1. CLINICAL AUDIT A quick guide

2. Why Audit? ‘Clinical audit is about improvement. If you are not changing or improving things as a result of audit then ask yourself why am I doing this?’

3. Audit Cycle

4. Choose your topic What makes a good topic? Agreed problem Important Good evidence Measurable Amenable to change Achievable within your resources (IT, space, financial and human)

5. What is an important topic? · High level of concern · High impact on health of patients or resources · Common procedures or conditions Examples????

6. Define your Aims and Objectives Aims Why are you doing this project? What are you hoping to achieve? Objectives How specifically will you achieve your aims? What will you improve and assess?

7. Set your Standards If you are looking critically at clinical care you need to identify evidence of good practice as a basis for setting standards. Where do you get your standards from? o National guidelines, standards & local priorities - Example ??? o Other teams o Establish baseline standards

8. CRITERIA State your Criteria – elements of care or activity, which can be measured Set your desired level of performance or target (usually a percentage) Example Standard: Patients with a diagnosis of diabetes mellitus should be reviewed every 6months (British Hypertension Society guideline 2004) Criteria: All should have a BP check Target: 30% to have a BP of <140/<80 mmHg Clinical audits usually involve looking at information already collected

9. Sources of data · Clinical records · Survey/questionnaire · Interview.

10. Analyse your data Make sure you leave time to analysis your data Do you need statistical help? Use spreadsheets if you can Present your data in a clear, understandable and visually appealing way

11. Is change indicated? What changes need to be made? To help you implement changes, develop an action plan Do you need to look at something in more detail? Is it clear what changes need to be made? (If not, you may need to look in more detail at a specific part of treatment e.g. use run charts to track variation) How are you going to implement changes? Who needs to be involved? What new resources do you need?

12. Make the changes. Set new targets Tell people what you’ve done o Your colleagues and manager o Audit newsletter o Poster display at local events o Present or display findings at national events · Reaudit your practice with the changes, check standards

13. PRESENTING YOUR AUDIT 1. TITLE PAGE/ SLIDE Name of the organisation and name of division/specialty Project title Project lead/s (and name of the person who wrote the report, if different) Date of report/ presentation

14. BACKGROUND This section explains the rationale for doing the audit, i.e. why it is a priority for quality improvement. The evidence base for the audit topic should be summarised, with full references provided at the end of the report. If you convened a team to undertake the audit, this is a good point to explain how this was organised and who was involved.

15. AIM, OBJECTIVES & STANDARDS This section sets out the aim, objectives and standards of your clinical audit project. Aim - Defines what you hope to achieve i.e. the overall purpose of the project. Objectives - Defines the individual steps that need to be taken in order to achieve your aim. Standards - The quantifiable statements detailing the specific aspects of patient care and/or management that you measure current practice against.

16. METHODOLOGY This section should outline: The population for your audit project. For example: “Patients aged over 50 years of age admitted to the BRI for a suspected MI”. Whether it is a retrospective or prospective audit. For example: “A prospective audit assessing the first 30 patients aged over 50 who were admitted to the BRI for a suspected MI from 01/03/10”. “A retrospective audit looking at all patients aged over 50 who were admitted to the BRI for a suspected MI during February 2010”.

17. RESULTS The results for each standard should be presented in this section to establish which standards are being met and which are not. If you find a standard is not being met you need to identify why and how practice can ben improved to ensure that the standard is met in the future.

18. Audit Cycle

19. Let’s look at some audits and criticise (or praise)!!