This document discusses medical audits and provides information on various types of audits including internal and external audits, managerial/organizational audits, medical/clinical audits, and financial audits. It explains the need for audits to maintain safety, quality, reputation and funding. The document outlines the six stages of clinical audits including preparing, selecting criteria, measuring performance, making improvements, sustaining improvements, and re-auditing. Methods used in audits like direct observation, checklists, documentation reviews, questionnaires and interviews are also mentioned.
Access, Assessment and Continuity of Care (AAC) NABHDr Joban
This ppt is prepared on the basis of the NABH standards (2nd edition).it contains simple presentation of chapter 1 Access, Assessment and Continuity of Care (AAC). It may be useful for the trainers, AHCOs and the Vaidyas who are undergoing NABH accreditation.
A presentation, describes basics of Clinical Governance
What do we have in common
as Medical Doctors/Medical
Practitioners?
1. We are technical experts in our fields
2. We are leaders
3. We are managers
4. We are accountable for the patient care and health services
5. We are change agents
6. We are respected highly in the community
7. We are responsive
8. We are good communicators and negotiators
9. We are kind and empathic
10. We are decent and disciplined
Clinical Governance is a strategic framework for the development of high quality healthcare
"A framework through which organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish" – NHS, UK
“clinical governance is a way of making sure that everyone who passes through health system is well cared for”
or
System that enable staff to work in the best possible way
+
Staff performing to the highest possible standards
Seven pillars of Clinical Governance
Patient and public involvement (PPI)
Risk management
Staffing and staff management
Education and training
Clinical effectiveness & Research
Using clinical information & IT
Clinical audit
Patient and public involvement
Ensuring services meet the need of the patients
Patient and public feedback is used to improve services
Patients and the public are involved in the development of services and the monitoring of treatment outcomes
Risk management
Complying with protocols
Learning from mistakes and near-misses
Reporting adverse events
Assessing the risks – probability of occurrence, impact
Promoting blame free culture
Staffing and staff management
Appropriate recruitment and management of staff
Ensuring that underperformance is identified and addressed
Encouraging staff retention by motivating and developing staff
Providing good working conditions
Education and Training
Providing appropriate support available to enable staff to be competent in doing their jobs and to develop their skills so that they are up to date
Professional development needs to continue through lifelong learning
Clinical effectiveness & Research
Clinical effectiveness implies ensuring that everything we do is designed to provide the best outcomes for patients
Clinical audit
Clinical audit is a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes
Clinical audit is a systematic process of looking at your practice and asking:
What should we be doing?
Are we doing it?
If not, how can we improve?
Medical Records is a foremost important in the healthcare accreditation bodies like JCI,NABH are very adherent about its documentation,retention and confidentiality.
Credentialing refers to the process of collection and verification of the evidences of credentials of a doctor who is to be given the responsibility of
treating patients in the hospital. The process
ensures the authenticity of the details provided
by the healthcare practitioner or doctor.
Access, Assessment and Continuity of Care (AAC) NABHDr Joban
This ppt is prepared on the basis of the NABH standards (2nd edition).it contains simple presentation of chapter 1 Access, Assessment and Continuity of Care (AAC). It may be useful for the trainers, AHCOs and the Vaidyas who are undergoing NABH accreditation.
A presentation, describes basics of Clinical Governance
What do we have in common
as Medical Doctors/Medical
Practitioners?
