British Association of Dermatologists National Clinical Audit Programme 2015: Atopic eczema in children (NICE CG57)

BAD-BSPD-NICE national audit on atopic eczema in children Audit contributors BAD and BSPD members, with some contributions from non-members and private providers Leads Drs Ali Al-Sharqi, David de Berker, M. Firouz Mohd Mustapa Audit standards source NICE clinical guidelines for the management of atopic eczema in children (CG57) Completion date March 2015 Number of contributors 128 submissions from 98 identifiable centres (including 6 private providers) Number of patients 1264 n=128

Age distribution and breakdown of disease severity

Breakdown of treatment regimen by disease severity

Disease severity of patients receiving emollients with bandages, systemic and phototherapy

Audit standard: Provision of evidence-based information 34/46 72/169 28/50 89/170 85/134 19/40 28/59 44/70 42/70 24/40 60/120 15/38 99/180 61/78 n=1057 42/46 145/169 41/50 119/170 119/134 38/40 55/59 48/70 63/70 28/40 93/120 37/38 155/180 74/78 Boxplots: the national mean is denoted by the horizontal red line; regional sample medians are denoted by red dots with blue outline; lower or upper quartiles are denoted by ‘whiskers’; outliers are denoted by blue dots; high median values indicate widespread alignment with the standard; small interquartile ranges indicate little variation in practice within the region. Boxplots representing the distributional mean percentage of “Yes” responses (n=700) and “Yes” with “Partial Yes” responses (n=1057) to having provided evidence-based information to each patient and/or carer, per hospital in each region.

Audit standard: Assessment of disease severity 19/46 121/169 28/50 100/170 105/134 16/40 39/59 54/70 46/70 22/40 73/120 27/38 118/180 49/78 n=1165 40/46 163/169 44/50 155/170 126/134 39/40 57/59 67/70 70/70 36/40 106/120 35/38 162/180 65/78 Boxplots representing the distributional mean percentage of “Yes” responses (n=817) and “Yes” with “Partial Yes” responses (n=1165) to having recorded assessment of disease severity for each patient at any visit, per hospital in each region.

Audit standard: Assessment of impact on quality of life 17/46 39/169 15/50 32/170 48/134 4/40 19/59 27/70 31/70 24/40 42/120 8/38 38/180 28/78 n=895 42/46 100/169 41/50 96/170 101/134 37/40 43/59 51/70 65/70 84/120 31/38 111/180 56/78 Boxplots representing the distributional mean percentage of “Yes” responses (n=372) and “Yes” with “Partial Yes” responses (n=895) to having recorded assessment of impact on quality of life for each patient at any visit, per hospital in each region.

Audit standard: Assessment of impact on psychosocial well-being 19/46 31/169 16/50 20/170 41/134 1/40 10/59 23/70 24/70 25/40 38/120 4/38 30/180 22/78 n=788 44/46 84/169 41/50 80/170 88/134 22/40 41/59 48/70 44/70 37/40 79/120 22/38 101/180 57/78 Boxplots representing the distributional mean percentage of “Yes” responses (n=304) and “Yes” with “Partial Yes” responses (n=788) to having recorded assessment of impact on psychosocial well-being for each patient at any visit, per hospital in each region.

Audit standard: Assessment of trigger factors at initial consultation 29/46 123/169 46/50 120/170 91/134 27/40 47/59 53/70 58/70 31/40 93/120 28/38 81/180 57/78 Boxplots representing the distributional mean percentage of “Yes” responses to having recorded assessment of trigger factors for each patient at initial consultation, per hospital in each region.

Audit standard: Management approach according to stepped-care plan 45/46 151/169 50/50 142/170 131/134 34/40 53/59 67/70 69/70 38/40 109/120 38/38 171/180 75/78 Boxplots representing the distributional mean percentage of “Yes” responses to having recorded a management approach according to the stepped-care plan, per hospital in each region.

Audit standard: Prescription of leave-on emollients (250-500 g weekly) 10/46 89/169 50/50 105/170 95/134 21/40 14/59 39/70 30/70 7/40 47/120 18/38 89/180 53/78 Boxplots representing the distributional mean percentage of “Yes” responses to having recorded prescription of leave-on emollients in quantities of 250-500 g per week for each patient, per hospital in each region.

Audit standard: Moderate steroids on face and neck >5 days 44/46 134/169 34/50 105/170 106/134 38/40 55/59 61/70 65/70 32/40 84/120 35/38 158/180 52/78 Boxplots representing the distributional mean percentage of “No” responses to having recorded the use of moderate potency topical corticosteroids on the face and neck for more than 5 days between the last two visits for each patient, per hospital in each region.

Audit standard: Moderate/potent steroids on vulnerable areas >7-14 days 46/46 136/169 38/50 112/170 113/134 40/40 56/59 63/70 66/70 30/40 91/120 29/38 157/180 71/78 Boxplots representing the distributional mean percentage of “No” responses to having recorded the use of moderate or potent topical corticosteroids on vulnerable areas for more than 14 days between the last two visits for each patient, per hospital in each region.

Audit standard: Very potent steroids in the absence of specialist care 46/46 153/169 42/50 157/170 116/134 29/40 55/59 70/70 65/70 38/40 106/120 38/38 166/180 71/78 Boxplots representing the distributional mean percentage of “No” responses to having recorded the use of very potent topical corticosteroids in the absence of specialist care for each patient, per hospital in each region.

Audit standard: Appropriate referral 43/46 162/169 50/50 146/170 129/134 32/40 52/59 67/70 58/70 40/40 109/120 38/38 170/180 72/78 Boxplots representing the distributional mean percentage of “Yes” responses to having recorded an appropriate referral for each patient, per hospital in each region.

Audit standard: Late referral 40/46 148/169 46/50 141/170 120/134 30/40 51/59 63/70 52/70 31/40 94/120 35/38 138/180 71/78 Boxplots representing the distributional mean percentage of “No” responses to having recorded a late referral for each patient, per hospital in each region.

Audit standard: Availability of a range of unperfumed emollients