Audit of rescue pack antibiotic use in COPD patients: Improving stewardship and patient care

A recent audit at Worcestershire Royal Hospital reviewed whether rescue pack antibiotics were being prescribed and monitored in line with national and local guidance.

Why rescue pack antibiotics matter in COPD management

COPD exacerbations are a major cause of hospital admissions and morbidity. Rescue packs, typically containing antibiotics (with or without steroids), can support early treatment of flare-ups and reduce the need for hospitalisation.

However, overuse or inappropriate use of antibiotics can contribute to antimicrobial resistance and reduced treatment effectiveness. National guidance (NICE NG114) recommends reviewing antibiotic use if symptoms do not improve after repeated courses, but does not specify how often sputum cultures should be repeated. This leaves a gap in ensuring that antibiotics remain appropriate over time.

Aim of the audit

The audit evaluated the prescribing of rescue pack antibiotics for inpatients with COPD admitted to the Acute Respiratory Unit (ARU) at Worcestershire Royal Hospital. It focused on three key areas: how frequently patients used their rescue pack antibiotics, whether sputum samples were taken before prescribing antibiotics—with the standard being 100%—and whether sputum culture organisms were sensitive to the antibiotics provided, again with a target standard of 100%.

How the audit was conducted

Over a three-month period, data were collected from 30 patients with COPD who had been prescribed rescue packs. Patients were identified through the ward pharmacist. Information was gathered on allergy status and rescue pack use at three, six, and twelve months by reviewing patient histories, GP records, and community pharmacy dispensing data. In addition, sputum culture results were analysed using the hospital’s electronic system (ICE). This approach provided insight into both prescribing patterns and the microbiological appropriateness of the antibiotics used.

Key results of the audit

The audit highlighted several important findings. Ninety per cent of patients (27 out of 30) had a sputum culture at some point, but only half of them (15 out of 30) had a culture performed within the last year. Of those with recent cultures, 20% (3 out of 15) had organisms resistant to the antibiotics they had been prescribed.

Rescue pack usage also varied. In the past three months, 19 patients had used their packs between one and five times. In the past six months, 20 patients reported using them between one and five times. Looking at the past year, 15 patients had used their packs between one and five times, while 10 patients had used them six to ten times; the highest use recorded was 12 times in a year.

In addition, 30% of patients (9 out of 30) reported antibiotic allergies. Despite this, most still had sputum cultures that showed sensitivity to the antibiotics they had been prescribed.

What the findings mean for antibiotic stewardship

The audit highlights variability in both rescue pack usage and microbiological review. While many patients had sputum cultures taken, these were not always recent enough to guide prescribing. The finding that 20% of patients had organisms resistant to their prescribed antibiotics raises concerns about ongoing appropriateness and antimicrobial resistance.

Recommendations from the audit

The findings suggest several opportunities for improvement. More frequent sputum sample requests should be encouraged for COPD patients prescribed rescue packs. Stronger review of sputum culture results is needed by both primary care and hospital clinicians to ensure antibiotics remain appropriate. Seasonal patterns of rescue pack use could be analysed to identify trends and target interventions. Finally, education should be enhanced for both patients and clinicians to promote safe and effective antibiotic use in COPD exacerbations.

Conclusion: supporting safer COPD management

Rescue pack antibiotics are an important tool in COPD care, but without regular microbiological review, there is a risk of inappropriate prescribing and reduced effectiveness.

This audit underscores the need for closer collaboration between hospital and primary care teams to review sputum cultures and tailor rescue packs accordingly. By embedding these practices into routine COPD care, hospitals can improve outcomes for patients while supporting antimicrobial stewardship.

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About the authors

Sadiya Hussain and Millie Harris are Clinical Pharmacists at Worcestershire Acute Hospitals NHS Trust