EVALUATION OF BRONCHIOLITIS MANAGEMENT PRACTICES AGAINST NICE GUIDELINES (NG9): A BASELINE CLINICAL AUDIT
Main Article Content
Keywords
Bronchiolitis, clinical audit, NICE guidelines, quality improvement, unnecessary medications, Pakistan
Abstract
Background
Bronchiolitis is the leading cause of hospitalization in infants under two years. International guidelines, including NICE NG9, recommend supportive care only and explicitly discourage routine bronchodilators, corticosteroids, and antibiotics. Despite this, off-guideline prescribing remains common in low- and middle-income countries. We conducted this audit to evaluate compliance with NICE NG9 in a tertiary care hospital in Pakistan.
METHODS
A retrospective, criterion-based baseline clinical audit was performed at Paediatric B Ward, Saidu Group of Teaching Hospital, Swat. Fifty consecutive patients aged <24 months with a discharge diagnosis of bronchiolitis (January – March 2026) were included. Data were extracted from medical records using a standardized proforma. Five standards from NICE NG9 were assessed: (1) diagnosis documentation, (2) hydration assessment and management, (3) oxygen therapy for SpO₂ <92%, (4) appropriate NG intubation, and (5) avoidance of unnecessary medications (bronchodilators, corticosteroids, antibiotics without bacterial infection). Target compliance was ≥90% for supportive standards and <10% for unnecessary medication use.
Results
Complete compliance was achieved for diagnosis documentation (50/50, 100%), oxygen therapy (12/12, 100%), and NG intubation (3/3, 100%). Hydration assessment and management compliance was 96% (48/50). However, 38/50 (76%) patients received at least one unnecessary medication, far exceeding the <10% target. Bronchodilators were prescribed to 30 (60%), antibiotics without bacterial evidence to 24 (48%), and corticosteroids to 20 (40%). Eighteen patients (36%) received two or more unnecessary drug classes.
ConclusionsSupportive care for bronchiolitis was excellent. However, unnecessary pharmacological treatment is highly prevalent (76%). This represents a major quality gap requiring urgent intervention. We propose a low-cost bundle including a ward protocol, visual aids, monthly prescription review, and antibiotic stewardship, with a re-audit at 3 months to target <20% unnecessary medication use.
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Samreen Khan
Department of Paediatrics, Saidu Group of Teaching Hospital, Swat, Pakistan
Mahnoor Khan
MBBS (Final) Saidu Medical College, Swat, Pakistan
Mohsin Ali
MBBS (Final) Saidu Medical College, Swat, Pakistan
Abdullah
Senior Registrar, Paediatric B Ward Saidu Group of Teaching Hospital, Swat, Pakistan