1. We are technical experts in our fields
2. We are leaders
3. We are managers
4. We are accountable for the patient care and health services
5. We are change agents
6. We are respected highly in the community
7. We are responsive
8. We are good communicators and negotiators
9. We are kind and empathic
10. We are decent and disciplined
Clinical Governance is a strategic framework for the development of high quality healthcare
"A framework through which organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish" – NHS, UK
“clinical governance is a way of making sure that everyone who passes through health system is well cared for”
or
System that enable staff to work in the best possible way
+
Staff performing to the highest possible standards
Seven pillars of Clinical Governance
Patient and public involvement (PPI)
Risk management
Staffing and staff management
Education and training
Clinical effectiveness & Research
Using clinical information & IT
Clinical audit
Patient and public involvement
Ensuring services meet the need of the patients
Patient and public feedback is used to improve services
Patients and the public are involved in the development of services and the monitoring of treatment outcomes
Risk management
Complying with protocols
Learning from mistakes and near-misses
Reporting adverse events
Assessing the risks – probability of occurrence, impact
Promoting blame free culture
Staffing and staff management
Appropriate recruitment and management of staff
Ensuring that underperformance is identified and addressed
Encouraging staff retention by motivating and developing staff
Providing good working conditions
Education and Training
Providing appropriate support available to enable staff to be competent in doing their jobs and to develop their skills so that they are up to date
Professional development needs to continue through lifelong learning
Clinical effectiveness & Research
Clinical effectiveness implies ensuring that everything we do is designed to provide the best outcomes for patients
Clinical audit
Clinical audit is a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes
Clinical audit is a systematic process of looking at your practice and asking:
What should we be doing?
Are we doing it?
If not, how can we improve?
Medical Records is a foremost important in the healthcare accreditation bodies like JCI,NABH are very adherent about its documentation,retention and confidentiality.
Credentialing refers to the process of collection and verification of the evidences of credentials of a doctor who is to be given the responsibility of
treating patients in the hospital. The process
ensures the authenticity of the details provided
by the healthcare practitioner or doctor.
This is an overview on the organization andd function of the medical records department in a hospital. It would be of help to administrators and planners, as well as for teachers.
Root Cause Analysis is the method of problem solving that identifies the root causes of failures or problems. A root cause is the source of a problem and its resulting symptom, that once removed, corrects or prevents an undesirable outcome from recurring.
Delegation in healthcare and nursing. Delegating a task does not mean that you have absolved yourself of the responsibility of that task. You are still the principal person in charge of the task and how well the job is done ultimately rests on you. This is why a delegation model is essential in the workplace.
This presentation will identify the key phases of a delegation model, and use that model in a case study based in the healthcare setting.
Needlestick Injuries: A guide for safe needle handlingMarketLab Inc.
Needlestick injuries are a serious occupational hazard for healthcare workers. Offset your risk by following procedure guidelines and using needle safety devices.
Nursing audit assists in:
1. Evaluating Nursing care given,
2. Achieving deserved and feasible quality of nursing care,
3. Stimulating better nursing records maintenance,
4. Focuses on patient care provided and not on care provider,
5. Contributes to research in nursing.
MEDICAL AUDIT
Evaluation of data, documents, and resources to check performance of systems meets specified standards
PRESCRIPTION MONITORING, ADR, DRUG RELATED PROBLEMS, staff safety, data,defining standards,
collecting data,
identifying areas for improvement,
making necessary changes
back round to defining new standards.
Nursing Audit Dr. Rangappa. S .Ashi SDM Institute of Nursing sciences Shri D...rangappa
Nursing audit one of the control tools, responsible for controlling the activities of the nurses that focuses on providing the best possible nursing care. The actual nursing rendered is compared with the standards. This is mainly refers to clinical nursing audit. The nursing management audit is an evaluation of nursing management as a whole. It is critically examination of the entire nursing management process.
Clinical Audits and Process Improvement in HospitalsLallu Joseph
How to conduct a clinical audit, differences between research and clinical audit, medical audit, History of audit, benefits of audit, standard, criteria, benchmarks, compare performance, examples of clinical audit, audit cycle, types of audit, NABH, JCI, QAPI, PDCA, Hospital accreditation,
All hospitals should be disability friendly, to ensure easy movement of disable patients. The presentation arrives at a solution to the all above disability issues to serve as a guide line.
In the presentation, a summary of initiatives to be taken by hospitals in different areas for patient safety have been described for the knowledge, practices and implementation of patient safety initiative by hospital managers/Administrators.
In the presentation efforts have been made to guide the medical professionals how to deal with a MLC case in a step by step manner and certain issues relating to medical case records.
The presentation describes in brief the patients need, expectations and how to develop the patient care and feedback system to obtain maximum patient satisfaction.
In this presentation it has been tried to give a glimpse of different type of consent, how it should be taken, how the patient to be explained, when consent is must and conditions where consent is not required, so as to guide you in your every day practice.
The objective of this presentation is to make you aware of issues which are generally confronted during medical practice.
