1. Effective audits

2. Aim  To develop an understanding of the audit process and how to facilitate effectiveness when undertaking audit.

3. Definition  Auditing is defined as a systematic and independent examination of data, statements, records, operations and performances (financial or otherwise) of an enterprise for a stated purpose.

4. What is clinical audit?  Clinical audit is a way to find out if healthcare is being provided in line with standards and lets care providers and patients know where their service is doing well, and where there could be improvements. Clinical audit  The aim is to allow quality improvement to take place where it will be most helpful and will improve outcomes for patients.  Clinical audits can look at care nationwide (national clinical audits) and local clinical audits can also be performed locally in trusts, hospitals or GP practices anywhere healthcare is providednational clinical auditslocal clinical audits

5. What is effective audit? 1  Difficult to define  Audit effectiveness means different things to different people  “Effectiveness’’ can be regarded as a composite of competence, procedural arrangements, quality control and quality assurance.  Can answer it in the negative.  That is: What is not an effective audit?  If you know what is not an effective audit you can see what is.

6. What is effective audit? 2  Consider Results:  Does the audit result in effective, practical solutions which are supported by management and based on complete and accurate information and improve the organisation’s risk management, control and governance processes?  Look at the processes:  Has the audit been carried out in a way which makes cost- effective use of the organisation’s resources

7. Audit process

8. In terms of processes, effective audits must meet the following criteria :  Make efficient and effective use of the organisation’s physical, financial and human resources  Gather and make best use of available information  Balance operational constraints with the requirement to deliver rigorous and valid findings  Be delivered on time and within agreed budget  Provide relevant information and advice to management, where appropriate, outside the terms of the assignment  Enhance the perceived value of the audit function within the organisation

10. Preparing for audit  Background/rational e.g.  Existence of a potential quality problem in the topic area  The area has been subject to recent clinical incidents  Aims/Objectives:  What will the audit tell us?  Identify main objectives from outset  Standards which are set relate to local and national standards.  Multiprofessional involvement.  Project Lead identified  Time frame

11. Preparing for audit 2  Data Source  Audit Type  Methodology – including data collection methods  That analysis of the collected data takes place and is compared to set standards.  Changes are Specific, measureable, achievable, realistic and time bound.  Changes DO take place.  Change benefits patients/clients/carers.  That re-audit happens to enable comparisons with previous results.

12. Critical success factors for clinical audit  Clinical leadership  Vision, strategy, objectives & planning  Audit staff & support  Structures & systems  Training & education  Understanding & involvement  Organisational environment

13. Common pitfalls  Topics chosen are not relevant, for example, no benefit to patients or audit for audit sake!  Topics no-one wants to do because the topic has been imposed on them rather than having an involvement in that area.  Standards are non existent, too high or too low.  Poor methodology  Poor data collection  Sample sizes which are too large or too small.  Analysis is not thought through.  No change takes place.

14. Audits within maternity services?  NICE:  RQIA:  Pricewaterhouse-Cooper  Risk Management Strategies  GAIN – funding for undertaking of regional clinical audit three times per year.  The Baby Friendly Initiative –Audit tool for Maternity Services  The NMC will implement and evaluate the actions arising from the recommendations of the internal audit of the NMC LSA review process, including the introduction of the quarterly quality monitoring in 2011.  LSA annual audits - LSAs undertake annual audits of the statutory supervision of midwives within their maternity services.  SoMs are continually involved in undertaking regular audit programmes; for example, record keeping and the development of action plans, which improve the delivery and quality of midwifery care.

15. Recent audits within SHSCT  Controlled Drug audit – record keeping  Maternity Hand Held Records  IOL  MSLC - women's views of maternity service provision  Customised Growth Chart  Maternity Admission Room Activity  Baby Friendly –CAH-Stage 3, DHH-Stage 2  C/Section audit  Catheterisation  Monthly audits of deliveries – D/S, MLU, Home confinements  OEWS  FBC

16. Audit findings within SHSCT  Admission and assessment room-  findings suggest many inappropriate referrals (Self/GP/Midwife)  OEWS –  Majority of staff have been training in OEWS.  Why not completed: Sick leave, maternity leave etc.  E-Learn now available to facilitate staff  IOL –  Documentation- Controlled drug audit

17. Controlled Drug audit – record keeping

18. In conclusion Reviewing Performance Organisation Policy Measuring performance Planning and implementing Audit

19. References  Department of Health, Social Services and Public Safety (2006) Audit of Acute Maternity Services. United Kingdom: PricewaterhouseCoopers  NHS (2012) CNST Maternity Clinical Risk Management Standards- Clinical Audit Report Template. NHS