How the Clinical Effectiveness Team can help you to audit your Prescribing Practice Jude Scott Clinical Governance & Risk Management Unit Clinical Effectiveness Team St Martin’s House 181 Union Street Aberdeen AB11 6BB Tel (01224)

Resources Available - CE Team Database of Previous & Unsupported Audits Questionnaire Design/Samples Data Capture Sheet Design/Samples Data Analysis Packages Off-the-shelf audits Data Analysis Presenting Audit Results Access to Medical Records

Advice Available - CE Team Choosing an Audit Topic Project Design & Planning Audit Methodology Literature Searching Data Collection METHODS Data Analysis Implementing Change Reporting

Resources Available - Intranet Audit Booklets (1-9) Audit Basics Basic Data Analysis Planning a Clinical Audit Workbook Report Templates Register Audits Document Information Silo Audit Presentation Sessions Record Keeping Audits

Clinical Effectiveness Priorities Priority 1 - External “must do” projects e.g. NHS HIS, Scottish Intercollegiate Guideline Network (SIGN), HEAT Targets. Priority 2 - Internal “must do” projects e.g. Topics linked to organisational objectives, clinical risk issues, issues identified through incident recording on DATIX. Priority 3 - Sector priority Service evaluation following redesign, baseline audits to aid design of new services and local clinical interest audits agreed by Sector Management as a priority. Priority 4 – Clinician interest Audits undertaken during FY1 and FY2 Programme and audits linked to the Clinical Effectiveness training programme.

The Healthcare Quality Strategy for NHS Scotland The Scottish Government May 2010

 Caring and compassionate staff and services  Clear communication and explanation about conditions and treatment  Effective collaboration between clinicians, patients and others  A clean and safe care environment  Continuity of care  Clinical excellence The Quality Strategy is built around the priorities of:

“The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit and wasteful or harmful variations will be eradicated” Effectiveness

Effective Appropriate treatments and interventions Provided at the right time To everyone who will benefit Eradication of wasteful or harmful variations

Stages of an Audit Project Choosing a topic Setting aims and objectives Defining criteria and setting standards Data collection Data analysis Reporting Implementing change

Who to Involve? Colleagues Experts Facilitator Patients/customers Managers

Audit Aims and Objectives Aim Overall purpose of your audit Objectives State specifically what you wish to achieve Fulfil the aim Specific, measurable and achievable No more than 4 or 5

Clinical Audit Cycle Create Data Collection Form Pilot Adjust Data Collection Form (if required) Collect Data (methodology & sample size) Data Analysis Reporting Disseminate Report Implement Change (if required) Re-audit

The Clinical Audit Cycle Choose audit topic Plan the audit: Standards Methodology Sample size Pilot Data collection Evaluate results Implement change Re-audit The Clinical Audit Cycle

Audit Data (1 st April 2010 / 31 st March 2011) 220 Completed Projects 126 “Notes Requests” 77 Unsupported Projects

Examples of Pharmacy related Keywords Anticoagulation Antimicrobials Beta Blockers Dispensing Drug Monitoring Drug Use Formulary Fridge Insulin Medication Methodone Paracetamol Pharmacy Prescribing Proton Pump Inhibitor Vaccine Vancomycin Warfarin

Audit Examples Glaucoma Clinic Audit Antibiotic Point Prevalence Medication Interruptions and use of Drug Round Tabards Grampian-wide Audit of Methodone Prescribing

How to get our assistance Telephone – Submit a proposal form –Available on the Intranet / Clinical Effectiveness / Support Request

An Audit of the Management of Glaucoma

Introduction A disorder in which pressure in the eye ball increases, damaging the optic nerve thus causing a loss of vision Most patients with glaucoma respond well to treatment Regular and sustained use of eye drops and medication prevents further loss of vision

Aim To improve the management of patients with glaucoma

Objectives To identify all patients with glaucoma To determine last date of hospital review appointment To ensure that practice prescribing record agrees with the last hospital letter To ensure that directions for use are stipulated on the prescription

Criteria Audit criteria are statements which specify what is to be measured about the quality of care.

Criteria Criteria must be relevant to the subject - few and simple are best Must be justified as important to the condition or topic Common error - Vague or no criteria

Criteria Patients with glaucoma will be recorded on the practice glaucoma register Patients with glaucoma will have been seen by the hospital opthalmology department in the last 12 months Prescriptions for patients with glaucoma agree with the last hospital letter Prescriptions for eye drops and medication to treat glaucoma stipulate directions for use

Standards Audit standards state the proportion of times criteria should be fulfilled.

Standards Realistic and achievable Evidence based or consensus Numerical target (percentage) Minimal or gold standard

Standards 100% patients with glaucoma will be recorded on the practice glaucoma register 90% patients with glaucoma will have been seen by the hospital opthalmology department in the last 12 months 100% prescriptions for patients with glaucoma agree with the last hospital letter 100% prescriptions for eye drops and medication to treat glaucoma stipulate directions for use