The PCT had funded practice nurses to undertake formal competency based training in spirometry measurements. An audit of spirometry provision in practices within the PCT was undertaken to assess equipment, training and quality of spirometry being performed with comparison made between spirometry undertaken by trained staff (ARTP Cert) and that performed by untrained staff. The aim was to assess the effectiveness of the competency based training being funded by the PCT.Methods
36 practice nurses had received training from Respiratory Physiologists based in an acute hospital trust to ARTP Full Certificate in Spirometry standards. 62 Primary Care practices were sent a questionnaire, designed by the author, and asked to supply five recent anonymous spirometry traces.Results
26 practices responded (42%); 5 (19%) did not perform spirometry testing, due to a “lack of staff skills” (4/5) and “young patient population” (1/5). Of those practices performing spirometry, all were using the Care Fusion MicroLab spirometer and the following training had been undertaken; ARTP training course (16/21), drug representative training (3/21), COPD Diploma (1/21) and no response (1/21). 81% of practices performing spirometry had a calibration syringe and performed calibration either at each session or weekly. Training for the practices that did not have a calibration syringe (19%) was by; COPD Diploma (1/4) and drug representative (3/4). 18/21 practices performing spirometry sent five traces for analysis. Only 17% practices performed relaxed VC manoeuvres and of these 66% achieved acceptability criteria. 13/18 performed the recommended minimum of three FVC's (72%) with 11 of these (85%) achieving two results within 5% or 100 ml.1 5/18 did not perform a minimum of three manoeuvres (for three practices only one of the five traces met acceptability criteria, two of whom were ARTP spirometry trained). Two practices submitted five traces where none of the traces achieved the required acceptability criteria (both Drug Representative trained).Conclusion
Training staff to ARTP standards improves the quality of spirometry performed in primary care (when compared to other modes of training), however once training is completed, it is important to audit quality standards to ensure that they are still met.