Rhona Hughes

January 2016

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Improving the quality ofpatient care by looking at current

practice and modifying it where necessary.

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Research◦ Find out what you should be doing

◦ Seek new knowledge

Audit◦ Tells you if what you are doing is what you should be

doing

◦ Reviews current practice to stimulate change

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Audit Today

General Medical Council“ All doctors must take part in regular and

systematic clinical audit.” Nursing and Midwifery Council

“Clinical audit is the business of every registered practitioner.”

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Clinical audit is a part of clinical governance

Required by

◦ The Government (our employers)

◦ The GMC (our regulatory body)

◦ Our insurers (MPS, MDU)

◦ Our professional bodies (RCOG)

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Improves delivery of health care. Highlights deficiencies. Highlights good practice to patients and staff. Promotes change. Ensures standards exist and raises them. Improves team work.

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Identify an audit topic Define objectives Identify standards Develop methodology Data Collection Data analysis Review results Plan and implement / sustain improvement ? Re-audit

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Relevant

Potential benefit◦ To patient or to the organization

Must have a known standard.

Your area of interest.

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Own speciality or multidisciplinary

High risk or

Common

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◦ Thromboprophylaxis following caesarean section (CS)

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Identify an audit topic Define objectives Identify standards / criteria Develop methodology Data Collection Data analysis Review results Plan and implement / sustain improvement ? Re-audit

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To ensure that:◦ Women undergoing caesarean section have a VTE risk

assessment performed◦ Women undergoing caesarean section receive the

appropriate post-op thromboprophylaxis

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Identify an audit topic Define objectives Identify standards Develop methodology Data Collection Data analysis Review results Plan and implement / sustain improvement ? Re-audit

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RCOG guideline NICE guideline SIGN guideline Hospital protocol

Possible standards for VTE audit?

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l Possible standards for VTE audit:◦ Weight, height, BMI recorded for all women◦ Risk assessment documented◦ TEDS / LMW heparin or both◦ Thromboprophylaxis started at right time◦ Advice about hydration and mobilisation

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Identify an audit topic Define objectives Identify standards / criteria Develop methodology Data Collection Data analysis Review results Plan and implement / sustain improvement ? Re-audit

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?Prospective ?Retrospective

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Prospective◦ Audit proforma completed for every CS over a specified

time scale.◦ People change practice when monitored

Retrospective◦ Case note review◦ Data collection sheets◦ Risk of missing the inclusion of some patients

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Plan methodology in detail.

Keep it simple.

Allow sufficient time.

Share ownership, involve others.

Carry your colleagues with you.

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Identify an audit topic Define objectives Identify standards / criteria Develop methodology Data Collection Data analysis Review results Plan and implement / sustain improvement ? Re-audit

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Data Collection –how?

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Computer registers - Theatre registers

- Pharmacy registersReview of content of medical recordsData collection PerformaQuestionnaires - Patients, staff

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Identify an audit topic Define objectives Identify standards / criteria Develop methodology Data Collection Data analysis Review results Implement changes ? Re-audit

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How?

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Identify shortcomings and potential causes Never attribute any failures to individuals Identify specific improvements needed. Make practical and specific recommendations. Time scale for implementing the recommendations Presentation to all staff Positive feed-back Action plan

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Development and implementation of new guidelines.

Changes in procedures or systems. Staff education. Individuals named as responsible for actions. Deadlines for actions.

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Select a Topic(what should be happening)

Observe Current Practice(What is happening?)

Compare with Standard/Guideline(What changes are needed?)

ImplementChange

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Re-audit at a specified date - ensure that the actions taken have resolved the problems identified

Ongoing monitoring provides feedback to sustain improvements

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Plan Do Study Act

PDSA

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