1. Medical Audit

2. Frame work What is audit? What is medical audit? Why audit?
Audit versus research
The quality cycle
Stages of medical audit

3. What is audit?
Evaluation of data, documents and resources to check performance of systems meets specified standards.
Audit in the wider sense is simply a tool to find out what you do now; this often to be compared with what you have done in the past, or what you think you may wish to do in the future.

4.  What is medical audit
“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.”
An audit is a cyclical process
-defining standards,
collecting data,
identifying areas for improvement,
making necessary changes
back round to defining new standards.

5. Why audit? Maintain participant and staff safety.
Maintain data quality .
Protect reputation of staff, host and sponsorer
Protect current and future funding
Improve quality.
It does not involve experiments
It uses data that already exists

6. Audit:- are we doing the best thing in the best way?
Measures current practice against specific standards
Never experimental
Uses data in existence by virtue of practice
May require ethical approval
Aims to improve delivery of patient care

7. Research:- What is the best thing to do/the best way to do it
Provides sound basis for medical audit
Involves experimental trials
Uses detailed data collection
Needs ethical approval and registration
Aims to add to body of scientific knowledge

8. Prevent future problems
Quality cycle
Identify
barrier
Prevent future problems
Identify problems
Correct the problem

9. Five stages of clinical audit

10. Stage 1: Preparing for audit
Involving users
Selecting a topic
Defining the purpose
Planning

11. Stage 1: Preparing for audit continue…….
Involving users:
genuine collaborators
sources of data
The concerns of users can be identified from various sources, including: -Letters containing comments or complaints -Critical incident reports -Individual patients’ stories or feedback from focus groups -Direct observation of care -Direct conversations

12. Stage 1: Preparing for audit continue…….
Selecting a topic:
starting point
careful thought and planning
There seems little point in trying to audit a rare condition, with a cheap intervention with a fairly superficial outcome

13. Stage 1: Preparing for audit continue……. Selecting a topic:
Tool for prioritise audit topics questions:
Is the topic concerned of high cost, or risk to staff or users?
Is there evidence of a serious quality problem?
for example patient complaints or high complication rates?
Is there potential for involvement in a national audit project or pertinent to national policy initiatives?
Is the topic a priority for the organisation?
Is good evidence available to inform standards?
for example systematic reviews or national clinical guidelines?

14. Stage 1: Preparing for audit continue…….
Defining the purpose
purpose must be established before appropriate methods for audit can be considered.
Once topic selected, purpose define then suitable audit method can be chosen.
The following series of verbs may be useful in defining the aims of an audit to improve to enhance to increase to change to ensure

15. Stage 1: Preparing for audit continue…….
Planning:
Involve ALL the people concern.
Time and resources
Access the evidence
Methodology
Pilot
Report and Action
Re-audit
Data collection instrument
All these should be documented.

16. Stage 2: Selection criteria
Defining criteria
Sources of evidence
Appraising the evidence

17. Stage 2: Selection criteria continue………
Definition of criteria:
an individual, a team, or an organisation
This can include assessment of the process and/or outcome of care
The choice depends on the topic and objectives of the audit.
They should relate to important aspects of care and be measurable.

18. Stage 2: Selection criteria continue………
Sources of evidence:
Systematic methods should be used
. good-quality guidelines
. reviews of the evidence
. previously use criteria for same purpose
. Measurement of outcome
Can develop own standards.
reference to levels achieved in audits undertaken by other professionals is useful.

19. Stage 2: Selection criteria continue………
Appraising the evidence:
-Evidence needs to be evaluated to find out if it is valid, reliable and important
Aim /objectives
Methodology
Results /conclusions
Applicable to your patient group
Bias/ causes for concern

20. Stage 3: Measuring level of performance
Planning data collection
Methods of data collection
Handling data

21. Stage 3: Measuring level of performance continues…….
Planning data collection:
the data collected are precise
Essential
User group to be included
Examples 1.All children under 16 years diagnosed with asthma and registered with the primary healthcare team.
2. All women receiving treatment for breast cancer in M.G.I.M.S

22. Stage 3: Measuring level of performance continues…….
Methods of data collection: Do not try and collect too many items,keep it simpleaand short.
- Computer stored data,Case notes/Medical Records,Surveys , Questionnaires, Interviews
Focus Groups, Prospective recording of specific data
- How will this be done? -Compare performance against the criteria -Keep focused on the objective of the audit

23. Stage 3: Measuring level of performance continues…….
Handling data:
ethical implications of and their responsibilities under the Data Protection Act (1998) when collecting data and presenting results.

24. Stage 4: Making improvements
Identifying barriers to change
Implementing change

25. Stage 4: Making improvements continues……..
Identifying barriers to change
- Fear
- Lack of understanding
- Low morale
- Poor communication
- Culture
- Pushing too hard
- Consensus not gained

26. Stage 4: Making improvements continues……..
Implementing Change:
systematic approach
identification of local barriers to change
support of teamwork
use of a variety of specific methods

27. Stage 5: Sustaining improvement
Monitoring and evaluation
Re-audit
Maintaining and reinforcing improvement

28. Stage 5: Sustaining improvement continues……..
Monitoring and evaluation
- systematic approach to changing professional practice should include plans to:
monitor and evaluate the change
maintain and reinforce the change

29. Stage 5: Sustaining improvement continues……..
Re-audit
-Review evidence
-Measure effectiveness
-Decide how often to re-audit
- Ongoing process monitoring
-Adverse incidents
-Significant events audit

30. Stage 5: Sustaining improvement continues……..
Maintaining and reinforcing improvement
reinforcing or motivating factors built in by the management .
integration of audit
strong leadership