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REVIEW

Using clinical audit to reflect and revalidate

  • Comment

A trust encouraged nurses to become involved in clinical audit and to reflect on their experience as part of their revalidation requiremen

Abstract

Although much of it is overlooked in favour of mandatory or formal training, there is a plethora of evidence available from nurses’ daily practice that can be used to meet revalidation requirements. Leicestershire Partnership Trust has been preparing for the introduction of revalidation and supporting its nursing workforce to recognise all opportunities for reflection and learning. This article discusses how participation in clinical audit can support nurses and midwives to meet the Nursing and Midwifery Council revalidation requirements and how organisations can facilitate increased awareness of the value clinical audit has towards maintaining professional registration.

Citation: Rashid C et al (2016) Using clinical audit to reflect and revalidate. Nursing Times; online issue 12, 9-11.

Authors: Claire Rashid is clinical effectiveness lead and Rachel Bradley is revalidation project lead both at Leicestershire Partnership Trust; Stephen Ashmore and Tracy Ruthven are directors at the Clinical Audit Support Centre.

Introduction 

Revalidation is the process that all nurses and midwives in the UK need to follow to maintain their registration with the Nursing and Midwifery Council (NMC).

In place since April this year, the introduction of revalidation has triggered anxiety in some nurses about how they will meet the requirements and more importantly how they will find the time within their clinical practice. Vincent (2015) suggests that anxiety around revalidation stems from lack of information and support; only 37% of Unite members felt that employers would be supportive and allow extra time around busy workloads to complete revalidation. However, Edwards et al (2016) suggest that despite the palpable anxiety around revalidation the process should not be thought of as a burden as it provides a more robust framework for nursing practice.

This article discusses how Leicestershire Partnership Trust (LPT) has supported embedding revalidation into practice by highlighting the role clinical audit plays in achieving quality improvements through maintaining professional requirements.

Clinical audit

Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care and the implementation of change (Patel, 2010). LPT held a one-day event to raise awareness about the role clinical audit can have in meeting revalidation requirements. Most of the nurses attending the event had not conducted a clinical audit, however most had participated in a part of the clinical audit cycle, for example collecting data, sharing results or making changes in patient care following a clinical audit.  See Fig 1 (attached) for the clinical audit cycle.

During the day, nurses shared their experiences of participation in clinical audit. There were presentations from nurses in the form of reflections highlighting their personal learning (see Box 1). Reflection is a way of thinking about our experiences to give them meaning (Finch, 2016). Revalidation seeks to build on this by giving a platform to nurses who participated in clinical audit to realise the value of reflection in identifying opportunities to improve practice. Giving nurses the opportunity to share their experiences of clinical audit allowed them time to pause and acknowledge the positive impact of their work. Furthermore, it gave them opportunity for positive feedback, therefore reinforcing self-worth.

Box 1. Presentations during the audit day 

  • Setting clinical audit standards/defining best practice
  • Developing and piloting an audit tool
  • Collecting audit data
  • Sharing audit outcomes with patients and colleagues
  • Participation in a national clinical audit
  • Implementing an audit action plan

The presentations were followed by a workshop during which nurses were able to reflect on their participation in clinical audit and complete a reflection template adapted from the NMC reflective account for use at the event. While completing reflection, many took the opportunity to engage in reflective thinking with others.  This enabled unstructured discussions during which delegates were able to explore and explain their clinical audit experiences. Anecdotally, nurses valued time being built into the event for reflection because often, after such events, nurses go home with the best intentions of reflecting on learning but it is not prioritised and everyday work takes over.

At the beginning and end of the event, nurses completed a confidence questionnaire asking them how likely they were to undertake a clinical audit.  By the end of the one-day event 83% of nurses said they would undertake a clinical audit in order to meet revalidation requirements. The event was successful in highlighting how clinical audit can be used as evidence for revalidation. The nurses went home with a completed reflective account of their own learning from participation in clinical audit. Attendance at the event amounted to seven hours participatory continuing professional development and certificates were issued for inclusion into nurse portfolios.

