CLINICAL AUDIT

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CLINICAL AUDIT

• Jim Jones
• RGN RMN MSc.
• Senior Lecturer, Nurse Prescriber
• West Yorkshire

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What would you do?

• A candidate comes to you with a draft
  questionnaire they want to give all their addicts
  to complete whilst waiting to be seen. It is
  about their use of local needle exchanges.

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• Another candidate brings you notes of some chats
  they have had with prisoners they are treating,
  in which they discuss how the other prisoners see
  the drug treatment system. The candidate wants to
  do more interviews to see where the service could
  improve.

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• A candidate brings a copy of the 1999 clinical
  guidelines and asks you to show them a suitable
  topic for their audit.

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• Clinical Audit is defined as
• ..a quality improvement process that seeks to
  improve patient care and outcomes through
  systematic review of care against explicit
  criteria and the implementation of change
• Principles for Best Practice in Clinical Audit
  (2002, NICE/CHI)
• Are we doing what we are supposed to be doing?

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Component Parts of Clinical Audit

• Identifying or setting standards
• Measuring current practice
• Comparing results with standards (criteria)
• Changing practice
• Re-auditing to make sure practice has improved

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Topic Selection

• Should be important, e.g. based on at least one
  of these
• An identified problem (e.g. from complaints or
  adverse incidents).
• High volume, high risk or high cost areas of
  practice.
• Published evidence about clinically effective
  treatment.
• The availability of clinical guidelines (e.g.
  from NTA, NICE, or Royal Colleges).

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Support

• From practice colleagues.
• To carry out the audit
• To make the changes it identifies
• From RCGP Cert. Tutor.
• To identify suitable focus
• To keep it realistic, relevant and not research

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Research

• Aims to derive new knowledge which is
  generalisable / transferable.
• Asks the question What is best practice?
• Must comply with Research Governance.
• Must be registered with the Research and
  Development Department.
• LREC approval required

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Service Evaluation

• Has this service been a success?
• Usually requires governance
• May require local approval if involves patients.
• Should be part of an overall Trust strategy.
• Could be an RCGP assignment if small scale.

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Back to Clinical Audit
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Clinical Audit

• SELECT AN AUDIT SAMPLE
• PLAN AND CARRY OUT DATA COLLECTION
• Retrospective? Prospective?
• Be clear who, what and when.
• ANALYSE THE DATA
• Compare your results with the standard(s).

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PRESENT YOUR FINDINGS

• To Colleagues
• Do we need to change practice?
• Do standards or guidelines need to be updated?
• Do staff need training/re-training?
• WRITE A REPORT
• Share it with Local Master Class
• Submit it with a confident smile

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AND FINALLY

• IMPLEMENT CHANGES
• RE-AUDIT
• GET PUBLISHED?
• Local trust-wide report,
• Regional newsletter
• National SMMGP, Comic, Journal.