Clinical audit resources

Clinical audit resources GLOSSARY OF TERMS TERM Audit assistant Clinical audit action plan Anonymity Check-list Clinical audit Clinical audit cycle Clinician Closing the loop Confidence interval Consensus Criteria Data Data collection tool Effectiveness Exception/ non-applicable Feedback MEANING A member of staff whose role is to provide support for audit activities, e.g. advising on methodology. A plan which details what needs to change, how, by whom, etc. as a result of the clinical audit findings. Remaining nameless in terms of clinical audit this involves ensuring that people s identities are not disclosed (service users and staff). A comprehensive list containing the criteria you are measuring in the clinical audit project often used for data collection purposes. The systematic and critical analysis of the quality of clinical care (provided by all health care professionals), using the clinical audit cycle as a framework. Provides the basic framework for the clinical audit process by identifying a series of key stages (e.g. selecting a topic, setting standards, designing the audit, collecting data to enable comparison of actual practice with standards set). The ongoing nature of the clinical audit process is shown by the cycle. A person who provides direct care to patients/service users, e.g. clinical psychologist, psychiatrist, nurse. Completing the clinical audit cycle by: (a) implementing changes in practice as a result of initial clinical audit (b) repeating the clinical audit process (a re-audit) to ensure that the changes have been effective. The confidence interval quantifies the uncertainty in measurement; usually reported as 95% confidence interval which is the range of values within which we can be 95% sure that the true value for the whole population lies. An agreement reached by a group of people. Defined and measurable statements about health care. A criterion forms the main body of a standard statement. Quantitative and/or qualitative pieces of information which, in clinical audit, are used to assess the quality of clinical practice and services provided. An instrument used to obtain the information required for the clinical audit project, e.g. a questionnaire, an interview schedule The benefits/outcomes achieved in relation to previously identified aims and objectives. That which is excluded. In clinical audit projects certain cases are sometimes deemed as exceptions or non-applicable because they do not meet standards for clinically acceptable reasons. The process by which progress and findings are communicated to the necessary stakeholders. This should ideally occur on a frequent basis. Clinical audit resources 119

Guidelines Intervention (clinical) Medical audit Multi-professional/ multi-disciplinary National standards Objective Protocol Prospective data Pilot ilot study Qualitative data analysis Qualitative data collection Quantitative data analysis Quantitative data collection Re-audit Reliability Retrospective data Sample Service evaluation Service user Stakeholders These are statements which are systematically developed to assist individuals in making decisions about the most appropriate treatment/intervention/course of action for a particular clinical circumstance. A therapeutic treatment or associated activity aimed to improve the quality of life for a service user. As for clinical audit apart from the fact that it only examines the work of doctors. Individuals from a range of professional disciplines e.g. psychiatry, nursing, psychotherapy etc. Standards which are set by professional bodies or the Department of Health. A clinical audit objective is a statement defining the purpose of the project - what it intends to measure, why, how and with what aim. A formal document containing a system of rules describing the correct way to behave in certain situations i.e. what to do, how and in what order. Information required for a clinical audit project which has not been previously collected and is therefore not available. The data therefore has to be collected in the future in order for the clinical audit project to be completed. Testing your clinical audit design, data collection tools etc. and trying to locate and overcome any problem areas by carrying it out on a small sample before embarking on the main clinical audit project. Processing and interpretating non-numerical data, e.g. words and text. Gathering non-numerical data such as words and texts through various techniques, e.g. interviews and observations. Processing and interpretation of numerical data. Gathering primarily numerical data through various techniques e.g. structured questionnaires, measuring scales, physiological measurements. A repeat of the clinical audit cycle. The consistency with which a clinical audit tool measures what it is supposed to be measuring i.e. does it give the same result if repeated under similar conditions? Information required for a clinical audit project which is already available since it relates to care/services received in the past. A subgroup of a population which is selected in such a way (usually at random) that it is representative of the population from which it was taken. Inferences can therefore be made from the subgroup about the whole population. An examination of a service s merit by systematically assessing its aims, objectives, activities, costs and outcomes. Any individual who receives a particular service. In this book, service user and patient are used interchangeably. Individuals or groups who have an interest/concern in a clinical audit project, i.e. those who could potentially be affected by the clinical audit process and its findings. 120

Standard Structure/process/ outcome Structure Process Outcome Target Uni-professional Validity A standard is a statement which outlines an objective with guidance for its achievement given in the form of criteria sets which specify required resources, activities and predicted outcomes (Royal College of Nursing, 1990). Terms originally devised by Donabedian (1966) which are used to categorise clinical audit topics. The availability and organisation of resources. The activities undertaken (e.g. clinical interventions etc.). The effect of the activities on the health/well-being of the service user. The degree of compliance with a particular criterion, considered acceptable (e.g. 80%, 75%). Standard statements should, where possible, contain a target. Professionals from a single discipline. The degree to which an audit tool measures what it is supposed to be measuring. Clinical audit resources 121

