1. Module 3. Session 3 3.2 Clinical Audit Prepared by J Moorman

3. What is clinical audit Clinical audit involves systematically looking at the procedures for diagnosis, care and treatment, examining how resources are used and investigating the effect care has on the outcome and quality of life for the patients In short – clinical audit provides a method for systematically reflecting on and reviewing practice.

4. Not just about collecting data Measure current patient care But there is an expectation that practice will improve Clinical audit also monitors the success of efforts to improve quality

5. Three elements Measure – measure a specific element of clinical practice Comparison – compare to a gold standard Evaluation – reflect and change practice

6. Why is clinical audit important Improves that quality of care being offered to users Identifies and promotes good practice Provides the evidence that you need to show that your service is effective Provides opportunities for training and education Helps to ensure better use of resources

7. Who should be involved in clinical audit Service providers – clinical and non clinical Service users People who will be required to implement change

8. Difficulties and barriers to audit Time Honesty Potential for difficult or uncomfortable experience Group dynamics Motivation Concerns about confidentiality

10. Steps in clinical audit process – audit cycle

11. Choosing a topic Input – the availability and organisation of resources and personnel Process – the activities undertaken with these resources Outcome – the effect of the activities on the health and well being of the individual

12. Choosing a topic Often selected for you National priorities Confidential enquiries Complaints Research Other audits Adverse events Local priorities – how cost / high volume

13. What is a good topic Agreed problem – management need to agree it is a problem. Specific – can’t be “antenatal care” for example – what bit of ANC High cost High volume Important High level of concern High impact on patients Common procedure Good potential for improving the quality of care (not always possible) There needs to be evidence for clinical effectiveness Measurable – have to be able to measure what you are doing Amenable to change

14. Has admission policy been followed Have guidelines been followed? Has patient history and examination been properly recorded. Have appropriate investigations been done Have treatment guidelines been followed What was the outcome

15. Setting aims and objectives and standards for audit

16. An example of aim and objectives TopicBreast cancer screening WhyImportant, common, amenable to change, ProblemWomen not referred as per clinical guidelines AimsReduce morbidity and mortality from breast cancer ObjectivesEnsure women are referred appropriately

17. Setting aims and objectives and standards for audit

18. Writing standards Specific – clear, unambiguous and jargon free. Measureable – is the information required to measure you standard available? Agreed – by all concerned Relevant – the area of care being audited Theoretically sound – based on evidence about best practice

19. Collect data on current practice Study population Sample – how many What data do you need to collect How will you collect the data Telephone calls Document reviews Observation Questionnaire Who will collect the data

20. Example – breast cancer Study population – all women over 50 Sample – women attending clinic in a certain month What data do you need to collect Evidence that discussed Number women having mammogram Time since last mammogram How will you collect the data – telephone interviews / document review Who will collect the data - nurses

21. The most important part of an audit is making change

22. Process of change Initiation Implementation Continuation

23. Initiation Do people recognise the need for change? Present audit results Think about reward / penalties – consequences Who has power – and money?

24. Implementation Break down activities into tasks Communication important May need to consider piloting change

25. Continuation Communication really important Feedback on what has worked

26. Why change fails Lack resources Lack motivation Inadequate management of process Lack of communication

27. So.... Create multi-disciplinary team – with the right people Ensure management (or people with resources) agree to audit

28. A final word on health service evaluation (audit) and research.

29. South African National Health Act (61 of 2003) Any research that contributes to knowledge of Biological, clinical, psychological or social processes in human beings Improved methods for the delivery of health services Human pathology The cause of disease The effects of the environment on the human body The development, or new application of pharmaceuticals, medicines and related substances and The development of new applications of health technology

30. Health services research Health services research is the scientific investigation of the use, costs, delivery and effects of health care treatments or services for individuals and populations. It is not about collecting information for information’s sake or transforming facts from one place to another. Health services research involves systematically seeking knowledge which will lead to improvements in the delivery of health care.