NHSLA Risk Management Standards Criterion 5.1 - Clinical Audit

1. NHSLA Risk Management StandardsCriterion 5.1 - Clinical Audit HQIP National Conference Gaynor Pickavance and Gill Feerick, DNV Risk Management Assessors, DNV Healthcare UK 28th April 2010

2. Session structure • Provide an overview of the NHSLA schemes and assessment process • Highlight the requirements of the new criterion 5.1 - Clinical Audit • Breakout sessions 1 and 2 and feedback • Consider how you can assist your organisations

3. The NHSLA - What is it? • Special Health Authority - part of NHS • Geographical limits - England • Not an insurance company (mutual pool) ROLE OF THE NHSLA Handle clinical and non-clinical claims Encourage good risk management practices Provide a Human Rights Act information service Support the activities of the Family Health Services Appeals Authority Coordinate equal pay claims

4. The NHSLA and assessment process • The NHSLA is a Special Health Authority which provides the means for NHS organisations to fund the cost of legal liabilities for clinical negligence, third party and property losses • It provides a fair and cost-effective means of handling claims, supported by risk management activities to enable learning from claims experience • Membership of the schemes is voluntary and open to all NHS trusts, foundation trusts and PCTs in England • Organisations are entitled to a discount on their scheme contributions if they can demonstrate compliance with the standards • The standards have been designed to encourage and support organisations in taking a proactive approach to risk management • Organisations have a formal assessment on a periodic basis dependant upon their level of compliance

5. Aims of the NHSLA schemes Contribute to improvements in patient safety and well-being of staff Increase risk management awareness Improve systems and processes Reduce the number and severity of incidents Lower the number and cost of claims

6. NHSLA Risk Management Standards for Acute Trusts, Primary Care Trusts and Independent Sector Providers of NHS Care NHSLA Risk Management Standards for Mental Health & Learning Disability Trusts NHSLA Risk Management Standards for Ambulance Trusts CNST Maternity Clinical Risk Management Standards The Risk Management Standards • Moved from separate clinical and non-clinical standards • Self-assessment to determine level of assessment • Informal visit(s) • Formal assessment

7. Level 1 Risk management systems and processes have been documented (Policy) Level 2 The systems described at Level 1 have been implemented (Practice) Level 3 The organisation is monitoring its compliance with the systems and acting on the findings (Performance) NHSLA Risk Management Standards - Levels • Organisations have a financial and quality incentive to contribute • Discounts are awarded at three levels when compliance with the standards is demonstrated • An organisation’s contributions decrease in accordance with the level achieved

8. NHSLA Acute Standards 2010-11

9. Why did we bring clinical audit into the NHSLA Risk Management Standards? What do you think we have seen during our assessments that has concerned us? New criterion 5.1 - Clinical Audit

10. Areas of concern observed at assessment One page audit results/reports Standards of performance not stated or not tested properly - e.g. wristband audits Audits with no proforma attached so we couldn’t see the audit questions Results which gave overall compliance opinions when there were several parts to the documented process Poor results with no formal actions Subsidiary risk issues that had not been picked up - e.g. six health records could not be found - the missing health records then ignored in the actions Actions that merely stated “re-audit in six months”

11. Why did we bring clinical audit into the NHSLA Risk Management Standards? New criterion 5.1 - Clinical Audit

12. Reasons for including clinical audit Alignment of concerns and complaints regulations left a gap in Standard 5 Quality of audit and approaches taken to audit were of concern both in the acute and maternity settings Uncertainty in the value that those audits were bringing Poorly written audit reports with very little learning contained within them Claims histories showing that despite clinical audit lessons were not being learned rigorously enough

13. 5.1 - Clinical Audit: Level 1

14. 5.1 - Clinical Audit: Level 2

15. 5.1 - Clinical Audit: Level 3

16. 5.1 - Clinical Audit: Assessment in 2010-11 • Pilot criterion for the year 2010-11 - a positive score will be awarded • Developed in conjunction with HQIP • New template document and Audit Report Proforma in line with the HQIP documents Link • Adapted Audit Report Proforma for maternity services Link

17. Ensuring appropriate standards of performance are audited So what does this mean? Q

18. Ensuring appropriate standards of performance are audited • To make sure that staff know what the standards of performance are, and that they are tested in an audit and not something else • So you are required to document the process you have in place for making sure that audits are carried out properly and actually test the 'standards' that have been set within approved documents The 'appropriate standards of performance' relates to the documented standards that staff are expected to achieve

19. Ensuring appropriate standards of performance are audited • Training those who undertake audit • Making staff use approved audit proformas that are checked prior to the audit being undertaken • Documenting examples of how to/how not to set the questions that the audit should ask Ensuring the audit process tests the documented ‘standards’ may require… You can decide on the best process for yourselves but you must document your process at Level 1 and be able to demonstrate it at Level 2 and monitor it at Level 3

20. Misinterpretations • Performance management of clinical areas and the selection of the most important to audit and monitor • Reference to the standards of an individual audit • The process by which the department knows that standards are being used for audit purpose • Auditing standards of service (although that could be how you may monitor at Level 3) “Ensuring appropriate standards of performance are audited” is NOT…

21. Breakout group 1 TASK: • To look at examples of maternity documents: • Guideline on the management of severe or fulminating pre-eclampsia (high blood pressure) • Audit proforma • Audit report and action plan • Power point presentation of the audit results Breakout group Determine whether this was a good audit that clearly tested the appropriate standards of performance Are there any suggestions or changes that you would make?

22. Breakout group 2 TASK: • To look at two policies for patient identification in the primary care setting: • One policy for in-patient areas • One policy for community settings Breakout group To devise an audit that clearly shows that the appropriate standards of performance will be audited?

23. TOP TIP It cannot be stressed enough… READ THE MANUAL And stay in contact with your assessor

24. Any questions?

25. Safeguarding life, property and the environment www.dnv.com