1. Clinical Audit How to make it work Clinical Audit Department Last revised July 2009

2. An introduction to clinical audit ‘ Clinical Audit is a quality process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team or service level and further monitoring is used to confirm improvement in healthcare delivery’ ‘Principles for Best Practice in Clinical Audit’ the National Institute for Clinical Excellence (2002)

3. Why undertake clinical audit? To ensure the best possible care for patients is provided To ensure clinical practice is evidence-based Audit is an integral part of Clinical Governance Assist with the implementation of national initiatives (NSFs, NICE) To improve working between multi-disciplinary groups

4. Essential Elements of Clinical Audit It should be patient focused It should have a direct impact on patient care Audit assists to improve patients’ experience of NHS It can highlight an area of concern It should be based on evidence based practice Helps to ensure an efficient use of resources

5. What can be audited? Structure – The resources and personnel available, e.g. skill mix of staff, patient access to see GP Process – Amount and type of activities of clinical care, e.g. annual review for diabetes Outcome – Result of an intervention, e.g. pain relief, patient satisfaction

6. Clinical Audit Cycle 1.Select topic 2. Agree standards of best practice 3. Define methodology 4. Pilot and data collection 5. Analysis and Reporting 6. Make recommendations 7. Implement change 8. Re-audit ActionPlanning Audit

7. If you require help at any stage Gordon Lyth Effectiveness and Audit Coordinator (Commissioning) Belmont 01432 344344 ext 3839 Susan Little Clinical Governance Manager (Commissioning) Belmont 01432 344344 ext 3845

8. Stages in completing the audit Step 1 Select a Topic Choose a topic or area of importance or concern Useful questions to ask are: Is it measurable? Is it evidence based? Complete a literature search Is improvement achievable? Does the project have clinical/relevant support? Who is going to undertake the audit?

9. Be SMART! S pecific M easurable A chievable R ealistic T imely

10. Stages in completing the audit Step 1 continued… Define your objectives for the audit Give a clear outline / purpose of what you expect to achieve from the audit, this will assist with step 3. The following verbs may be useful: To improve…..To enhance…… To ensure….. To change…..

11. Stages in completing the audit Step 2 Define your criteria and then set your standard CriteriaDefined & measurable statements about healthcare which describe the quality and can be used to assess it StandardThe proportion of times the criteria can be fulfilled to ensure the quality of care and is measured as a percentage

12. Stages in completing the audit Example Topic – Annual Reviews for people with Diabetes Criteria: Patients will have a blood test taken for their NbA1C and the result is recorded in their medical notes Patients will have their blood pressure recorded Standard – 100%

13. Stages in completing the audit Step 3 Identify how you are going to collect the information or data to measure against your criteria & standard Retrospective – focuses on the evidence of the care or service that has been provided in the past Prospective – focuses on the care being provided in the future Sources of data – patient record, computer system, survey, focus groups, direct observation.

14. Stages in completing the audit Step 4 – the data collection sheet/questionnaire Pilot - the data collection sheet This will ensure the DCS/questionnaire is workable and highlight any areas that may need adapting. It will also help to make sure you are collecting the data you want to collect! Collect your data Collate the results – organise your data

15. Stages in completing the audit Step 5 Analyse the results Compare the results with the initial criteria and standards and examine the reasons for any deviation Write a report

16. Writing a report What to include: 1. Title page 9. Audit Type 2. Contents Page 10. Methodology 3. Executive Summary11. Caveat 4. Background/Rationale12. Findings 5. Aims & Objectives13. Observations 6. Standards/Guidelines/14. Presentation/Discussion Evidence Base15. Recommendations 7. Sample16. Learning Points 8. Data Source17. References Template Available on Intranet

17. Stages in completing the audit Step 6 Make Recommendations Recommendations for practice – how the outcome of the audit will change practice Give feedback of the results to colleagues and ensure an action plan to implement any changes is developed alongside colleagues – ownership.

18. Stages in completing the audit Step 7 Implement Change Share the information with colleagues Share the information with people who can influence change Publish outcomes

19. Implementing Change 1. Involve all concerned in project 2. Ensure consensus to the changes – avoid conflict 3. Identify any resources / training needed 4. Ensure everybody understands why change is necessary – helps build teamwork 5. Effective change takes time – don’t re-audit too soon! 6. Agree an action plan for how to implement change

20. Stages in completing the audit Step 8 Re-Audit – to ensure change in practice has been implemented Close the Loop!

21. Clinical Audit Cycle 1.Select topic 2. Agree standards of best practice 3. Define methodology 4. Pilot and data collection 5. Analysis and Reporting 6. Make recommendations 7. Implement change 8. Re-audit ActionPlanning Audit

22. Confidentiality Patients confidentiality is achieved by ensuring that access to information is appropriately controlled. Ways to achieve this: Ensure compliance with the six Caldicott principles Ensure compliance with the Data Protection Act (1998) For further information please refer to the Handling information leaflet – Information Governance available on the PCT intranet.

23. Annual Audit Plan Create an Annual Audit Plan Being pro-active Involves colleagues Demonstrates good practice

24. Any questions? Please contact the Clinical Audit Department on 01432 344344 x 3839