This page summarises the resources developed to help participants in the Multi-Region Audit on the Management of Adults with SLE 2018 to implement local quality improvement (QI) interventions. Key to success is that your lupus specific QI projects are led locally and are bespoke to individual departments, using site-specific data.
You will find resources developed specifically for this Lupus audit and then guidance outlining some principles of QI via the links at the bottom of this page.
The resources are:
• Audit standards
• Other areas amenable to quality improvement
• Background to driver diagrams
• Background to clinic prompt
• Useful links for QI
The audit standards:
• 80% of patients should have a record of disease activity at each clinic visit
• 90% of patients should have appropriate urine protein quantification
• 90% of patients with inactive disease should be on ¬<7.5mg maintenance prednisolone/day
• 95% of patients on hydroxychloroquine should be on <6.5mg/kg/day
• 80% of eligible patients should be on hydroxychloroquine
• 90% patients treated with biologics should be recruited to BILAG BR
• 90% of patients should have documented evidence of screening for cardiovascular risk, defined as measurement of BP and lipids in the last year
Other areas amenable to quality improvement
• Monitoring for eye disease in patients on hydroxychloroquine
• Documentation of discussion of UV protection with patient
• Documentation of smoking status
• Documentation of contraception and pregnancy issues in female patients of reproductive age
• Documentation of IHD
• Documentation of diabetes
• Documentation of TIA
• Documentation of hypertension
Background to driver diagrams
Each audit standard comes with an accompanying example driver diagram. Driver diagrams are developed starting with the primary aim, working through primary and secondary drivers towards potential interventions to achieve the primary aim. This step-by step approach should help identify multiple small interventions.
There is additional general explanation of driver diagrams here.
Each site will experience their own context-specific facilitators and barriers to high quality care. Development of driver diagrams should ideally occur locally and involve several members of the MDT.
Our examples are illustrative rather than exhaustive; we expect there to be additional areas for individual sites and not all of ours will be applicable to every site.
The driver diagrams can be edited and some spaces are left blank. Instructions for completion and further resources are in the ‘instructions’ tab at the bottom of the page within each diagram.
1. Driver diagram - disease activity
2. Driver diagram - urinalysis
3. Driver diagram - steroid dose
4. Driver diagram - HCQ dose
5. Driver diagram - BILAG BR
6. Driver diagram - BP
7. Driver diagram - lipids
8. Driver diagram – blank, for your own use
This clinic prompt has been developed using evidence from the 2018 multi-regional audit of the BSR guideline for the management of adults with SLE. Items have been prioritised for inclusion that are likely to have the strongest impact on patient care via improving compliance with the guideline.It is intended as an aide-memoire to support decision-making and could also be used as a training tool at induction, and for educational interventions.
The prompt could also be used as a tool for local audits of the management of SLE in adults.
Other useful resources
Toolkits / practical resources
• RCGP Quality Improvement Guide
• Institute for Healthcare Improvement Quality Improvement Essentials Toolkit
• RCP Quality Improvement Resources
• Trainees Improving Patient Safety through Quality Improvement
• BMJ Open Quality
• BMJ QI series