Introduction of Clinical Audit

1. IntroductionIntroduction
toto
Clinical AuditClinical Audit
Bachchu Kaini;
(Cert in Clinical Audit, MBA, PGDHM, LLB, Bcom)

2. 'about finding out if we'about finding out if we areare
doing what wedoing what we shouldshould bebe
doing'doing'
Every One’s Business ….......Every One’s Business ….......

3. What is Clinical Audit?What is Clinical Audit?
“Clinical audit is a quality
improvement process that seeks to
improve patient care & outcomes
through a systematic review of care
against explicit criteria and the
implementation of change”.
(NICE, 2002)

4. More SimplyMore Simply
Actual Practice Best Practice
Clinical Audit
Measures & Bridges
the Gap
Mind the Gap!

5. Patient&
publicinvolvement
Education&Training
RiskManagement
UseofInformation
Clinical
Effectiveness
ClinicalAudit
Staff&Staff
Management
Clinical Governance
Clinical Governance and Clinical AuditClinical Governance and Clinical Audit

6. Why Clinical Audit &Why Clinical Audit &
Effectiveness Important?Effectiveness Important?
 Patient Reason
› Better healthcare, less complaints &
complications, more satisfaction
 Professional Reason
› Lifelong learning, enhance
accountability, reflective activity
 Political Reason
› Annual health check, meeting
national standards & guidance

7. Clinical Research & Clinical AuditClinical Research & Clinical Audit
Characteristic Clinical Research Clinical Audit
Purpose To prove To improve
Character Scientific Inquiry Systematic
Measurement
Function Suggests Standards Compares Practice
with Standards
Sample Size Sufficient for Statistical
Significance
Sufficient for
Commitment to Act
Bases for
Measurement
Testing Hypothesis Standard of good
Practice
Methods New Treatment No New Treatment
Outcome Increased Knowledge Improved Practice &
Quality of Care

8. Clinical Research & Clinical AuditClinical Research & Clinical Audit
Research
Guidelines
Protocol
Clinical Audit
What is the best way?
This is the best way.
Does your clinical practice
match the best way?

9. Clinical Audit & Clinical ResearchClinical Audit & Clinical Research
 Podiatrists in a clinic surveyed
healing rates in their patients with
planter warts to compare results of
different treatments.
Clinical Audit Clinical Researchor

10. Clinical Audit & Clinical ResearchClinical Audit & Clinical Research
 General surgeon adopted a
recommendation from pharmacists
that an expensive antibiotic should
have restricted clinical use. This led
to a 90% reduction in use.
Clinical Audit Clinical Researchor

11. Significant Event AuditSignificant Event Audit
 SEA is a form of audit
 Focus on particular incidents
considered significant, to learn and
improve. e.g.
› Drug errors
› High infection rate in a certain case
› Patient complaints

12. Significant Event AuditSignificant Event Audit
 Inter-professional team activity
 Regular meeting to discuss events
(both positive and negative aspects)
 Focus on system improvement rather
than individuals
 Development of a ‘no blame’ culture

13. SurveySurvey
 Describes a group – how many, when,
where, who? (Audit describes and
investigates the problems)
 Aims to give you a big picture (Audit
measures compliance of standards)
 Could be an audit if practices are
measured against standards.

14. Types of AuditTypes of Audit
 Structural Audit (staff, equipment,
resources)
 Process Audit (treatment, procedures,
service delivery)
 Outcome Audit (result of intervention,
treatment, mobility, quality of life)

15. Stages of Clinical AuditStages of Clinical Audit
Stage One
Preparing for Audit
Using the
Methods
Creating
Environment
Stage Two
Selecting Criteria
Stage Three
Measuring Performance
Stage Four
Making Improvements
Stage One
Preparing for Audit
Using the
Methods
Creating
Environment
Stage Two
Selecting Criteria
Stage Three
Measuring Performance
Stage Four
Making Improvements
Stage Five
Sustaining Improvements

16. The Clinical Audit CycleThe Clinical Audit Cycle
Identify
Topic
Change
Mgmt
Report &
Action Plan
Setting
Standard
Planning
Project
Piloting
Project
Collecting
Data
Analysing
Data
Project
Team
Setting Aim

17. Step 1: Identify TopicStep 1: Identify Topic
 Local concern
 Patient’s concern
 Wide variation
 Trust priorities
 Areas of high volume, risk or cost
 Risk, complaints and litigation
 Mandatory audits
 Annual programme

18. Step 2: Project Team FormulationStep 2: Project Team Formulation
Consider for……………..
 Audit Lead/Supervisor
 Audit Owner
 Singular or multi-disciplinary
team
 Team members

19. Step 3: Setting Aims and ObjectivesStep 3: Setting Aims and Objectives
 Aim
Exactly what you want to achieve in performing this audit
 Objectives
Specific
Measurable
Achievable
Relevant
Timely
 Useful verbs
› To improve, enhance, increase, change, ensure etc.

