1. Lack of time

2. Lack of access to local clinical audit experts

3. Lack of training in clinical audit skills, e.g. questionnaire design, change management, report writing, etc

4. Confusion over how clinical audit differs from research, service evaluation, etc

5. Lack of management support for clinical audit

6. Problems with clinical data, e.g. accessing records and/or concerns that data is not accurate

7. Fear that clinical audit will be used negatively, e.g. blaming staff

8. Perception that clinical audit is dull/boring

9. Inability to choose clinical audit topics, i.e. audit is ‘done to’ staff, not led by them

10. Problems identifying or agreeing what is best practice

11. Perception that clinical audit does not make a difference

12. Difficulties in identifying appropriate topics to audit