MEDICAL AUDIT Evaluation of data, documents, and resources to check performance of systems meets specified standards PRESCRIPTION MONITORING, ADR, DRUG RELATED PROBLEMS, staff safety, data,defining standards, collecting data, identifying areas for improvement, making necessary changes back round to defining new standards.

1. Medical Audit
Sourabh Kosey
Department of Pharmacy Practice
I.S.F. College of Pharmacy, Moga

2. Frame work
1. What is audit?
2. What is medical audit?
3. Why audit?
4. Audit versus research
5. The quality cycle
6. 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. Quality cycle
Identify
barrier
Correct
the
problem
Prevent
future
problems
Identify
problems

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:
o Involve ALL the people concern.
o Time and resources
o Access the evidence
o Methodology
o Pilot
o Report and Action
o Re-audit
o Data collection instrument
o 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
o Aim /objectives
o Methodology
o Results /conclusions
o Applicable to your patient group
o 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
o identification of local barriers to change
o support of teamwork
o 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:
o monitor and evaluate the change
o 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

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