Clinical Audit

NHS GG&C Community Pharmacy Clinical Governance Audit Facilitator Team

November 2010

Programme

• Objectives• Definitions• Why audit?• Process• Examples• Future direction• Questions

Objectives• Define the term audit • Describe the audit cycle• Explain the difference between audit and

research• Define appropriate criteria & standards for a

criterion audit• Awareness of how completion of the NES

criterion audit can contribute to CPD

Audit definition: National Institute for Clinical Excellence (NICE)

• Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery.

Audit versus Research

• Audit seeks to determine that we are doing what we should be doing

• Research seeks to determine the right thing to do

Why do audit?

• Educational• Improve practice• Improve patient care• Gain NES hours (NES criterion audit )• Demonstrate CPD • Build teamwork• Quality improvement culture

Audit cycle

define criteria/standards

implement change measure practice

compare with criteria/standards

Audit spiraldefine criteria/standard

assess local practice

compare practice with criteria/standard

reaudit

repeat audit

Getting started : choosing a topic

• National priority• Evidence base• Common theme – compliance aids

• High risk – methotrexate

• Change in practice – new development/evidence

• Clinical concern/problems – risk of ADRs, interactions

• Potential for change• High cost

Getting Started…..

• Who to involve ….get everyone on board from the

start

- Ethical Approval ….may be required…….ASK

Definitions

• Structure: - refers to the input of care such as manpower, premises and facilities

• Process: - refers to the provision of care (looking at what is done and how it is done)

• Outcome: - refers to the result of clinical intervention

Definitions - criteria & standards • A Criterion is an item of care or some

aspect of care that can be used to assess quality. It is written as a statement

• A Standard describes the level of care to be achieved for any particular criteria

Preparation and Planning

Describes how the audit was • prepared • Planned• Who helped• Who you discussed it with etc.

Data Collection

• Identify what data needs to be collected

• How and in what form • Who is going to collect it • Only collect essential information

Process

• Assess performance v criteria and standards• Analyse data• Identify and describe changes• Identify best format to present findings• Prepare executive summary• Add to CPD record• Identify target audience to share

Hot tips

• Don’t make ambiguous statements • Keep the task focused on the audit project • Refer to the literature indicating current

practice • Choose criteria & standards in line with

current practice • Ensure criteria and standards are based on

fact • Involve the whole team

Examples of some projects

• Fridge audit• Controlled drug prescription audit• Osteoporotic treatment• Sun safety awareness• Oxygen audit• Balance audits• Aspirin and clopidogrel

Future direction

- Useful links• http://www.clinicalgovernance.scot.nhs.

uk/• http://www.clinicalaudit.mvm.ed.ac.uk/• http://www.nes.scot.nhs.uk/pharmacy/c

pd/audit/default.asp

• Projects• Conferences• Publications

And finally…….any questions?