SOURCES OF LAWS:
PRIMARY SOURCES
Laws passed by the Parliament or the State Legislative
Ordinances passed by the President and the Governor
Subordinate legislation: Rules and regulations made by the executive through the power delegated to them by the Acts.
SECONDARY SOURCES:
Judgments of the Supreme Court, High Court and Tribunals (The ratio decedendi is a binding precedent)
Judicial legislation
Judgment of Foreign Courts
International Treaty
Emergency is the gateway to the hospital, patients with pain and agony, relative emotionally charged enter the emergency department at any hour of the day or night, expecting immediate treatment and solace.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. WHAT IS AUDIT
A systematic and critical appraisal of the planning,
delivery and evaluation of service/s in terms of
efficiency, effectiveness and quality, within given
resources.
Evaluation of data, documents and resources to
check performance of systems if meets specified
standards.
Audit in the wider sense is simply a tool to find out:
-how you do now;
-what you have done in the past,
-what is wish to be done in the future for
remedy.
3. WHY AUDIT
•Maintain participant and staff safety.
•Maintain data quality .
•Protect reputation of staff, organiser and hospital
•Protect current and future funding
•Improve quality.
•Useful for clinical improvement
•Encourages teamwork
•Improves patient care
•Financial benefits
•Contractually an obligation as per government policy
•Becoming essential for meeting litigations under CPA
•It does not involve experiments or research
4. TYPES OF AUDIT
AUDIT MAY BE INTERNAL OR EXTERNAL
MANAGERIAL/
ORGANISATIONAL
MEDICAL AND
FINANCIAL
CLINICAL
5. DIFFERENT AUDITS
Distinctions have been drawn between different
types of audit in terms of the focus of the
activity and the personnel involved. Thus:
* medical audit involves the review of activities
initiated directly by doctors
* clinical audit covers all aspects of clinical care
including that provided by nursing and
paramedical staff
* organisational audit refers to investigation of
aspects of practice such as appointments
systems, policies, practices, standards which are
regarded as primarily administrative functions.
6. METHODS USED IN AUDIT
Direct observation
Checklists
Documentation/records audit
Questionnaires
Interviews
Clinical Case review
7. WHAT IS MEDICAL AUDIT
"Medical Audit" is a planned review programme which
objectively monitors and evaluates the clinical performance of all
practitioners, records by qualified professional personnel to
identify, examine,or verify the performance using established
criteria.
There by identifies opportunities for improvement, and
suggests mechanism through which action is taken to make and
sustain those improvements.
The systematic critical analysis of the quality of medical care,
including the procedures used for diagnosis and treatment, the
use of resources and the resulting outcome and quality of life for
the patient
Clinical Audit A quality improvement process that seeks to improve patient
care and outcomes through systematic review of care of health care team
against explicit criteria and the implementation of change.
8. TYPES OF CLINICAL AUDIT
CLINICAL AUDIT
CONCURRENT RETROSPECTIVE
AUDIT AUDIT
Care is evaluated at care is evaluated after it
the time it is taking has been completed
place through records.
9. NEED FOR MEDICAL AUDIT
1. For Professional
•Health care providers can identify their lacunae &
deficiencies and make necessary corrections.
2. For society
•To ensure safety of public and protect them from
care that is inappropriate, suboptimal & harmful.
3. For health promotion
•To reduce patient sufferings and avoid the
possibility of denial to the patients of available
services or injury by excessive or inappropriate
service.
10. PURPOSE OF CLINICAL AUDIT
1. To plan future course of action, it is necessary to obtain
baseline information through evaluation of achievements
2. For comparison purpose with a view to improve the
services.
3. It is regulatory in nature ensuring full & effective utilisation
of staff and facilities available.
4. Assess the effectiveness and efficiency of health
programs & services put into practice.
5. Describe and measure present performance
6. Help developing explicit standards
7. Suggests what needs to be changed
8. Help Mobilise resources for change
9. Reviews the past and modify the present process
11. PRE-REQUISITE FOR CLINICAL AUDIT
CLINICAL
AUDIT
MEDICAL AUDIT WELL ORGANIZED
COMMITTEE MEDICAL RECORD
HOSPITAL
STATISTICS
12. 1.MEDICAL AUDIT COMMITTEE
Hospital Administration - Chairman
Officer In charge MRD - Member Secretary
Heads of Surgery, Medicine,
Paed, Gynae, Pathology,
Radiology, Casualty, Anaes, - Members
Nursing Supdt.
