Clinical audit in health care
Thyrotoxicosis is a common condition in which there can be problems with both diagnosis and the provision of well controlled, effective treatment. The experiences of a patient led to the development of a project between primary and secondary care in which a patient was a key member of the multi-disciplinary steering committee and actively involved in all stages of the project. Involvement of the patients and access to their views and suggestions provided valuable insight for clinicians into all aspects of the investigation and management of thyrotoxicosis.
The project aimed to determine whether:
• Assessed standards relating to the diagnosis of thyrotoxicosis (must be confirmed by biochemical results)
• Assessed standards to ensure medical treatment was continued for the recommended minimum 12 month period
• Assessed standards to ensure biochemical status was regularly monitored
• Assessed standards to ensure that referrals to endocrine specialists were seen within one month
• Patients felt sufficiently informed about their condition and its management
An appropriate sample of patients was identified by the GPs. Clinical management was followed through primary and secondary care and patient’s views of the service were sought using a written questionnaire that was designed in conjunction with the patient from the steering group.
The project demonstrated variations in referrals and clinical management. Delay in diagnosis was a problem for several patients and there was a general need for better information about the condition and its treatment.
Specific outcomes included
• Presentation by patient representative of findings from the questionnaire at a GP study day and a major clinical education meeting in secondary care
• Production of local guidelines for GPs
• Introduction of an open access thyroid clinic in secondary care
• Improvements in patient information including the provision to patients of graphical print-outs of biochemical results
• Improved links and support from secondary care for primary care nurses
Drug administration constitutes one of the highest risk areas of nursing care and a drug error is likely to be the adverse clinical event most feared by practising nurses. In its entirety, drug administration consists of a complex chain of events, involving different members of staff and several professional groups. Drug errors may arise as a result of a fault at any part of this chain.
The project methodology was developed and subsequently reviewed by the local ethics committee.
The hospital has used the project to:
• Ensure safe and accurate drug administration to patients
• Improve clinical practice in the multi-professional team
• Provide evidence to support the planning and implementation of educational input and managerial changes
The project employed a range of qualitative techniques such as observation and in-depth interviews. The project identified confusion regarding defining and reporting drug errors, fear of disciplinary action and lack of updating in drug administration skills.
Outcomes of the project have included:
• Review of pre and post registration education programmes relating to drug administration
• Introduction of a trust wide policy for managing and supporting nurses involved in drug incidents
Explain how clinical audit relates to the wider clinical governance agenda (guideline 100-200 words).
List and provide examples of the clinical audit obligations for the organisation that you currently work in (guideline 100-200 words).
Assess the actual/potential benefits of clinical audit and explain why it is important that clinical audit is carried out by healthcare staff. If you have previously taken part in clinical audit projects you may wish to reflect upon past experiences and identify how clinical audit has led to changes and improved patient care (guideline 300-500 words).
Provide a clear definition of clinical audit criteria and standards and supply a suitable example (guideline 100-200 words).
Critique the following examples and determine whether they represent well-written and accurate criteria and standards. Provide reasoning for your answers. If you feel that the criteria and standards could be improved you may wish to devise what you consider to be a more appropriate criteria and standard for measuring care (guideline 100 words for each).
1. Diabetic patients should have their feet and eyes checked annually (100%)
2. The front sheet of the patient record should include the following information: patient name, NHS number, date of birth, patient’s address (100%)
3. Patients over 65 should be offered an influenza vaccination annually (100%)
It is important to ensure that clinical audit data is representative of the wider population being audited.
Working on a confidence level of 95% (+/-5%) please provide an accurate sample size needed for audit data collection for the patient populations below:
PATIENT POPULATION AUDIT DATA COLLECTION SAMPLE
Please devise a simple documentation audit that could be used to assess the quality and accuracy of patient information. In the first instance you are required to research, develop and write a minimum of ten appropriate criteria and standards that could be used to assess documentation. Please provide background to the documents that your audit will focus on and list the criteria and standards. It would also be helpful if you can provide references in relation to best practice sourced to develop the criteria and standards (e.g. Royal College of Physicians ‘Generic medical record keeping standards’.
Provide background to documents being audited, e.g. why this area was selected, how data is stored (e.g. paper-based/electronically), how data will be accessed, how criteria and standards have been agreed and devised, etc. (guideline 100-200 words).
Table attached – Please list your criteria and standards in the table below. If there are more than ten criteria/standards please add to the table provided. To assist you, an example has been given.
Please devise a suitable data collection form that could be used to carry out the documentation audit that you have developed. The form should be user-friendly and well constructed. The form should contain no patient identifiable data and all criteria and standards must be covered via this document.