit of data collected at Whipps Cross Hospital over a

Number of phototherapy treatments
for Psoriasis and Eczema:
Audit of data collected at Whipps
Cross over a three year period.
Jane Watts Senior Nurse
Melissa Macqueen, Steve Isaac,
Avinash Nanayakkara
Phototherapy can be used as a second
line treatment for Eczema and
psoriasis
In our unit:
• All Patients have MED/MPD prior to
treatment.
• A weekly review session is held, to review
patients with problems or near the end of
treatment. This is with the consultant,
specialist nurses , Registrar and the team.
Data Base
• We have kept a data base of all patients who
have been treated in our phototherapy unit
since 2004.
• In 2005 when we introduced Narrow Band
UVB, an audit of practice showed that
patients with psoriasis needed an average of
23 treatments of NBUVB to clear.
Questions ?
• We wanted to look at numbers of patients we
treat each year with Eczema and Psoriasis.
(full body treatments not hand and foot)
• Also, most importantly to look at the number
of NBUVB treatments on average we used to
treat our patients with Eczema and Psoriasis.
• We focused on NBUVB as it is now the most
common form of phototherapy used to treat
skin disease.
Questions ?
• We also looked at the response to treatment,
as recorded by the nurse. ( observational)
• And The DLQI scores recorded by the patients.
• We wanted to answer the following
questions…….
1)In the 3 years (2011, 2012 and 2013), how many patients were treated for :
i)Psoriasis
ii)Eczema ?
iii)Numbers in each year ?
2) In the 3 years, the average number of NBUVB treatments for:
i)Psoriasis ?
ii)Eczema?
3) Treatment response (observational) for:
i)Psoriasis
ii)Eczema
4) The % DLQI forms were completed?
5) Difference in DLQI index for
i)Psoriasis
ii)Eczema
In the 3 years, how many patients
were treated for PS?
217
In the 3 years, how many patients were
treated for EC?
50
1
Number Of Patients Treated Each Year with
phototherapy
Year
PS
EC
2011 (04/01/11- 03/30/12) 70
24
2012 (04/01/12-03/30/13)
71
13
2013 (04/01/13- 03/30/14) 76
13
Total
50
217
1
% of Patients who had NBUVB for
Psoriasis
Total number
of patients
TLO1
PUVA
% of TLO1
2011
70
61
9
87.14
2012
73
72
1
98.63
2013
76
68
8
89.47
% of Patients who had NBUVB for
Eczema
Total number
of patients
TLO1
PUVA
% of TLO1
2011
24
20
4
83.33
2012
13
12
1
92.31
2013
9
7
2
77.77
Average number of treatments for Psoriasis
(NBUVB only)
Average # of Treatments
2011
27.66
2012
26.27
2013
22.57
Total
25.5
Audit done in 2005 for average number of treatments of NBUVB= 23
2
Average number of treatments for
Eczema (NBUVB) only
Average # of Treatments
2011
26.42
2012
26.86
2013
20.53
Total
24.60
2
Treatment Response for Psoriasis
Patients
79% had a positive response
Response
No. of Patients
0 ( No response)
39
1 ( Moderate improvement)
55
2 ( Large improvement)
91
3
Treatment Response for Eczema
Patients
77% had a positive response
Response
No. of Patients
0 ( No response)
9
1 ( Moderate improvement)
9
2 ( Large improvement)
21
3
% of Completed DLQI
for eczema and psoriasis patients
Year
Total # Of Records
# Incomplete
% Complete
2011
60
23
61.66
2012
70
24
65.71
2013
66
33
50.00
4
Difference in DLQI Psoriasis
Average
Difference in DLQI
Interpretation
2011
-8.69
improvement
2012
-7.91
improvement
2013
-5.20
improvement
4
Difference in DLQI Eczema
Average Difference in
DLQI
Interpretation
2011
-9.69
improvement
2012
-8.00
improvement
2013
-2.33
improvement
4
• Scottish phototherapy managed network, Photonet, the
standard for the median number of treatments for clearance
with NBUVB is <30. We met this standard.
Photobiology unit Dundee:
• Cameron et al 2002, in a study,. found the
number of treatments needed for clearance
/minimal residual activity of psoriasis was 24.
• Our unit has continued to be in line with this.
Conclusions
• Number of treatments: in line with other
studies/ audits
• Approx. 90% having NBUVB for PS
• Approx. 85% having NBUVB for EC
• Improvement observational, almost 80%
positive response but, would be more
accurate with PASI
• DLQI , need to improve numbers, ensure we
get a start and finish DLQI
Actions:
• Presenting the audit to all members of the team
so they can see importance of accurate data
collection.
• Created a new post in phototherapy who will
work in there three days a week , but also have
daily input.
• Mini audit of notes to be carried out regularly to
ensure data is collected, and that patients are
started on the correct dose for their MED/MPD
• Ensure all patients are reviewed at or before 25
treatments.
References
•
Narrowband UV-B (TLO1) Phototherapy vs. Oral 8-Methoxypsolaren Psolaren- UVA for the treatment of Chronic Plaque Psoriasis, Arch Dermatol. 2003;139:325-328
•
Photonet, National Managed Clinic Network for Phototherapy, Audit
Vhttp://www.photonet.scot.nhs.uk/wp-content/uploads/2013/11/Audit-Report06_07.pdft 2006- 2007
•
A randomized, observer-blinded trial of twice vs.three times weekly narrowband
ultraviolet B phototherapy for chronic plaque psoriasis, British journal of
Dermatology, 2002:147:973-978.
•
Colour Atlas and Synopsis of Clinical Dermatology, Common and Serious Diseases,
Third Edition, Thomas B. Fitzpatrick, Richard Allen Johnson