There were many positive comments on evaluation/learning from the event:

“Clinical audit is a means of driving up patient care/safety and personally as evidence for ongoing CPD/revalidation.”

“Reflective practice helps me to learn and improve.”

“Greater awareness of audit and its relevance to revalidation (and everything we do).”

“Importance of reflective practice – to consider every learning opportunity and ensure that I maximise each opportunity presented to me.”

“Clinical audit can be a driver for change and impact on quality.”

“It’s not difficult to undertake an audit. It is an excellent opportunity to reflect on our practice and to improve.”

Clinical audit support

To assist nursing staff to complete high quality clinical audit projects, LPT offers a clinical audit course with the support of a private provider, the Clinical Audit Support Centre (CASC). The course is accredited via the Open College Network West Midlands Region. Learners are able to gain certificates in Principles of clinical audit and Conducting a clinical audit.

A wide range of clinical audit projects have been conducted by nursing staff who have undertaken the course, for example:

  • Depression in adults with a chronic health problem (NICE Guideline 91);
  • Audit of NICE CG101 for patients on the domiciliary and community hospital caseload of the LPT COPD specialist nurse team;
  • Audit of five key NICE guidelines relevant to health visiting practice;
  • British Thoracic Society audit of COPD (pulmonary rehabilitation);
  • Clozapine clinic record-keeping audit;
  • Pressure ulcer prevention (SSKIN);
  • Audit of chronic heart failure;
  • Audit of use of new psychoactive substances (NPS) within Her Majesty’s Prison Leicester;
  • Audit of nocturnal enuresis: the management of bedwetting in children and young people;
  • Observational audit of the daily reviews held within the mental health unit.

Clinical audits completed by nursing staff on the course were presented at the LPT event as posters as part of a poster competition. The posters showcase the value and impact of clinical audit in the LPT; the winner was a nurse. We hope more nurses will undertake the course in order to meet their revalidation requirements and to improve patient care. The role of the manager in supporting nurses in carrying out audits is outlined in Box 2.

Box 2. How managers can support nurses in carrying out audits

Managers have an important role to play in motivating staff and encouraging best practice through participation in clinical audits. A good audit topic will have clinical and managerial support to address a known quality issue in an important area of practice. Managers could consider the following to support staff:

  • Are annual appraisals used as a forum for discussing clinical audit? Have learning needs been identified that could be included as an objective?
  • Are staff members’ perceptions of clinical audit explored and barriers such as anxiety identified?
  • Do staff understand why clinical audits are carried out? Are they aware of the potential it has to drive improvement in providing good-quality patient care?
  • Do staff members have the resources they need, such as access to evidence, administrative support and other relevant personnel?
  • Are staff members supported to use participation in audit as evidence towards meeting revalidation requirements?
  • Are audits incorporated into day-to-day activities to make them feel less time-consuming?
  • Do staff receive feedback on audits in a timely manner? This will support staff to use the outcomes as CPD and to reflect on practice.

Conclusion

This article highlights how LPT has tapped into existing resources to support its nursing workforce in meeting revalidation requirements and maintaining their professional registration. Nurses can use clinical audit as CPD and as a vehicle for reflection, and while this will be evidence for revalidation it will also drive service improvements. The feedback from nurses following the event clearly demonstrates that this event has supported a change in the perceptions of clinical audit being a ‘chore’ to it being ‘do-able’. There was an increased awareness of the importance of clinical audit and expressions of interest from nurses who had previously shied away from participating. The introduction of NMC revalidation has helped the LPT to highlight this untapped opportunity.

Useful resources

Key points

  • Clinical audit is a quality improvement process that provides an opportunity to meet revalidation requirements
  • The majority of nurses participate in some aspects of clinical audit
  • Participation in clinical audit provides a topic for reflection
  • Nurses value the opportunity to complete reflective accounts at events
  • Clinical audit can be used as part of the revalidation requirement for CPD hours  
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