Clinical Audit

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Clinical Audit Summary Guide
This guide gives a brief introduction to the
principles of clinical audit and information
about how to undertake a clinical audit at Great
Ormond Street Hospital. For further information
please contact the Clinical Audit Team ext 5892
Pearsa_at_gosh.nhs.uk or ShinkL_at_gosh.nhs.uk
http//97.0.0.55/corporate/safetyClinAudit.htm
http//97.0.0.55/corporate/clinical_audit4/
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• What is Clinical Audit?
• Clinical Audit was first introduced in the NHS in
  1993 although the term "medical audit" has been
  known In the NHS for many years. Great Ormond
  Street recognises the NICE definition of Clinical
  Audit
• "A quality improvement process that seeks to
  improve patient care and outcomes through
  systematic reviews of care against explicit
  criteria and the implementation of change"
  (Principles for Best Practice in Clinical Audit,
  2002, NICE/CHI. http//www.nice.org.uk/pdf/BestPra
  cticeClinicalAudit.pdf
• Clinical Audit is not research. It is true that
  research and clinical audit share similarities.
  They both involve answering specific questions,
  which relate to the quality of care. They can
  both be carried out retrospectively,
  prospectively, involve careful data collection
  design principles and should be professionally
  led. However, the truth is there are also
  important differences between the two
  disciplines. Research is about obtaining new
  knowledge and about finding out what is best
  practice. Clinical Audit is about measuring
  quality of patient care. The clinical audit
  team have a number of resources to help you
  decide what type of project you are conducting,
  please contact the team for further information.
• The component parts of clinical audit, known as
  the clinical audit cycle, have been highlighted
  as
• Choosing an audit topic
• Setting Standards
• Measuring against current practice
• Comparing results with standards
• Changing practice

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• Undertaking a clinical audit project at GOSH
• The clinical audit team supports clinical audit
  at Great Ormond Street Hospital. Before you
  undertake any clinical audit within the trust,
  you should discuss your proposed audit with a
  member of the clinical audit team and complete
  the clinical audit registration form (also
  available on the GOSH web). The steps you will
  then need to go through are summarised below,
  further information is available in the clinical
  audit advice pack.
• Choose an audit topic
• Clinical audits at GOSH usually focus on
  measuring adherence to healthcare investigations,
  treatments and/or procedures that have been shown
  to produce the best outcomes for patients. Audit
  topics should focus on
• An identified problem (e.g. from complaints or
  incidents)
• High volume, high risk or high cost areas of
  practice
• Areas with high variation in practice
• Published evidence about clinically effective
  treatment
• The availability of clinical guidelines (e.g.
  NICE and Royal Colleges)
• If you are keen to undertake an audit but are
  unsure about an appropriate topic to chose the
  clinical audit team will be able to assist you to
  identify key areas in your clinical area, for
  example, relevant NICE guidance, infection
  control issues or Royal College guidance and/or
  standards that need to be audited or re-audits
  that should be undertaken.
• If your audit has financial implications, please
  follow the guidance provided on the GOSH intranet
  Planning and Performance pages here
  http//97.0.0.55/nonclindirs/ClinOperations/BusPla
  nning/business_planning.htm
• Develop an audit team
• Clinical audit at GOSH should be
  multidisciplinary (i.e. involving more than one
  group of staff). If an audit has implications
  for other teams or clinical areas they should be
  involved or consulted at the initial planning
  stage of the audit. If your audit is looking at
  the patient journey across different care sectors
  please ensure all staff representatives from all
  organisations are involved.
• Consider including patient/parent representation
  on your audit team/group or gaining their views
  on your audit topic, design and implementation of
  relevant changes. Consider other methods of
  patient involvement such as the Consultation
  Panel, contact Beki Moult ext 8558 for further
  information regarding the Consultation Panel.
  Remember it is important that your audit is
  supported by colleagues in your clinical area to
  ensure any necessary changes, indicated by the
  audit results, are put into practice.

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• Consider your aims and objectives
• Decide what your objectives of doing the audit
  are and write this either as a statement or
  question which best describes what you want your
  audit to achieve/answer. Consider the steps you
  will need to take to achieve these objectives and
  write this either as a series of tasks or as
  different aspects of quality that your audit will
  focus on. Collectively these will form your
  audit aims and objectives.
• Agree audit standards
•  
• Audit standards define the aspects of care to be
  measured, in order to find out whether we are
  doing what we should be doing. Your audit
  standards should flow from or be related to the
  audit aims and objectives. Ideally you should
  look to use standards that already exist locally
  or nationally in the form of evidence based
  guidelines, procedures or protocols.
• If there are no locally or nationally developed
  standards you may have to write the standards
  yourself. These should always be based on best
  available evidence and you should ensure there is
  consensus agreement with your standards in the
  relevant clinical areas before you audit against
  them. Agreement is absolutely necessary if you
  wish to eventually improve practice. The
  clinical audit team and/or staff at GOSH/ICH
  library can help you to carry out a literature
  search to find relevant evidence in order to
  develop your audit standards.
•  
• Consider Ethics
• Although clinical audits at GOSH do not have to
  be approved by the ethics committee they still
  need to be undertaken to the highest professional
  standards. This means considering the principles
  of data protection and confidentiality in every
  clinical audit undertaken. If you have concerns
  about ethical issues regarding your clinical
  audit, please contact the clinical audit team who
  will assist you.
•  
• Select an audit sample
• You need to ensure that the information you
  collect from a sample will be representative of
  the whole population. A small sample from your
  particular patient group will be sufficient for
  an audit project. Please refer to the clinical
  audit advice pack for further information
  regarding sample selection.