-The committee to meet once a month on fixed day.
-Preparation of Agenda and records by Member
Secretary.
-Discussions are kept secret.
-The important findings are communicated to concern
department to take remedial action.
13. 2. MEDICAL RECORD
-All the junior staff (Residents) to be trained and
retrained how to fill up the medical records.
-All the medical records must be complete on all
aspects before sending to record department.
-Records to be properly tied up, coded and indexed
month wise/ disease wise for easy retrieval.
-A complete and correct medical record is the back
bone of medical audit.
3. Hospital operational statistics
(a) Hospital resources : Bed compliment, diagnostic and treatment
facilities, staff available.
(b) Hospital utilisation Rates : Days of care, operations, deliveries, deaths,
OPO attendance, laboratory investigations, bed turn over rate etc.
(c) Admission Data: Information on patients i.e. Hospital morbidity and
mortality statistics, average length of stay, Hosp. infection rate
14. SIX STAGES OF CLINICAL AUDIT
STAGE –I
PREPARING FOR AUDIT
STAGE –II
SELECTING CRITERIA
USING METHODS STAGE –III CREATING
MEASURING PERFORMANCE ENVIRONMENT
STAGE –IV
MAKING IMPROVEMENT
STAGE –V
SUSTAINING IMPROVEMENT
STAGE-VI
RE AUDIT
15. STAGE 1: PREPARING FOR AUDIT
USERS
INFORMATION
PLANNING SELECTING A
AUDIT TOPIC
DEFINING THE PRIORITISE
PURPOSE AUDIT
16. 1. USERS INFORMATION
The concerns of users can be identified from
various sources, including:
-Letters containing comments or complaints
-Critical incident reports
-Individual patients’ stories or feedback from
focus groups
-Direct observation of care
-Direct conversations
-genuine collaborators
-sources of data
17. 2. SELECTING A TOPIC
-starting point
-careful thought and planning
- There seems little point in trying to audit
a rare condition, with a medical
intervention with an insignificant outcome
-Try to select topics directly influencing
quality of care
18. 3. MEASURE FOR PRIORITISE
Is the topic concerned is of high cost, or risk to
staff or users?
Is there evidence of a serious quality problem?
( for example patient complaints or high infection
rates?)
Is there a potential for deviating from or pertinent
to national policy initiatives?
(for example systematic reviews or national clinical
guidelines? )
Is the topic a priority for the organisation?
Is good data is available to compare standards?
19. 4. DEFINING THE PURPOSE
-purpose must be established before appropriate
methods for audit can be considered.
-Once topic selected, purpose defined then suitable
audit method can be chosen.
-The following objectives may be useful in defining
the aims of an audit
•to improve the quality
•to enhance performance
•to increase efficiency
•to change procedure
•to ensure patient satisfaction
•to reduce cost
20. 5. PLANNING AUDIT
Involve ALL the people concern.
Fix time and Plan resources
Access the evidence/data
Methodology to be followed for data collection
Pilot study
Audit Report for Action
Re-audit
All activities should be documented.
21. STAGE 2: SELECTION OF CRITERIA
APPRAISING
DEFINING
THE
CRITERIA
EVIDENCE
SOURCES OF
EVIDENCE
22. 1. DEFINITION OF CRITERIA
-Which area:-
-an individual, a team, or an organisation
-This can include assessment of the process
and/or outcome of care
-The choice depends on the topic and
objectives of the audit.
-They should relate to important aspects of
care and be measurable.
23. 2. SOURCES OF EVIDENCE
Systematic methods should be used
• Good-quality data
• Reviews of the past audit
• Previously used criteria for same
purpose
• Measurement of outcome in the past
• Need to develop new criteria
24. 3. APPRAISING THE EVIDENCE
Evidence needs to be evaluated to
find out if it is valid, reliable and
important.
