1. Audit to improve consistency & reduce variation
Assessment and response framework

2. Auditing
Improves consistency and reliability of the PCOC assessment tools
Reduces variation in assessment and response
Identifies areas for improvement
Tip: Use your PCOC report to highlight areas to audit

3. What to Audit Assessment and clinical response protocol
1. Response to assessments
2. Phase definition
3. Phase change
These are retrospective audits requiring access to the patient’s medical record and PCOC assessments.
Tip: the 3 retrospective audits can be completed together or separately

4. What to Audit Consistency between clinician assessments Phase SAS
PCPSS
These are real time (prospective) audits comparing assessment score between clinicans

5. How to Audit- Leadership
It is important that the audit is supported and endorsed by the organisation executive, managers, and clinical leaders.
This leadership will help to ensure that the results are used to drive improvement and decision making for how to conduct the audit and prepare results
Tip: Use the PCOC resource ‘Quick Guide to Audits’

6. How to Audit- Preparation and management
Determine the resources required.
Schedule the date to commence the audit. One-off, regular or continuous.
Determine processes for data management. Paper based or computer based.
Establish the process and method for feedback. Who and How.
Tip: Conduct audits in pairs or in teams.

7. How to Audit- Staff engagement and support
Communicating with relevant staff at all levels, is essential to ensure they understand and support the aims of the audit and the improvement that may need to be made.
Consider the use of flyers, s, posters and presentations

8. How to Audit- feedback
Establish the process for feedback, by which audit results can be fed back into organisation decision making and quality improvement processes.
Consider verbal, visual and written methods
Summarise key messages for improvement
Feedback to all staff involved in using the assessment and response framework

9. When to Audit- the PCOC report cycle 1
Review current patient outcomes report
Identify areas for audit
Identify appropriate audit tool
Conduct audit
April & October
Review next report
May & November

10. When to Audit- the PCOC report cycle 2
Conduct audit
April & October
Review audit results against outcome report
Align improvement actions accordingly
Implement change / intervention
May & November
Review next outcome report

11. When to Audit- the PCOC report cycle 3
April & October
Review outcome report
May & November
Review next outcome report for evidence of improved outcomes
Repeat audits if necessary

12. The PCOC Audit tools
Response to PCOC Assessments helps identify areas for improvement in documenting the five clinical assessments
PCPSS Quality Improvement Audit supports consistent use of the PCPSS assessment between clinicians
Phase Assessment Quality Improvement Audit supports consistent use of the phase assessment between clinicians
Phase Change Quality Improvement Audit helps identify areas for improvement in documenting phase change
Phase Definition Quality Improvement Audit helps identify areas for improvement in applying phase definitions
SAS Quality Improvement Audit helps to compare the difference between clinician (proxy) SAS scores and patient self-assessed scores

13. Case Scenario
North East community palliative care service have just received their latest PCOC report. In this report they notice the terminal phases do not match the number of deaths. They “data dive” and find they had 40 patients who died outside of the terminal phase.
These results are discussed at a team meeting and they decide to investigate with an audit
Data dive is a technique used to follow a particular issue or outcome through PCOC report

14. CASE SCENARIO - Audit
Which audit tool/s should they select and how many of the 40 patient cases should they audit?
Response to assessments. 40 patient cases
Phase Change. 40 patient cases
Phase Definition. 10 patient cases
Phase Definition and Phase Change. 10 patient cases
The answer is D
Both tools can be used in combination to understand if there are issues with detecting the terminal phase change or applying the terminal phase definition.
10 patient cases is adequate to detect trends.
pcoc.org.au

15. Case Scenario
During a multidisciplinary team meeting it becomes apparent that not everyone is using the Problem Severity scale in the same way.
To improve the use of the PCPSS the team decide to conduct an audit

16. CASE SCENARIO - Audit
Which audit tool/s should they select and how many patients should they audit?
Response to assessments. All current patients
Phase Change. 10 patients
PCPSS comparing assessments. 10 patient
SAS comparing assessments. All current patients
The answer is C
This tool compares the scores of two clinicians using the PCPSS at the same time. It helps to identify focus areas for improvement in the way the tool is used.
pcoc.org.au

18. PCOC is a national palliative care project funded by the Australian Government Department of Health
Thank You
pcoc.org.au
Prepared by Clapham S for the Palliative Care Outcomes Collaboration (2018) Australian Health Services Research Institute (AHSRI), University of Wollongong, NSW 2522 Australia. © PCOC 2018
For further information please view the resources contained in the PCOC Clinical Manual, go to or contact your PCOC Facilitator