1. Training and educating the clinical team in effective clinical audit practice Gaynor Smith Dr Anthony Choules Burton Hospitals NHS Foundation Trust

2. If something’s worth doing… Developing a clinical audit training programme for the clinical team Empowering junior doctors to take an active interest in clinical audit and coordinating activity into an integrated audit programme Developing a directorate clinical audit programme in practice

3. Burton NHS Foundation Trust Junior Doctor Patient Safety Forum S Wren, D Clutton, G Dimitropoulos What’s this then? It’s a collaboration between the patient safety lead, audit department, clinical education team and junior doctors, we meet once a month though we get support throughout Why? Because too often we become bogged down with repetitive tasks and don‘t see the bigger picture! It’s brilliant, we’ve covered some really important topics already like venous thromboembolism prophylaxis, oxygen therapy and IV cannula care. We’ve had talks from airline pilots as well as consultants and we actually feel like we make a difference! Sounds great! I’ll definitely come along, I think every hospital should have a group like this! What do you do there? Special thanks to Dr Choules, Dr Vickers & Ruth Turner, medical photography

5. Why do QA projects ? Trusts need quality improvement/audit projects to be done –To ensure patient safety –To improve patient care –To satisfy monitoring processes

6. Why do QA projects ? Junior doctors are required to do quality improvement projects –To learn how important they are –To pass their training –To show leadership skills But: –They rotate frequently –They don’t always understand what they are looking at –The are not always well placed to lead change

7. The Plan Meaningful audits –Trust wide –Large scale –Longer timescale Enthusiastic supervisors Good logistic support An opportunity to implement change and improve patient care Fulfilling requirements of Trust and trainee doctors

8. Topics Communication of DNAR Communication of deceased patients VTE prophylaxis Handovers Documentation Consultant First review Self harm in Emergency Department Consent

9. Timeline Aug/Sept: Assign topics/groups Introduction to audit Sept/Oct: Meet supervisor, plan and obtain approval Oct/Nov: Gather data and process Dec: Clinical Audit Showcase –Presentation –Plans –Prizes

10. Timeline Jan/Feb/Mar: Implement changes Apr: Re-audit May: Clinical Audit Showcase –2 nd Presentation –Prizes

11. Results High standard of audits Feedback demonstrated the effectiveness of the training and understanding of the clinical audit process Some changes were made… Good publicity ( Inside and outside the Trust) eportfolio sign-off/publications Leadership skills

12. Results Handover audit - Standardized handover order of proceedings - Implementing poster in handover room Consultant First Review - PTWR proforma to become part of a generic notes – better recording of EDD and diagnosis, VTE prophylaxis etc…

13. Poster for the handover room

14. PTWR proforma

15. PTWR proforma cont

17. “They have helped to engage us, as junior doctors, in the audit process of the trust and, therefore, instilled in us the skills and enthusiasm to play an active role in quality improvement projects in the future.”

18. Publicity Joint Foundation Programme Sharing Event The National Association of Clinical Tutors (NACT) Clinical Audit Support Centre winners! NHS local website International presentations

19. Our poster for the FP shared event

21. Publicity www.learning.nhslocal.nhs.uk /best-practice/medicine/programme- improve-audits-junior-doctorswww.learning.nhslocal.nhs.uk

22. Taking things forward Smaller groups Access to eportfolio FY2’s New topics More consultant supervisors Wider interest across the Trust

23. Workbooks Just one workbook – As a tool

24. New Topics for 2012-13 Surgical Handover IV vs Oral drugs Catheters and incidences of UTI Frequency of common pathology blood tests Urgent Cancer referrals Documentation Oxygen prescribing Re-Admissons Use of Gentamicin

26. Key benefits Trainees learnt leadership skills Consultants got a willing workforce Rekindled enthusiasm for audit/QA Developed relationship with Trust chairman/NEDs/board Junior staff felt valued

27. Key Messages A Trust wide, collaborative approach allows focus on more meaningful audits and better opportunity for re-audit Generates enthusiasm across the Trust Enhanced experience for juniors Training junior doctors properly in audit is an investment for the future

29. What’s next? More great quality Audits/Quality improvement projects Gaynor.Smith@burtonft.nhs.uk Clinical Audit Department Burton Hospitals NHS Foundation Trust Anthony.Choules@burtonft.nhs.uk Postgraduate Clinical Tutor Burton Hospitals NHS Foundation Trust