20. Step 4: Setting StandardsStep 4: Setting Standards
Criteria, Targets and Standards:
 Criteria a basis for comparison or a reference point
against which other things are assessed
 Standards are known levels of best practice
 Targets are the pre-stated or implicit levels of success that
you wish to achieve
While setting standards use:
 National Guidance e.g. NICE
 Local Guidance
 Guidance prepared by professional bodies
 Literature review
 Evidence based practice
 NSFs

21. Standards for Clinical AuditStandards for Clinical Audit
NSF
Diabetes
Standard
Standard Target Exceptions Data
Collection
3 Empowering people with diabetes to enhance day to day
management of their diabetes. (This is a ‘general’ statement, so,
what are the standards that will allow us to measure this?)
e.g. Patient attends
Diabetes Group Ed
sessions for Type 2
(for new patients)
100% Pts with Type 1
Diabetes and
existing type 2
patients
Patient asked
via the data
collection
proforma /
questionnaire
e.g. Personal care plans
to help empower
people with diabetes
100% None Copy of
personal care
plan in notes

22. Step 5: Planning the ProjectStep 5: Planning the Project
‘No one sets out to fail, they just fail to
plan’
 Stakeholder involvement
 Proposal
 Sample
› Census Vs sample
› Sample frame
› Sampling method
› Size
› Time
 Methodology
 Data source
 Time frame

23. Step 5: Planning the ProjectStep 5: Planning the Project
Ask Questions……………..
 What are we going to audit?
 Why are we going to audit?
 Who are we going to audit?
 Who is going to be involved?
 When are we going to audit?
 How are we going to audit?

24. Step 5: Planning the ProjectStep 5: Planning the Project
Questionnaire Design
 Visual impact, layout
 Explanations
 Covering letter
 Question phrasing
 Open Vs Close
 Cost implication
 Approval

25. Step 6: Piloting the ProjectStep 6: Piloting the Project
Consider for…..
 Testing audit tool
 Sampling
 Consistency
 Validity & reliability of the tool
 Re-design the audit tool or
project if necessary

26. Step 7: Data CollectionStep 7: Data Collection
Activity Logs
Written documentation of
clinic attendance, episodes
of diagnosis tests,
examinations
Good for what and how
many questions
Document/ Data
review
Review of written
documents such as Patient
notes, PAS records,
Indicators
Good for what and how
many questions
Focus groups Moderated discussions on a
particular topic or issue
Good for what, how, and
why questions
Interviews Data collection through oral
conversations
Good for what and why
questions
Observation
Watching people engaged in
activities and recording
what occurs
Good for how, what, and
how many questions
Questionnaires Written responses to clearly
defined questions
Good for what and how
many questions

27. Step 7: Data CollectionStep 7: Data Collection
DO NOTDO NOT record anything and everything !
DO NOT collect data unless you actually
need it !
› KKeep IIt SSimple &SSpecific
› Standardization (follow instruction,
collect data in the same way for all)
› Respect confidentiality
› Optional participation

28. Step 8 : Data AnalysisStep 8 : Data Analysis
Analysis
Formic software for scanning the response
Excel spread sheet
• Quicker
• More accurate
• Evidence for queries
SPSS/Statistical tools
Evaluation
 Link findings with objectives
 Compare actual practice with the best practice
 Identify problems & analyse inconsistencies
 Look potential for change

29. Step 9: Report and Action PlanStep 9: Report and Action Plan
 Report & Presentation
 Anonymity
 Clarity
 Simplicity
 Action Plan
 Presentation forum
 Confidentiality
 No blames
 Contents of Audit Report
 Background/Introduction
 Aim/Objective
 Standards, criteria
 Methods
 Results
 Recommendations
 Action plan
 Recommendation for
further audit
 Appendix

30. Step 9: Report and Action PlanStep 9: Report and Action Plan
 Propose solutions for improvements
 Propose change in policies &
procedures if necessary
 Convert solutions into action plan
› Issue
› Action plan
› Responsible person
› Time scale
› Review plan

31. Step 10: Change ManagementStep 10: Change Management
 Stakeholder involvement
 Commitment
 Impact assessment if necessary
 Dealing with emotional aspect
 ‘Change resistant’ culture
 Sustain the improvement

32. Step 10: Change ManagementStep 10: Change Management
Re-audit
• Make sure the change makes things
better
• Change is improvement – not always the
case
• Don’t do it too soon
• Let change ‘bed down’ in the organization
• Not always done – poor practice

33.  Share the success
 Share the learning
 Publicise results
 Give where credit is due
Celebrate the Success!!Celebrate the Success!!

34.  An educational activity
 Raises standards
 Promotes understanding
 Resource effective
 Promotes change
 Sources of information
 Peer led
 Involves patients
An Effective Clinical AuditAn Effective Clinical Audit