clinical audit by bachchu kailash kaini
TRANSCRIPT
IntroductionIntroductiontoto
Clinical AuditClinical Audit
Bachchu Kaini; (Cert in Clinical Audit, MBA, PGDHM, LLB, Bcom)
'about finding out if we 'about finding out if we areare doing what we doing what we shouldshould be doing' be doing'
Every One’s Business Every One’s Business ….......….......
What is Clinical Audit?What is Clinical Audit?
“Clinical audit is a quality improvement process that seeks to improve patient care & outcomes through a systematic review of care against explicit criteria and the implementation of change”.
(NICE, 2002)
More SimplyMore Simply
Actual Practice Best Practice
Clinical Audit Measures & Bridges
the Gap
Mind the Gap!
Pa t
ien t
&
p ub l
i c in
v ol v
e me n
t
Ed u
c atio
n &
Tr a
i ni n
g
Ris
k M
a na g
emen
t
Us e
of
Inf o
r mat
ion
Cli
ni c
alE
ffec
t iv e
ne s
s
Cli
ni c
al A
ud
i t
Sta
ff &
Sta
f fM
a nag
emen
t
Clinical Governance
Clinical Governance and Clinical Clinical Governance and Clinical AuditAudit
Why Clinical Audit & Why Clinical Audit & Effectiveness Important?Effectiveness Important? Patient Reason
› Better healthcare, less complaints & complications, more satisfaction
Professional Reason› Lifelong learning, enhance
accountability, reflective activity
Political Reason› Annual health check, meeting
national standards & guidance
Clinical Research & Clinical Clinical Research & Clinical AuditAudit
Characteristic
Clinical Research
Clinical Audit
Purpose To prove To improve
Character Scientific Inquiry Systematic Measurement
Function Suggests Standards Compares Practice with Standards
Sample Size Sufficient for Statistical Significance
Sufficient for Commitment to Act
Bases for Measurement
Testing Hypothesis Standard of good Practice
Methods New Treatment No New Treatment
Outcome Increased Knowledge Improved Practice & Quality of Care
Clinical Research & Clinical Clinical Research & Clinical AuditAudit
Research
GuidelinesProtocol
Clinical Audit
What is the best way?
This is the best way.
Does your clinical practice match the best way?
Clinical Audit & Clinical Clinical Audit & Clinical ResearchResearch
Podiatrists in a clinic surveyed healing rates in their patients with planter warts to compare results of different treatments.
Clinical Audit Clinical Researchor
Clinical Audit & Clinical Clinical Audit & Clinical ResearchResearch
General surgeon adopted a recommendation from pharmacists that an expensive antibiotic should have restricted clinical use. This led to a 90% reduction in use.Clinical Audit Clinical Researchor
Significant Event Significant Event AuditAudit
SEA is a form of audit Focus on particular incidents
considered significant, to learn and improve. e.g.› Drug errors› High infection rate in a certain
case› Patient complaints
Significant Event Significant Event AuditAudit
Inter-professional team activity Regular meeting to discuss
events (both positive and negative aspects)
Focus on system improvement rather than individuals
Development of a ‘no blame’ culture
SurveySurvey
Describes a group – how many, when, where, who? (Audit describes and investigates the problems)
Aims to give you a big picture (Audit measures compliance of standards)
Could be an audit if practices are measured against standards.
Types of AuditTypes of Audit
Structural Audit (staff, equipment, resources)
Process Audit (treatment, procedures, service delivery)
Outcome Audit (result of intervention, treatment, mobility, quality of life)
Stages of Clinical AuditStages of Clinical Audit
Stage One
Preparing for Audit
Using the Methods
Creating Environment
Stage Two
Selecting Criteria
Stage Three
Measuring Performance
Stage Four
Making Improvements
Stage One
Preparing for Audit
Using the Methods
Creating Environment
Stage Two
Selecting Criteria
Stage Three
Measuring Performance
Stage Four
Making Improvements
Stage Five
Sustaining Improvements
The Clinical Audit CycleThe Clinical Audit Cycle
Identify Topic
Change Mgmt
Report & Action Plan
SettingStandard
Planning Project
Piloting Project
Collecting Data
AnalysingData
Project Team
Setting Aim
Step 1: Identify TopicStep 1: Identify Topic
Local concern Patient’s concern Wide variation Trust priorities Areas of high volume, risk or
cost Risk, complaints and litigation Mandatory audits Annual programme
Step 2: Project Team Step 2: Project Team FormulationFormulation
Consider for…………….. Audit Lead/Supervisor Audit Owner Singular or multi-
disciplinary team Team members
Step 3: Setting Aims and Step 3: Setting Aims and ObjectivesObjectives
AimExactly what you want to achieve in performing this audit
ObjectivesSpecificMeasurableAchievableRelevantTimely
Useful verbs› To improve, enhance, increase, change, ensure
etc.
