This audit may be particularly relevant in community-based and liaison services, as it is likely to be in these settings that people present with symptoms of chronic fatigue syndrome (CFS). It will also be relevant to those working in a specialist chronic fatigue service.
The National Institute for Health and Clinical Excellence (NICE) (2007) states that CFS is a relatively common illness (population prevalence 0.2–0.4%), the symptoms of which can be severe and disabling, placing a substantial burden on those affected and their families and carers. To help reduce this impact there is a need for the rapid assessment, investigation, diagnosis and management of symptoms.
The investigations recommended by NICE and the ME Association in the assessment and investigation of symptoms are (National Institute for Health and Clinical Excellence, 2007; Shepherd & Chaudhuri, 2007):
ᐅ full blood count, urea and electrolytes, liver function test, thyroid function test, erythrocyte sedimentation rate, C-reactive protein test
ᐅ serum creatinine
ᐅ gluten sensitivity
ᐅ creatine kinase
ᐅ tissue transglutaminase
ᐅ blood pressure (patient lying and standing)
ᐅ score on the Epworth sleepiness scale
ᐅ height/weight charts in children
ᐅ serum ferritin level in the young.
ᐅ A specific (4-month) period in which to conduct the audit was identified.
ᐅ The medical notes of all the patients who attended a CFS specialist clinic in this period were examined to identify whether each patient had the following documented:
▹ confirmation of diagnosis
▹ confirmation of routine physical investigations, as recommended by NICE and the ME Association.
The percentage was calculated of all patients who attended the CFS specialist clinic for whom the following standards were met:
ᐅ documentation of confirmation of diagnosis of CFS
ᐅ documentation of physical investigations as specified by NICE and the ME Association.
It is suggested that two people undertake this audit, owing to the amount of data to be collected.
For a service where 16 new patients attend over a 4-month period, it is estimated that it would take 10 hours to collect the data.
ᐅ No patients had all of the physical investigations recommended by either NICE or the ME Association.