Clinical audit
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Clinical Audit. Jill Warn, Audit & IT Lead Dr John Guy, Clinical Lead. What . do you hope to achieve today? experience have you had of audit?. Today we will look at…. Enhancing your understanding of Audit Getting Audit right for Revalidation The benefits of Audit in Primary Care

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Clinical Audit

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Clinical audit

Clinical Audit

Jill Warn, Audit & IT Lead

Dr John Guy, Clinical Lead


Clinical audit

What .....

do you hope to achieve today?

experience have you had of audit?


Today we will look at

Today we will look at…...

  • Enhancing your understanding of Audit

  • Getting Audit right for Revalidation

  • The benefits of Audit in Primary Care

  • Implementing change

    Please ask questions / interrupt


Clinical audit

A small change in practice is better than a major discussion of the possibilities


What is audit

What is Audit?


Some definitions

Some Definitions

  • Audit is a process used by health professionals to assess, evaluate and improve the care of patients in a systematic way in order to enhance their health and quality of life.

    • OR

  • Deciding what you should be doing, looking at what you are doing, deciding whether you can do it better, implementing any changes and then making sure the changes have worked!


  • What do we audit

    What do we audit?

    • Structure

    • Process

    • Outcome


    Why do an audit

    Why do an audit?

    • Bring about change

    • Best use of resources

    • Improve standards

    • Stimulate education

    • Reduce errors (clinical and organisational)


    Gmc advice

    GMC advice

    all doctors should take part in systematic audit and be familiar with the principles and practice of clinical audit


    It is about

    It is about

    Auditing your own practice!


    What to consider when choosing a subject

    What to consider when choosing a subject.

    Is your topic appropriate?

    Does it reflect the care undertaken by you the practitioner?

    Is it evidence based?


    Clinical audit

    QOF areas will not be acceptable


    Which topics to choose

    Which topics to choose?

    For principals / static salaried doctors

    For sessional docs


    Principals

    Principals


    Sessional

    Sessional


    When planning an audit

    When Planning an Audit

    Measure care against a set standard or criteria

    Take action to improve care

    Monitor to sustain improvement


    Clinical audit

    DDIAY


    Consider

    Consider

    • Being a Learning Organisation

      • Look at the skills within the team

      • Empowerment

      • How might this work?


    Audit and revalidation

    Audit and Revalidation

    • At least one full clinical audit cycle during a revalidation period

    • Significant Events Audit

      • A GP’s portfolio is expected to contain an analysis of at least ten significant events over a 5 year period


    Clinical audit1

    Clinical Audit

    • At least one full audit cycle during a revalidation period

      • Initial audit results

      • Change implemented for the GPs’ patients

      • Re-audit – demonstrating improvement by the GP


    The audit cycle

    The Audit Cycle


    What is an effective audit

    What is an Effective Audit?

    An educational activity

    Promotes understanding

    Resource effective

    Raises standards

    Promotes change

    Source of information


    Writing up your audit

    Writing up your Audit


    The great coffee audit

    The great coffee audit

    Found on Google:

    Gloucestershire PCCAG


    The great coffee audit1

    Problem:

    The doctors feel that their coffee isn’t hot enough after slogging through morning surgery

    The great coffee audit


    The great coffee audit2

    Problem:

    Criteria:

    The doctors feel that their coffee isn’t hot enough after slogging through morning surgery

    The coffee shall be hot and satisfying to the hard pressed docs

    The great coffee audit


    The great coffee audit3

    Problem:

    Criteria:

    Standards:

    The doctors feel that their coffee isn’t hot enough after slogging through morning surgery

    The coffee shall be hot and satisfying to the hard pressed docs

    The coffee shall be served at a temperature of 85-90C on 80% of occasions and there will be 90% satisfaction level expressed by the docs

    The great coffee audit


    The great coffee audit4

    Methods:

    The junior receptionist shall check the temperature of the coffee daily for two weeks and circulate a questionnaire to the partners asking them to score a coffee satisfaction level between 1 and 10. The practice manager shall visit Tesco’s and interview the manager about the availability, costs, quality and sell-by dates of the coffee brands available.

    The great coffee audit


    The great coffee audit5

    Review:

    After a rather tense audit team meeting it was found that the coffee temperature fell below 37C on at least 33% of occasions and reached the standard on only 10% of occasions. The doctors scored the coffee at an average 3/10 and two expressed it undrinkable. The practice manager reported the results of her Tesco’s visit.