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• Data collection.
• A well designed data collection tool will save
  time and can help with the data analysis. Always
  ensure that you are collecting enough data to
  answer your audit question or to establish
  whether you are meeting your audit standards.
  Consider whether you should be collecting your
  data
• Retrospectively for example looking at past
  treatments.
• Prospectively for example, looking at the time
  of treatment.
• Concurrent for example, looking at the here
  and now.
• Consider who and how you are going to collect
  your data. Will you use a proforma,
  questionnaire or enter the data straight into a
  computer? Ensure that the method you chose is
  appropriate for the audit topic. Always ensure
  that you conduct a pilot before starting the main
  data collection. This will enable you to
  discover any faults with your data collection
  method, identify ambiguous questions and/or
  difficulties in completing the data collection
  tool. By identifying these problems at this
  stage will enable you to rectify them saving you
  time in the long run.
• Data analysis
• Compare the data you have collected to your
  standards. Ensure that you analyse how well you
  have met those standards. If you are comparing
  compliance to a particular guideline and/or
  protocol ensure that you analyse your data to
  demonstrate this. The analysis of your data
  should be linked back to the audit aims and
  objectives. If you require further support
  please contact the clinical audit team.
• Present your findings
• Your audit findings should be initially presented
  to those individuals required to agree
  recommendations and implement an action plan.
  The results should then be presented to other
  colleagues. A summary of your findings should
  also be submitted to the clinical audit team for
  posting on the sharing knowledge website. When
  presenting your audit results ensure that you
  include your recommendations, think about what
  does the team need to change to improve
  practice? raising this question will also aid
  discussion at the end of your presentation.

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• Draft Audit Report
• Please ensure that you write up your audit in a
  report format. This will provide an official
  report of your audit and enough information for
  future re-audits. The team have a number of
  templates available to assist you at this stage
  of your audit. Your audit report should be well
  structured and include
• Introduction essential describes why you are
  doing the audit.
• Aims and Objectives describes the purpose of
  the audit
• Standards if you are measuring against
  standards or guidelines these should be stated
  at this stage of the audit report.
• Methodology detailing data collection. For
  example, how you collected the data, the size of
  the sample and your chosen population.
• Results - data analysis, descriptive graphs
  and tables demonstrating the audit results
• Conclusion make objective statements
  supported by your findings.
• Recommendations - make recommendations for
  change based on your audit results.
• Action Plan this refers to specific action
  that need to be taken to achieve the
  recommendations.
• References and Appendix
• Implementing change
• If your audit results demonstrate a need for
  improvement, making changes in current practice
  is therefore very important. Audit results
  should be used in conjunction with feedback,
  local consensus and opinion to achieve change in
  clinical practice. Ensure that the changes you
  make are essential to improving the standard of
  care and within your resources. Dont make
  changes for the sake of change. All changes need
  to be implemented in a systematic way, using an
  action plan enables staff to do this. The
  clinical audit team and the trusts improvement
  facilitators can assist you with the process of
  implementing change.
• Re-audit

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• Final Report Writing
• Once completed the re-audit should be the final
  stage of your audit report. The final audit
  report should contain all of the sections in the
  draft report and
• Results a comparison of findings should be
  made and reported
• Recommendations if necessary (if there has is
  no significant improvement) new recommendations
  should be agreed and reported.
• A summary and action plan must be completed at
  this stage. The summary of your audit will be
  posted on the Sharing Knowledge website if deemed
  to be a good example of best practice in clinical
  audit. Once agreed a copy of your action plan
  and final report should be sent to the clinical
  audit team.
• Publish Your Work
• If you have produced a piece of work which is a
  good example of best practice in clinical audit
  consider sharing this work outside of the trust
  by getting it published in a professional
  journal. Remember you should have completed the
  audit cycle i.e. a re-audit should have been
  conducted demonstrating that you have
  successfully improved practice. If you have
  completed the audit cycle your findings are more
  likely to be published as people can learn from
  your methodology and the changes you have made.
  Please ensure that if you do present your audit
  outside the trust or have an audit published you
  contact the clinical audit team to let them know.
• Further Information and Advice
• Please Contact the Clinical Audit Team for
  Further Information and Advice contact Andrew
  Pearson Ext 5892 or Leanne Shinkwin ext 5176