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How do I carry out a clinical audit? This section summarises the main stages in carrying out an audit. For more detail on each of the stages here to access the United Bristol Healthcare site. Your organisation may require you to register an audit. To find out if this is required contact your clinical effectiveness/governance support. (link to website NHS Board contact list – not available as yet) 1. Choose your topic What makes a good topic? · Agreed problem · Important · Good evidence · Measurable · Amenable to change · Achievable within your resources (IT, space, financial and human) What is an important topic? · High level of concern · High impact on health of patients or resources · Common procedures or conditions What are your organisational priorities? · National standards or guidelines · NHS Board priorities · local audit programme · Local problems and priorities · User views or complaints 2. Define your Aims and Objectives · Aims Why are you doing this project? What are you hoping to achieve? · Objectives How specifically will you achieve your aims? What will you improve and assess? 3. Set your Standards If you are looking critically at clinical care you need to identify evidence of good practice as a basis for setting standards. More information on appraising and using evidence is available in the Evidence and its Uses Unit (hyperlink to evidence and its uses unit) Where do you get your standards from? o National guidelines, standards & local priorities o Other teams o Establish baseline standards Once you have established your standards 1
· State your Criteria – elements of care or activity, which can be measured · Set your desired level of performance or target (usually a percentage) Standard: Patients with a diagnosis of diabetes mellitus should be reviewed every 6 months (British Hypertension Society guideline 2004) Criteria: All should have a BP check Target: 30% to have a BP of <140/<80 mmHg Clinical audits usually involve looking at information already collected about a patient or treatment. However issues of confidentiality and unsound practice have to be considered. Each NHS Board has an ethics committee that meets regularly to assess research and special interest projects. If you have any questions relating to ethical issues related to an audit it is useful to speak to someone from the committee or the research department. 4. Collect your data. Agree your method In the NHS we collect lots of data but how much of it is used to make useful, informed decisions about improving patient care? Before you design a data collection tool, check what information you collect at the moment. Consider · Retrospective (trawl existing records)or prospective (collect data from now) · Who is your target population? · What data will you collect? (only what is absolutely necessary) · Who will collect the data? · Where will you get the data from? · What time period will you use? (i.e. start date and finish date) · How will you select your sample? (how many subjects do you need) Data collection – Key points · Develop a simple data collection form based on the information you want to collect. · Check it out with colleagues to make sure that it is giving you the data you need to know. · Don’t be sidetracked into collecting information that is interesting rather than useful. · Remember to anonymise any personal data so that patients are not recognisable. Sources of data · Clinical records · Disease or activity data sets · Survey/questionnaire · Interview. If you are undertaking a large audit or are using unfamiliar data collection tools, PILOT first. 5. Analyse your data · Make sure you leave time to analysis your data · Do you need statistical help? · Use spreadsheets if you can · Present your data in a clear, understandable and visually appealing way 6. Interpret your data. 2
· What does it mean? · How does it compare with your target? · Look carefully at those that didn’t meet the target 7. What changes need to be made? To help you implement changes, develop an action plan · Do you need to look at something in more detail? · Is it clear what changes need to be made? (If not, you may need to look in more detail at a specific part of treatment e.g. use run charts to track variation) · How are you going to implement changes? · Who needs to be involved? · What new resources do you need? 8. Make the changes. · Set new targets · Tell people what you’ve done o Your colleagues and manager o Audit newsletter o Poster display at local events o Present or display findings at national events · Reaudit your practice with the changes, check standards. Clinical audit is about improvement. If you are not changing or improving things as a result of audit then ask yourself why am I doing this? You may need to rethink your audit priorities or get others involved. 3