PROGRAMME Audits for the PGA in Professional Skills Thursday 26 August, CSB UHCW 2.30 – 3.15pmPGA and Audit Dr Paul O’Hare 3.15 – 3.30 pmBreak 3.30 – 4.30pmWorkshops to review previous audits and reflective diaries Dr Paul O’Hare Dr David Bennett- Jones Jones 4.30 – 5.00pmDiscussion of audit Questions and ideas Dr Paul O’Hare Dr David Bennett- Jones Jones

POSTGRADUATE AWARD IN PROFESSIONAL SKILLS A stand alone qualification or 1 module (20 CATS) towards Masters (MSc) in Health Sciences Can use MRCP, FRCS, etc., as 2 modules (40) for Masters in Health Sciences

Designed around curriculum for generic and acute skills of Foundation Year 2. Course attendance and involvement recorded in reflective diary/personal development plan (1,000 words)

Assessment – PGA Professional Skills Communication Skills (40%) (exam) Audit – written assignment (40%) (2,000 – 3,000 words) Reflective Diary/PDP (20%) (1,000 words)

Deadlines for assessments  Audit – Wednesday, 25 May 2011  Reflective diary – Wednesday, 27 July 2011

Audit - F2 curriculum “. Has been actively involved in undertaking a clinical audit, and recognises how it relates to the improvement of clinical standards and addresses the clinical governance agenda”.

Assessment of Audit 1.Plan and carry out. Keep simple in area interested Manageable 2.Write up – 2,000 – 3,000 words Structured 3.Follow criteria in writing up audit assignment 4.Meet deadline – May Present as soon as complete Need written agreement before if late

Assessment of Audit (1) 1.Justify relevance and rationale of audit, clearly stating the reasons with reference to current clinical practice and literature 2.Clearly state objectives 3.Show evidence of teamwork in preparation, planning and carrying out audit and in discussion and presentation of findings 4.Justify your standards by clearly linking them to references in the scientific literature or to agreed written policies. Use clear, explicit, measurable quality criteria.

Assessment of Audit (2) 5.Use clear methods, data collection and correct sampling strategies 6.Explain clearly and fully what you have learnt in completing the audit 7.Conclusions – include thoughtful logical conclusions that demonstrate reflections on what you have learnt from the audit 8.References – all material should be properly referenced using Vancouver system (BMJ) (preferred) or Harvard formats

Reflection on experience (NHS Foundation Learning Portfolio) 1.Describe interesting, difficult or uncomfortable experiences. Try to record both positive and not so positive elements. What made the experience memorable? 2. How did it affect you? 3. How did it affect the patient? 4. How did it affect the team? 5. What did you learn from this experience and what (if anything) would you do differently next time?

 What do you understand by clinical audit?

Defining clinical audit (post Bristol) “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”……aspects of the structure, process and outcome of care are selected and systematically evaluated against explicit criteria. Where indicated changes are implemented at an individual team, or service level and further monitoring is used to confirm improvement in healthcare delivery”

 What do you understand by the audit cycle?

 In audit what do you understand as: –Aims –Objectives –Standards?

What is the aim of the audit?  Aims are broad statements of intent - e.g., to improve local practice in the management of leg ulcers - e.g. to improve the referral process top smoking cessation services - e.g. to improve the reporting process of laboratory results - e.g., to improve the management of observations

After topic comes your aim and objective Always know your aim and objective! “a project without clear objectives cannot achieve anything: a clear sense of purpose must be established before appropriate methods for audit can be considered…… …..once the topic for audit a clinical audit project has selected the purpose of the project musty be clearly defined so that your method chosen is the most suitable for your project” Objective of audit = quality of care

Common question But isn’t audit the same as research? ……what’s the difference?

Why does audit get confused with research?  Both involve collecting/accessing information to achieve an objective  Both involve observing practice to achieve an objective  Both have a data analysis component  Both produce written reports/findings/summaries

Audit versus research (1)  Calling something “audit” does not make it an audit: it’s the objective of the project that counts  Objective is the most useful factor for distinguishing between the two activities  For example, research answers the questions “what should we do?”: the objective of research is to create new knowledge, e.g., test a hypothesis

Audit versus research (2) *Audit answers the question “are we doing what we should be doing in the way we should be doing it” e.g., Objective is to measure the quality of care provided against agreed ways of working/evidence based medicine/guidelines/standards *Audit is not “poor” or “weak” research it is a totally different activity *Audit is not a quick fix for research to avoid ethical implications *Audit is not an easy way to conduct research

Audit versus research (3)  In general, the objective of audit is to evaluate the quality of local practice; by sharing findings locally one can improve local practices  Local audit would not necessarily benefit the wider health economy as it relates to a Trust and the practices of that Trust  In general, the objective of research is to create new knowledge that can be shared with others  Sharing this information (research) may benefit the wider health economy

Summary: what makes an audit a good audit?  Involve all concerned e.g., other departments, professional groups  Clear rationale/purpose  Explicit aims and objectives  Measurement against which to compare – evidence base/standards  Sound methodology – best approach, sampling techniques, proforma design  Data analysis that reflects the aims & objectives  Reported and presented to reflect aims & objectives  Reported & presented to reflect measures/standards utilised  Birmingham Clinical Audit Assessment Framework  More likely to change practice if methodologically rigorous* Spurgeon P, Walshe K (1997). Birmingham Clinical Audit Assessment framework. HSMC: University of Birmingham *Walshe, K (1999). BRI Inquiry on medical and clinical audit in the NHS. HMSO: London

What makes audit change practice?  Perception, attitude, motivation  Organisation and environmental factors  Choice of audit topic, adequacy of audit method and understanding the reasons for deficiencies identified  Extent to which audit is systematically integrated into routine management of care  Involve/Inform the “Change Makers” Walshe, K (1999). BRI Inquiry on medical and clinical audit in the NHS. HMSOI: London