CLINICAL AUDIT: WHERE TO START?

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1 CLINICAL AUDIT: WHERE TO START? Gillian Whyte Clinical Audit Facilitator (RGN, RNT, DipN, BNS, H.Dip, MSc, PgDip NurEd) Honorary Teaching Associate Faculty of Nursing and Midwifery RCSI Definition of Clinical Audit Clinical audit is defined as: a clinically led, quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and to act to improve care when standards are not met. (The Commission on Patient Safety and Quality Assurance 2008, p152)

2 The value of clinical audit The Commission (2008, p12) also states that clinical audit constitutes the single most important method which any healthcare organisation can use to understand and ensure the quality of the service that it provides. Clinical Governance Learning from other hospitals experience, learning from other wards/ specialties Changing practice- bare below elbow, alcohol gels, suggestions?? Hand hygiene training, Audit training Getting patients involved in hand hygiene Monitoring practice- Hand Hygiene Audit*** Reviewing complaints and incidents re hand hygiene What does audit tell us? Are we doing what we should be doing? If not why not? If not, do we need to change practice? Do we need more training? ii Is the guideline / policy not reflective of best practice?

3 WHAT DO YOU KNOW ABOUT AUDIT? Clinical audit is recognised as having three elements: 1. Measurement-Measuring a specific element of clinical practice 2. Comparison-Comparing results with the recognised standard (in circumstances where comparison is possible) 3. Evaluation -Reflecting the outcome of audit and where indicated, changing practice accordingly. Audit v Research

4 Audit Cycle Choosing topics Start with the change in mind Clinical Audit Programme- should link to Clinical Governance Donabedian s model of Quality- Structure- facilities, staff, skills Process- what we actually do Outcome- results Our topic Segregation and Disposal of Linen Aim: To prevent infection from contaminated linen

5 Developing an audit team Self-audit- own practice only Uni-professional audits and peer review Multi-professional audit Hospital wide audit Regional audits National audits Standard setting A standard is an explicit statement describing the quality of care to be achieved, which is definable and measureable Standards In real world audit standards based on local standards e.g. guidelines/ protocols/ policies Specific- unambiguous Measurable- need to be able to make comparisons Achievable Research based Timely- current

6 Follow the directed route Data Collection What to collect? Each item based on a standard Don t be tempted to collect info just because it s available Data Collection Timeframe: Retrospective Concurrent Audit Team Sources of data e.g. Patient records Lab reports Drug records Radiology reports Observations of practice HIPE Staff Patients Family Databases

7 Audit tool 1 Clean linen is stored in a clean designated area separate from used linen (not in the sluice or bathroom) 2 Clean linen is free from stains (randomly check linen) 3 Clean linen store is clean and free from dust 4 Clean linen store is free from inappropriate items 5 Linen is segregated in appropriate colour coded bags according to policy 6 Bags are less than 2/3 full and are capable of being secured 7 Bags are stored correctly prior to disposal 8 Linen skips and the appropriate bags are taken to the area required. (Staff are not carrying soiled linen or leaving it on the floor) 9 Gloves and apron are worn when handling contaminated linen Analysing Audit Data Convert data into useful information Look for Patterns Identify how going to analyse before you collect data If the results are to change practice, the analysis must be simple enough for everyone to understand K.I.S.S. Statistical Analysis Very much Amount of Info ormation Some Percentages Frequencies Mean, Range Confidence Intervals Descriptive statistics Difference in means, Cross tabulations Multiple Regression Simple Complexity Complex

8 Percentage Compliance= Mean Calculation example Ward Name Oak Ward Oak Standard Stored in a clean designated area No Clean linen is free from stains Clean linen store is clean and free from dust Clean linen store is free from inappropriate items Linen is segregated in appropriate colour coded bags according to policy Yes No No Yes Standard Bags are less than 2/3 full and are capable of being secured Yes Bags are stored correctly prior to disposal Yes Linen skips and the appropriate bags are taken to the area required. Yes Gloves and apron are worn when handling contaminated linen Yes Percentage Compliance= Mean Correct answers= 6 (Numerator) Number of criteria/ questions= 9 (Denominator) 6 x 100 = 66.6% or 67%

9 Writing Clinical Audit Reports Know your audience Who s going to read the report? Know your key message What do you want people to know? Why you did it; What you did; What you found; What it means; What you going to do about it. Remember- Your audit report is an official record of the audit project Quality Improvement Plan Standard Action Person Responsible Clean linen store is clean and free from dust Linen cupboard to be cleaned weekly and a record signed off Minnie Mouse Attendant Date for completion ongoing Stored in a clean Designated area for all non Donald Duck designated area linen items currently in the CNM linen room to be allocated Clean linen store is free from inappropriate items Inappropriate items to be removed from the linen room Minnie Mouse Attendant Where does the report go? Line Manager Departments affected by the audit Service Manager Governance Committee

10 Other methods of dissemination Presentations to ward staff, governance groups, audit groups, department meetings, conferences Poster presentations for conferences, local events Change Quality Improvement If you change nothing, Nothing will change

11 Other audit examples re HCAI Hand hygiene audits Environmental audits Sharps management Waste management Linen management Antimicrobial prescribing Prevention of Urinary Catheter HCAI Prevention of Vascular Catheter HCAI Where do I get audit tools Health Protection Surveillance Centre Hand hygiene audit tool Infection Prevention and Control for Primary Care in Ireland

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14 Sample Audit Programme Hand Hygiene Environmental audits Sharps management Waste management Linen management Antimicrobial prescribing Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Recap Keep it simple Always start with the standard Don t reinvent the wheel Complete the cycle with action plan, action and re- audit Aim for quality improvement Don t forget the reason you started the audit- patient safety!!