SPVS Roadshows 2005 Using clinical audit to optimise the provision of veterinary services

SPVS Roadshows 2005 Timetable 9.30 Introduction to clinical auditing in general practice– Bradley Viner 10.00Evidence based medicine – Dr Peter Cockcroft 10.30Interpreting and sharing data – Dr. Dave Brodbelt 11.00Tea 11.30Monitoring standards of performance in medical primary care – Dr Chris Jenner 12.00The role of the VN in clinical audit – Lisa Bluett VN 12.30Introduction to workshop 12.45Lunch 13.45Workshop on the application of clinical auditing 15.00Workshop presentations 16.15Plenary session – questions; discussion and summary 17.00End

SPVS Roadshows 2005 Introduction to clinical audit Bradley Viner BVetMed MSc(VetGP) MRCVS

Background London graduate 1978 London graduate 1978 Own small animal practice since 1979 Own small animal practice since 1979 MSc (VetGP) as part of SPVS group MSc (VetGP) as part of SPVS group DProf with Middx Uni into clinical audit DProf with Middx Uni into clinical audit Facilitating MSc group Facilitating MSc groupwww.vetgp.co.uk

Clinical audit - what is it? Clinical Audit is a quality improvement process in clinical practice that seeks to establish protocols for dealing with particular problems, based on documented evidence when it is available, monitoring the effectiveness of these protocols once they have been put into effect, and modifying them as appropriate. It should be an ongoing upwards spiral of appraisal and improvement. (Viner,2003)

Clinical audit – medical practice National Institute for Clinical Excellence “Principles for Best Practice in Clinical Audit” Healthcare Commission

Clinical audit – vet practice Veterinary Institute for Clinical Excellence V.I.C.E. VICE

THE CLINICAL AUDIT CYCLE The Audit Cycle

Kolb’s learning cycle (reflective practice) The Learning Cycle

Clinical audit- why bother? Bring about change Assure our clients Promote our services Assure our employers Practice standards Professional satisfaction

Clinical audit- obstacles Inertia Demands on time Cost Professional freedom Skills

Stages in the audit cycle Preparation Preparation Establish protocols Establish protocols Selection of criteria Selection of criteria Measure performance Measure performance Review and modify Review and modify Repeat Repeat

Preparation Area to audit Area to audit Define the problem Define the problem Stakeholders Stakeholders Audit team Audit team Resource requirements Resource requirements

Stages in the audit cycle Preparation Preparation Establish protocols Establish protocols Selection of criteria Selection of criteria Measure performance Measure performance Review and modify Review and modify Repeat Repeat

Protocols - EBVM Establish a protocol using EBVM: “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. This means integrating individual clinical expertise and the best available external clinical evidence from systematic research” Handbook of EBVM, Cockcroft and Holmes (2003)

Stages in the audit cycle Preparation Preparation Establish protocols Establish protocols Selection of criteria Selection of criteria Measure performance Measure performance Review and modify Review and modify Repeat Repeat

Selection of criteria Criteria are explicit statements that define what is being measured, and represent elements of care that can be measured objectively (NICE, 2002)

Selection of criteria DREAM…… Distinct Distinct Relevant Relevant Evidence-based Evidence-based Achievable Achievable Measurable Measurable

Stages in the audit cycle Preparation Preparation Establish protocols Establish protocols Selection of criteria Selection of criteria Measure performance Measure performance Review and modify Review and modify Repeat Repeat

Measure performance Can measure: Processes Processes Outcomes Outcomes

Measure performance Establish standards: “A statement which outlines an objective with guidance for its achievement given in the form of criteria sets which specify required resources, activities, and predicted outcomes. It decides the level of care to be achieved for any particular criterion”.

Stages in the audit cycle Preparation Preparation Establish protocols Establish protocols Selection of criteria Selection of criteria Measure performance Measure performance Review and modify Review and modify Repeat Repeat

Review and modify Assess the full impact of the solution, including issues such as compliance and audit design

Clinical audit - summary Ongoing cycle of improvement Ongoing cycle of improvement Pick key areas of audit Pick key areas of audit Build an audit team Build an audit team Create a positive working environment Create a positive working environment Define your criteria and standards carefully Define your criteria and standards carefully Use the best evidence available Use the best evidence available Exchange data with colleagues Exchange data with colleagues KISS KISS (Keep It Simple, Stupid!)

SPVS Roadshows 2005 Timetable 9.30 Introduction to clinical auditing in general practice– Bradley Viner 10.00Evidence based medicine – Dr Peter Cockcroft 10.30Interpreting and sharing data – Dr. Dave Brodbelt 11.00Tea 11.30Monitoring standards of performance in medical primary care – Dr Chris Jenner 12.00The role of the VN in clinical audit – Lisa Bluett VN 12.30Introduction to workshop 12.45Lunch 13.45Workshop on the application of clinical auditing 15.00Workshop presentations 16.15Plenary session – questions; discussion and summary 17.00End

Workshop Each group should submit a proposal for an audit of a clinical aspect of veterinary work, making a 5 minute presentation on it to the rest of the participants at the end, and fielding questions on its value and feasibility. The example used is likely to be hypothetical, but the topic chosen and the environment in which it is applied should be real Each group should submit a proposal for an audit of a clinical aspect of veterinary work, making a 5 minute presentation on it to the rest of the participants at the end, and fielding questions on its value and feasibility. The example used is likely to be hypothetical, but the topic chosen and the environment in which it is applied should be real