SLIDE 1 Clinical audit for practising
LOS 09.05.2016
SLIDE 2 What is clinical audit?
It has been described as a technique to “assess, evaluate, and improve the care of patients in a systematic way to enhance their health and quality
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How has audit developed?
Historical background Medical Audit Clinical Audit Clinical Governance
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Types of audit
Donabedian, 1980. Audits of structure; Audits of process; Audits of outcome.
SLIDE 5 The audit cycle
Select a meaningful topic Review the literature, and agree standards and criteria Plan your audit, devise and pilot a data collection tool, and collect data Analyse your data, identify changes, and implement those changes Re-audit, and record your findings in an audit report
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Research, audit, and data collection
What are the similarities and differences? Research Data collection Audit (http://www.ncor.org.uk/practitioners/audit/)
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Select a meaningful topic
Structure Process Outcome
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Review the literature
Criteria Standards Existing audit tools
SLIDE 9 What is a criterion?
Criteria are elements of care that can be defined and measured by
- clinicians. They provide clear
examples of what aspects of practice are important.
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What is a standard?
“A criterion with its expected level of performance” Samuel et al, 1993
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Searching the literature
PubMed http://www.ncbi.nlm.nih.gov/pubmed Stanford High Wire http://highwire.stanford.edu/
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SLIDE 14 Literature searching
http://www.ncor.org.uk/learning-
- nline/evidence-based-tutorials/
http://www.ncor.org.uk/learning-
- nline/critical-appraisal/
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Plan your audit
Clear audit topic Why is this important? Roles and responsibilities Time scale Analysis – who and how Making changes Sources of help
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Collecting data
Audit tool Piloting and modification Sample size and sampling Data protection Patient awareness
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Analyse your data
Choose how to do this; Identify changes that you want to make; Identify how you want to make changes; Identify a timescale and who needs to be involved.
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Next steps
Time for changes to take effect; Re-audit; Compile your findings in an audit report.
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Any questions?
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Audit of clinic notes
SLIDE 21 Audit plan
- Audit of patient case notes from
2005 onwards;
- Criteria;
- Standards;
- Sampling
SLIDE 22 Literature search
Pub Med:
- 1. case note* OR patient record*
- 2. AND standard*
Google search: record keeping + NHS guidelines
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SLIDE 24 Standards and criteria used
Criteria: All case notes should include the information listed in the Osteopathic Practice Standards (2012) (https://www.osteopathy.org.uk/uploads/os teopathic_practice_standards_public.pdf); All case notes should meet standards of good practice identified in NHS guidelines.
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Standards selected
100% of selected case notes should include the information listed in the Osteopathic Practice Standards (2012); 100% of selected case notes should meet standards of good practice identified from NHS guidelines.
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Collecting data
Audit tool (http://www.ncor.org.uk/practitioner s/audit/clinical-audit-tools/) Piloting and modification Sample size and sampling Data protection
SLIDE 28 Audit item 1 2 3 4 5
- 1. Are the records written in black ink?
- 2. Is the patient’s name written on every page?
- 3. Has the patient’s address been recorded?
- 4. Has the postcode been recorded?
- 5. Has a contact telephone number been
recorded?
- 6. Has the name of the patient’s GP been
recorded?
- 7. Has the GP practice address been recorded?
- 8. Has information about the presenting
complaint been recorded?
- 9. Has the patient’s family history been recorded?
- 10. Has the patient’s prescribed medication been
recorded?
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Analysis
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Identifying changes
A new case note sheet was devised specifically listing the headings in the GOsC Practice Standards All pens other than black ones were removed from the practice
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Re-audit
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Any questions?
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Practice audit
SLIDE 36 Literature search
Pub Med search and Google search http://www.cqc.org.uk/organisations
- we-regulate/registering-first-
time/essential-standards Local authority websites; Infection control nurses association.
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Planning the audit
Identify a specific date; Select a colleague to undertake the process or put aside diary time to do this; Identify an audit tool e.g. http://www.ncor.org.uk/wp- content/uploads/2012/12/A-general-practice- audit.pdf
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Collect and analyse data
SLIDE 39 Identify areas for change
- 1. Records of inspection of electrical
equipment;
- 2. Displaying fire exit signs?
SLIDE 40 Next steps
- 1. Locate electrical test certificates;
- 2. Display at practice;
- 3. Purchase fire exit signs;
- 4. Display in all relevant areas of
practice;
- 5. Identify a time for completion of
these activities;
- 6. Re-audit 3 months later.
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Any questions?
SLIDE 42 Audit of outcome
Aim: Progress of patients receiving
Objectives: To collect data which will identify how many treatments chronic back pain patients need; To identify the change in score on the BQ PROM that patients report as a result of treatment.
SLIDE 43 Criteria
Patients should need up to or less than the designated number of treatments identified in the NICE low back pain guidelines, 2009*.
* Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, Hill D, Browne N, Buchanan E, Coffey P, Dixon P, Drummond C, Flanagan M, Greenough C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D. Low back pain: early management of persistent non-specific low back pain. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners. http://guidance.nice.org.uk/CG88/Guidance/pdf/English.
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Standards
The recommended number of treatments for the management of chronic low back pain (9) will be reached in 75% of cases; Chronic low back pain patients will reach a change of *** points measured using the BQ PROM.
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SLIDE 46 Audit Handbook for Practising Osteopaths
https://www.osteopathy.org.uk/ozone/resources/publica tions-and-support-materials/NCOR-clinical-audit- handbook
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Other resources
http://www.uhbristol.nhs.uk/for- clinicians/clinicalaudit/how-to-guides/) http://www.nice.org.uk/niceMedia/pdf/Best PracticeClinicalAudit.pdf) (www.rcpsych.ac.uk/pdf/clinauditChap1.pdf).
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Final questions?
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Contact details
c.fawkes@qmul.ac.uk