    The great coffee audit


    The great coffee audit6

    Change:

    It was agreed to replace the aged coffee maker (after agreeing suitable redundancy terms for the senior receptionist) with a shiny new machine from Argos. As an additional ‘quality initiative’, cream cakes would be served after surgery. The coffee contract would be switched from the corner shop to Tesco PLC Trust.

    The great coffee audit


    The great coffee audit7

    Re-audit:

    For a further two weeks it was agreed to measure the coffee temperature and re-circulate the questionnaire. It was gratifying to find 100% correlation with agreed standards with the exception of one partner who didn’t like coffee anyway.

    The great coffee audit


    The great coffee audit8

    Re-audit:

    Future

    Audit:

    For a further two weeks it was agreed to measure the coffee temperature and re-circulate the questionnaire. It was gratifying to find 100% correlation with agreed standards with the exception of one partner who didn’t like coffee anyway.

    Cost implications of standard maintenance

    Cholesterol assays for partners

    The great coffee audit


    Clinical audit

    KISS


    Writing criteria

    Writing Criteria

    A criterion is a statement of what should be happening.

    Evidence based

    Measurable

    Clear, unambiguous


    Setting the standard

    Setting the Standard

    • A standard is a number

    • Usually quoted as a percentage

    • One for each criterion

    • Where you think you should be

    • Use group discussion, journals and press, financial targets, last year’s results.


    Collecting the data

    Collecting the Data

    • Consistent information

    • Dedicated time for audit

    • Team Approach

    • Sharing of information


    Collecting data

    Collecting Data

    • Be Organised. Collect essential information only.

    • Think of different possible sources of data.


    Comparing the results with the standard

    Comparing the Results with the Standard

    • Straight comparison

    • If the standard is not met, what can be done to improve things?


    We may not be quite as good as we think we are

    We may not be quite as good as we think we are!


    Onset of diabetes a

    Onset of diabetes (a)


    Onset of diabetes b

    Onset of diabetes (b)


    Onset of diabetes c

    Onset of diabetes (c)


    Onset of diabetes d

    Onset of diabetes (d)


    Making the changes

    Making the Changes

    • Is this something you have direct control over?

    • Does patient opinion come into this?

    • Who needs educating?

    • Selling your changes to your colleagues

    • How long will the changes need?


    What can we do to improve things

    What can we do to improve things?

    • ‘For every fatal shooting, there were roughly three non-fatal shootings. And, folks, this is unacceptable in America. It's just unacceptable. And we're going to do something about it.’

      George W. Bush


    Have the changes worked

    Have the Changes Worked?

    • Collect a second set of data

    • Allow time for the changes to take effect

    • Have the changes made a difference?

    • Has the target now been reached?

    • Can further changes be put in place?

    • Is this going to be reviewed again in the future?


    Presenting results

    Presenting Results

    • Results must be clear and understandable

    • Present data in a visual way

    • Avoid complex statistical analysis

    • Quote the numbers before the % for less than 50 pieces of data

    • Be tactful with difficult results


    Why do we use graphs

    Why do we use graphs?

    • The number of asthmatic patients attending for annual review varies according to age, with patients in the 16-24 age group least likely to attend.


    Types of graph pie chart

    Types of Graph: Pie Chart

    Percentage of patients discharged from hospital with either complete, incomplete or no discharge letter


    Types of graph bar chart

    Types of Graph: Bar Chart

    Patient who had a Health Check


    Types of graph line chart

    Types of Graph: Line Chart


    Writing it up for revalidation

    Writing it up for revalidation!

    Title

    Reason for choice

    Dates of first and second data collections

    Criteria and standards with justification

    Results of first data collection – reflection

    Summary of discussion and changes agreed


    Clinical audit

    • Changes implemented

    • Results of second data collection – reflection

    • Quality improvement achieved

    • Reflections

      • Knowledge skills performance

      • Safety and quality

      • Communication partnership teamwork

      • Maintaining trust


    Quality improvement projects

    Quality improvement projects


    Significant event audit

    Significant event audit

    • The audit should be:

      • transparent

      • It should not be confrontational or judgemental

      • It is not an opportunity to name, shame and blame.


    Clinical audit

    It should be something in which you are involved

    It should be discussed in a meeting

    Changes involve you

    Reports should not identify the patients


    Should include

    Should include

    Title of event

    Date of event

    Date of meeting

    Description of event

    What went well?

    What could have been done differently?


    Clinical audit

    and

    • Reflections

    • What changes were proposed

      • For me?

      • For the team?

    • What changes were implemented and their effect?


    Topics to pick

    Topics to pick


    Some ideas

    Some ideas

    New cancer diagnoses

    INR >8

    What about sharing across health economy?


    Any questions

    Any questions?


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