Step 4: Setting Step 4: Setting StandardsStandards
Criteria, Targets and Standards: Criteria a basis for comparison or a reference
point against which other things are assessed Standards are known levels of best practice Targets are the pre-stated or implicit levels of
success that you wish to achieve
While setting standards use: National Guidance e.g. NICE Local Guidance Guidance prepared by professional bodies Literature review Evidence based practice NSFs
Standards for Clinical Standards for Clinical AuditAudit
NSF Diabetes Standard
Standard Target Exceptions Data Collection
3 Empowering people with diabetes to enhance day to day management of their diabetes. (This is a ‘general’ statement, so, what are the standards that will allow us to measure this?)
e.g. Patient attends Diabetes Group Ed sessions for Type 2 (for new patients)
100% Pts with Type 1 Diabetes and existing type 2 patients
Patient asked via the data collection proforma / questionnaire
e.g. Personal care plans to help empower people with diabetes
100% None Copy of personal care plan in notes
Step 5: Planning the ProjectStep 5: Planning the Project ‘No one sets out to fail, they just
fail to plan’ Stakeholder involvement Proposal Sample
› Census Vs sample› Sample frame › Sampling method› Size› Time
Methodology Data source Time frame
Step 5: Planning the Step 5: Planning the ProjectProjectAsk Questions…………….. What are we going to audit? Why are we going to audit? Who are we going to audit? Who is going to be involved? When are we going to audit? How are we going to audit?
Step 5: Planning the Step 5: Planning the ProjectProjectQuestionnaire Design Visual impact, layout Explanations Covering letter Question phrasing Open Vs Close Cost implication Approval
Step 6: Piloting the Step 6: Piloting the ProjectProject
Consider for….. Testing audit tool Sampling Consistency Validity & reliability of the
tool Re-design the audit tool or
project if necessary
Step 7: Data CollectionStep 7: Data Collection
Activity Logs Written documentation of clinic attendance, episodes of diagnosis tests, examinations
Good for what and how many questions
Document/ Data review
Review of written documents such as Patient notes, PAS records, Indicators
Good for what and how many questions
Focus groups Moderated discussions on a particular topic or issue
Good for what, how, and why questions
Interviews Data collection through oral conversations
Good for what and why questions
ObservationWatching people engaged in activities and recording what occurs
Good for how, what, and how many questions
Questionnaires Written responses to clearly defined questions
Good for what and how many questions
Step 7: Data CollectionStep 7: Data Collection
DO NOTDO NOT record anything and everything !
DO NOT collect data unless you actually need it !› KKeep IIt SSimple &SSpecific› Standardization (follow
instruction, collect data in the same way for all)
› Respect confidentiality› Optional participation
Step 8 : Data AnalysisStep 8 : Data Analysis
AnalysisFormic software for scanning the
responseExcel spread sheet
• Quicker• More accurate• Evidence for queries
SPSS/Statistical tools
Evaluation Link findings with objectives Compare actual practice with the best
practice Identify problems & analyse
inconsistencies Look potential for change
Step 9: Report and Action Step 9: Report and Action PlanPlan Report &
Presentation Anonymity Clarity Simplicity Action Plan Presentation forum Confidentiality No blames
Contents of Audit Report Background/
Introduction Aim/Objective Standards, criteria Methods Results Recommendations Action plan Recommendation for
further audit Appendix
Step 9: Report and Action Step 9: Report and Action PlanPlan
Propose solutions for improvements
Propose change in policies & procedures if necessary
Convert solutions into action plan
› Issue› Action plan› Responsible person› Time scale› Review plan
Step 10: Change Step 10: Change ManagementManagement
Stakeholder involvement Commitment Impact assessment if
necessary Dealing with emotional
aspect ‘Change resistant’ culture Sustain the improvement
Step 10: Change Step 10: Change ManagementManagement
Re-audit • Make sure the change makes things better• Change is improvement – not always the case• Don’t do it too soon• Let change ‘bed down’ in the organization• Not always done – poor practice
Share the success Share the learning Publicise results Give where credit is due
Celebrate the Success!!Celebrate the Success!!
An educational activity Raises standards Promotes understanding Resource effective Promotes change Sources of information Peer led Involves patients
An Effective Clinical AuditAn Effective Clinical Audit