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SKILLS - CLINICAL AUDIT

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Abstract

VOL: 99, ISSUE: 13, PAGE NO: 31

WHAT IS IT?

Clinical audit is a clinically led initiative to improve the outcomes of patient care via structured review - clinicians examine their practice and results against agreed standards and modify their practice where indicated (Mann, 1996).

The stages of the clinical audit cycle must be undertaken to ensure an audit is systematic and successful.

1. IDENTIFY A TOPIC

The first step is to select a topic that is important or significant and interests those conducting the audit.

  • Check that others who will be involved in the audit agree with your proposals. Implementing change will be difficult if they disagree.
  • Check that no one else in your work environment is conducting the same audit.

2. SET CRITERIA/STANDARDS

A criterion is an item of care or an aspect of practice that can be used to assess quality.

  • An audit criterion is a statement of what should be happening. For example: ‘The medical records show that patients with diabetes are reviewed every six months.’
  • Ensure that the criterion is measurable.
  • The standard needs to follow on directly from the criterion. For example, 100 per cent of the medical records show that patients with diabetes are reviewed every six months.
  • Audit standards are expressed as percentages and represent the minimum level of acceptable performance for that criterion.
  • Some criteria are so important they need a standard of 100 per cent.
  • However, standards of 100 per cent are unusual - patients or circumstances usually conspire against perfection and the standard needs to reflect that.
  • Your literature search should give you an idea of the standards others have managed to reach.
  • Criteria and standards should be based on the latest available research and evidence. If evidence is not available, it is acceptable to base criteria and standards on a consensus agreement by members of the team.
  • You should not try to audit too many criteria at once - one or two are likely to keep you busy.

3. DATA COLLECTION

After setting the criteria/standards for the audit, collect the audit data.

Data can be collected from questionnaires, computer and paper records, and data collection sheets.

Electronic data is preferable as it is likely to be quicker and more accurate. However, electronic audit tools should be checked thoroughly because problems can still emerge.

4. COMPARE RESULTS WITH CRITERIA AND STANDARDS

After collection, analyse the data.

  • In most instances, the analysis involves calculating percentages to determine whether the standard has been achieved.
  • Audit data should also be analysed to identify particular trends/problems.

5. IMPLEMENTING CHANGE

  • This stage of the audit cycle is one of the most crucial and often one of the most difficult.
  • After analysing the data, the audit team need to decide what changes should be implemented.
  • Whatever changes result from an audit, it is vital that the change process is not left to chance. A detailed action plan should be made stating exactly who, when, what and how changes are to be implemented.
  • All members of the team should be informed of the proposed changes and someone should take a lead role in overseeing that the changes occur.

6. RE-AUDIT

The final phase of the audit cycle is to undertake a re-audit to ensure that any remedial action undertaken in response to the first audit has been effective.

WEBSITES

National Institute for Clinical Excellence

Audit Commission

Clinical Governance Support Team

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