Meeting Aim /objectives
Study Methodology
Past Results /conclusions
Extent of Applicability to your present
study
Likely Bias/ causes for concern
25. STAGE 3: MEASURING LEVEL OF
PERFORMANCE
HANDLING
DATA
METHODS OF
COLLECTION
PLANNING
DATA
COLLECTION
26. 1. PLANNING DATA COLLECTION
-The data collected are to be precise
-Essential data
-Completed data
- Adequate data
-User group to be studied
-Example:
Immunisation status of pregnant
women
27. 2. METHODS OF DATA COLLECTION
•Do not try and collect too many items, keep it simple and
short, relevant to present study.
•Computer stored data, Case notes/Medical Records,
•Local Surveys through Questionnaires, Interviews
Focus Groups,
•Prospective recording of specific data and compilation
- How will this be done to get required information
-Compare performance against the criteria
-Keep focused on the objective of the audit
3. Handling data:
Ethical implications of decrecy and their responsibilities
under the Data Protection Act (1998) when collecting data
and presenting results to be kept in mind.
28. STAGE 4: MAKING IMPROVEMENTS
MAKING IMPROVEMENTS
CHANGE BY
IDENTIFY
REMOVE
BARRIERS
BARRIER
29. 1. IDENTIFYING BARRIERS TO CHANGE
- Fear
- Lack of understanding
- Low morale
- Poor communication
- Individual Culture
- Doubt of outcome
- Consensus not gained
30. 2. IMPLEMENTING CHANGE
systematic approach:
•identification of local barriers to change
•change culture
•Provide support for teamwork
•use of a variety of specific methods like
delegation and accountability
32. 1. MONITORING AND EVALUATION:
systematic approach to changing professional practice
should include plans to:
•monitor and evaluate the change
•maintain and reinforce the change
2. REINFORCING IMPROVEMENT:
•reinforcing or motivating factors by the management .
•integration of audit as part of regular practice
•strong leadership and high motivation
6. RE-AUDIT:
-Review evidence
-Measure effectiveness
-Decide how often to re-audit
- Ongoing process monitoring
-Adverse incidents
-Significant events audit
33. TYPES OF CLINICAL AUDIT
X -RAY REVIEW
STATISCIAL DISEASE
AUDIT AUDIT
MEDICAL
DEATH OBSTETRIC
AUDIT CASES
AUDIT
RANDOM CASE NURSING INFECTION TISSUE/OPERATION
AUDIT AUDIT CONTROL CASES
34. 1.STATISTICAL AUDIT
It is the first step in Medical Audit.
i) Data on different indicators set by audit committee are
prepared unit wise on monthly basis.
ii) A standard norm is evolved taking into consideration of
available facilities, services, resources by an expert
committee.
iii)The data so obtained is critically examined and
compared against the standard norms.
iv)Deviation from standard norm dictates investigation to
find out possible cause and its remedial measure.
v) The data are generated, compiled and supplied by MRD.
35. INDICATORS USED
NET DEATH RATE INFECTION RATE
< 4% < 2%
AVERAGE LENGTH OF CONSULTATION
STAY 7 TO 10 DAYS INDICATORS RATE
BED OCCUPANCY AUTOPSY RATE
80% < 15%
BED TURN OVER
ANAESTHETIC DEATH
RATE
< 1%
6 TO 10 DAYS
36. 2.AUDIT OF DISEASE CASES
This is the second step in Medical Audit.
-It starts with the case record examination of a particular disease
(Typhoid)
-All case sheets are arranged unit wise and month wise.
-A group of physicians are asked to lay down certain norms with
respect to
a) Investigations to be done
b) Line of treatment
c) Average length of stay
d) Likely complications
-Then the case sheets are examined as per the above norms to
find out difference.
-The unit in which short coming is detected in one of above
criteria are asked to rectify and improve.
- This helps in learning, education and improvement in quality
care.
37. 3.AUDIT OF OPERATED CASES
In this group patients operated for similar surgical
method are identified (Laparoscopic Chole- cystectomy)
-The cases are grouped as unit wise and month wise.
-A group of experts are asked to lay down certain norms in respect
of the following:
i) Methodological Approach
ii) Percentage of pre-operative diagnosis confirms the
surgery
iii) Types of pre- anaesthetic check up
iv) Types of post operative complications
v) Anesthetic Complications
vi) Patient consent, safety check list
vii) Use of Antibiotics
-Then the case sheets are examined in light of above norms.
