1. Quality Education for a Healthier Scotland Audit Fiona McMillan Principal Lead, Vocational Training and Leadership Development NHS Education for Scotland.

2. Quality Education for a Healthier Scotland Demonstrate an understanding of the audit process Demonstrate and understanding of the various factors required to achieve a ‘satisfactory’ audit Demonstrate an understanding of comments provided as feedback by the reviewers Be able to submit an audit for review as part of the NES national CPD project Be able to teach a member of your team about audit for submission as part of the NES national CPD project

3. Quality Education for a Healthier Scotland NES Pharmacy accepts for review audit from pharmacists and registered pharmacy technicians Audit is part of Clinical Governance Audit is a good way of achieving CPD Audit enables change and improvement in practice through a review of processes

4. Quality Education for a Healthier Scotland ResearchClinical AuditService Evaluation Generates new knowledgeDesigned & conducted to inform delivery of best care Designed & conducted to define or judge current care Addresses clearly defined questions, aims and objectives Measures against standards Measures current service without reference to a standard Evaluate or compare new interventions or studying how interventions and relationships are experienced Involves intervention in use only Usually involves collecting data that are additional to those for routine care but may include data collected routinely Usually involves analysis of existing data but may include administration of simple interview or questionnaire Usually involves analysis of existing data but may include administration of interview or questionnaire Involves patient allocation into intervention groups and randomisation No allocation to intervention Requires ethics approvalDoes not require ethics approval

5. Quality Education for a Healthier Scotland

6. 1 Reason for choice of audit 2 Criterion or criteria chosen 3 Standards set 4 Preparation and planning 5 Data collection (1) 6 Change(s) to be evaluated 7 Data collection (2) 8 Conclusion Criterion based audit

7. Quality Education for a Healthier Scotland Data Collection Assess performance against criteria & standards Identify changes Define Criteria & Standards Criterion based audit – audit cycle Identify an area for audit (local, regional, na-tional influences)

8. Quality Education for a Healthier Scotland Audit – key points Criteria – Specific, Precise, Logical, Measurable, Realistic Example: patients who are prescribed an oral NSAID or COX2 inhibitor for more than 2 months are co-prescribed gastro-protection Standards: 90% within 3 months (agreed by team)

9. Quality Education for a Healthier Scotland Audit - key points Ensuring criteria are precise and specific ensures that data collections are comparable Try to phrase criteria in a positive manner eg – Patient who are on Amlodipine and require a statin should be on Simvastatin at a dose of 20mg or less or another acceptable statin. Rather than: – Patient should not be on Simvastatin at a dose of over 20mg and Amlodipine

10. Quality Education for a Healthier Scotland Audit - key points Presentation of data – Compare data collection with standard and with each other – Use a simple table or bar chart Ensure sustainability of change (re- audit?)

11. Quality Education for a Healthier Scotland Identify an area for audit (local, regional, national influences) Start Risk of GI bleeds in patients on NSAIDs Area... Next Steps Stakeholders: -Identify & obtain consensus on topic and aims of audit as well as roles in audit Example: -Pharmacists -Consultants - GP/Prescribers - Nurses Evidence base: NICE: “If the person is at increased risk of GI adverse effects and requires an NSAID, co-prescribe a proton pump inhibitor” Data Consider, how is the data: - Identified - Collected - Analysed - Disseminated Confidentiality

12. Quality Education for a Healthier Scotland Patients who are prescribed an oral NSAID or COX2 inhibitor for more than 2 months are co-prescribed gastro-protection 90% in 3 months 114/168 (68%) met criteria this fell short of standard describe in detail (3 months later): 167/172 (97%) met criteria – improvement from data collection one and has reached our standard. what learned about process, how managed to achieve success, what about the 5 patients not on protection? How can you demonstrate that changes are sustainable? Can this audit be shared with others?

13. Quality Education for a Healthier Scotland Example Criteria : Patients who are prescribed an oral NSAID or COX2 inhibitor for more than 2 months are co-prescribed gastro- protection Standard : 90% in 3 months Data collection 1 : 114/168 (68%) met criteria this fell short of standard Change implemented : describe in detail Data collection 2 (3 months later): 167/172 (97%) met criteria – improvement from data collection one and has reached our standard. Discussion: what learned about process, how managed to achieve success, what about the 5 patients not on protection? How can you demonstrate that changes are sustainable? Can this audit be shared with others?

14. Quality Education for a Healthier Scotland Audit reporting form (on NES website CPD pages)website The feedback form (used by the reviewers, on NES website CPD pages)

15. Quality Education for a Healthier Scotland Benjamin A; Audit: how to do it in practice. BMJ. 2008 May 31;336(7655):1241-5. Benjamin A The Good GP Training Guide. Edited by Matt Burkes & Alec Logan. Royal College of General Practitioners 2014 Royal Pharmaceutical Society – Clinical Audit & Toolkit (members only content)Audit National Institute for Health and Care Excellence – Audit ToolsAudit Tools Scottish Intercollegiate Guidelines Network – Audit ToolsAudit Tools NHS Health Research Authority – Defining researchDefining research PSNC: Clinical Audit PSNC NES Audit - FAQsFAQs