-Shortcomings are intimated to concern unit for future precaution
and rectification.
38. 4. AUDIT OF OBSTETRIC CASES
The indicators used are same as
operation cases and in addition.
-No. of C.S done with indications.
-No. of forceps/ vacuum application
-No. of Material Complication
-No. of Maternal or Neonatal Death
39. 5. AUDIT OF RANDOM CASES
In this method some case sheets of discharged patients are
randomly selected during a month.
The objective of this type of audit is to study the quality
of record maintenance, diagnostic deficiency, treatment
and outcome.
The various parameters used:-
a) History, Physical Examination, Diagnostic Skills
b) Investigations done, Treatment given, Progress note
c) Nursing Care Chart
d) The initial diagnosis is compared with final diagnosis after
investigation.
e) Treatment given is judged against correctness, adequacy according
to norms.
f) The end result of treatment is compared with patient condition at
discharge.
g) Any deviation found from the norms are intimated for improvement.
40. 6. AUDIT OF DEATH CASES
This is also called death review.
All deaths occurring after 48 hours of admission should be
subjected to Medical Audit.
The death case sheets are examined in terms of qualitative and
quantitative adequacy.
The various parameter used are:
a) The diagnosis, investigation, treatment given in comparison to
normal standard.
b) Delay in examination, investigation or initial treatment.
c) Types of consultations obtained and recorded.
d) Daily Monitoring of Progress.
The various inadequacies found by the committee are
communicated to respective units for taking preventive
measures and improvement in future.
41. 7. NURSING AUDIT
Nursing audit, is a review of the patient record
designed to identify, examine, or verify the performance of
certain specified aspects of nursing care by using
established criteria.
The clinical audit process seeks to identify areas for
service improvement, develop & carry out action plans to
rectify or improve service provision and then to re-audit to
ensure that these changes have an effect
In this case the medical records are examined with
respect to type of nursing care given.
Special care, Input Output, O2 inhalation, Monitoring
record TPR chart, daily nursing note etc.
The audit may be retrospective or introspective
42. EVALUATION OF QUALITY OF CARE
QUALITY OF QUALITY OF ART ADMINISTRATIVE
TECHNICAL CARE OF CARE. SUPPORT
(a) Technical care: can be assessed by adequacy of
diagnostic and therapeutic processes.
(b) Art of care: Manner and behaviour of provider in delivering
care and communication with patient.
•A doctor is expected to know not only how to treat a patient but
also treat dying patient.
(c) Administrative support : Planning, organising & directing
all resources for patients care to maximise productivity towards
better patient care based on evaluation report.
43. ROLE OF HOSPITAL ADMINISTRATION IN AUDIT
(a) To facilitate and provide good working
environment.
(b) To provide physical facilities, resources and
smooth supply.
(c) To motivate to enable the medical care
providers to work enthusiastically.
(d) To attend patient complain, grievances by
grievance redressal committee.
(e) To edit& monitor media coverage/press notes.
(f) Patient satisfaction surveys to reveal the grey
areas.
(h) To conduct exit interview & make changes as
suggested.
(i) To frame clear cut objectives & policies.
44. ADVANTAGE OF CLINICAL AUDIT
An educational activity
Promotes understanding
Resource effective
Raises standards
Promotes change
Source of information
Peer led and peer understanding
Involves patients
45. PROBLEMS IN MEDICAL AUDIT
Lack of organized medical record
department.
Incomplete record, poor quality maintenance.
Fear of action and lack of motivation of
medical staff.
Ignorance of value of medical audit by
hospital staff.
Suppression of facts, wrong reporting,
Completion of records after death restrict the
true value of medical audit.
46. CONTENTS OF AN AUDIT REPORT
Background
Literature review
Criteria and standards
Methods or protocol used
Results
Recommendations for change
Recommendations for further audit
47. hospiad
Hospital Administration Made Easy
http//hospiad.blogspot.com
An effort solely to help students and aspirants
in their attempt to become a successful
Hospital Administrator.
DR. N. C. DAS