ORGANISA RGANISATIONS NATIONAL CLINICAL CENTRES AND PROJECTS CAA (UK CLINICAL ASSOCIATION) Cleethorpes Business Centre, Jackson Place, Wilton Road, Humberston, North East Lincolnshire DN36 4AS Tel/Fax: 01472 210 682; http://www.the-caa-ltd.demon.co.uk/ Promotes clinical audit and supports members in the provision of quality audit. Offers advice and literature references. Database of published clinical guidelines for clinical care. Organises workshops and conferences. Publishes Network a newsletter for clinical audit professionals. CRAG (CLINICAL RESOURCE AND GROUP) CRAG Secretariat, Room 159, St Andrew s House, Regent Road, Edinburgh EH1 3DG Tel: 0131 244 2235 Manages nationally funded audit projects. Disseminates audit information. CRU (COLLEGE RESEARCH UNIT) MULTI-CENTRE PROGRAMME The Royal College of Psychiatrists Research Unit, 11 Grosvenor Crescent, London SW1X 7EE Tel: 0171 235 2351, ext. 234; Fax: 0171 235 2954; e-mail: scoombs@rcpsych.ac.uk This is a continuous programme of national multi-centre clinical audit projects which include: the Care Programme Approach the prescribing of antipsychotic medication the management of violence. ELI LILY NATIONAL CLINICAL CENTRE Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW Tel: 0116 258 4873; http://www.le.ac.uk/clinaudit.html Conducts research into method for quality and clinical audit within primary health care settings. Maintains a database of clinical audit projects (published and unpublished). Offers advice and clinical audit protocols clinical areas in primary health. Offers workshops, seminars and conferences. Publishes Audit Trends a quarterly journal for primary care which includes clinical audit methods, examples and reviews. FOCUS The Royal College of Psychiatrists Research Unit, 11 Grosvenor Crescent, London SW1X 7EE Tel: 0171 235 2351, ext. 256; Fax: 0171 235 2954; e-mail: carol.joughin@virgin.net A project which promotes effective practice in child and adolescent mental health services. Collates and disseminates up-to-date knowledge of effective practice in CAMHS. Developing a database of clinical audits in CAMHS to support services. 122

KING S FUND 11 13 Cavendish Square, London W1M 0AN Tel: 0171 307 2400 Public library containing a large range of publications and journals on clinical audit. Provides database searches. NCCA (NATIONAL CENTRE FOR CLINICAL ) BMA House, Tavistock Square, London WC1 9JP Tel: 0171 383 6451; Fax: 0171 383 6373; e-mail: NCCA@ncca.org.uk; http://www.ncca.org.uk Provides a national clinical audit service. Has a database of clinical audits. Provides information and literature searches on clinical audit. SCARC (SCOTTISH CLINICAL RESOURCE CENTRE) University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX Tel: 0141 330 6190; Fax: 0141 330 6192; e-mail: scarc@pgn.gla.ac.uk; http://info.gla.ac.uk/acad/pgmed/scarc/ Information and library services database searches and literature. Has a CRAG clinical audit project register. Offers advice and training workshops in clinical audit. ROYAL COLLEGES AND NATIONAL PROFESSIONAL ASSOCIATIONS BRITISH PSYCHOLOGICAL SOCIETY St Andrews House, 48 Princess Road East, Leicester LE1 7DR Tel: 0116 254 9568; Fax: 0116 247 0787 Has developed and published professional guidelines for several areas. COLLEGE OF HEALTH St Magaret s House, 21 Old Ford Road, London E2 9PL Tel: 0181 983 1225 Focuses on service-user involvement in clinical audit and offers training in consumer audit techniques. COLLEGE OF OCCUPATIONAL THERAPISTS 106 114 Borough High Street, London SE1 1OB Tel: 0171 357 6480 (General); Tel: 0171 450 2333 (Clinical Audit Project); Tel: 0171 450 2320/ 2343/2316 (Library) Have many publications available, including standards for practice. Have produced a Clinical Audit Information Pack (Sealey, 1998), a resource pack to assist occupational therapists with clinical audit and clinical effectiveness. ROYAL COLLEGE OF NURSING CLINICAL INFORMATION SERVICE 20 Cavendish Square, London W1M 0AB Tel: 0171 409 3333; Fax: 0171 647 3435 Offers advice and information regarding clinical audit. Has a literature database of audit, guidelines, etc. Has a database of clinical audit projects. Clinical audit resources 123

ROYAL COLLEGE OF SPEECH AND LANGUAGE THERAPISTS 7 Bath Place, Rivington Street, London EC2A 3DR Tel: 0171 613 3855; Fax: 0171 613 3854 Has developed a clinical audit manual. Holds reference copies of a range of clinical audit projects. Provides advice on software designed for speech and language therapy audit. ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH 50 Hallam Street, London W1N 6DE Tel: 0171 307 5600; Fax: 0171 307 5601; Research Direct: 0171 307 5674; Research Fax: 0171 307 5690; e-mail: enquiries@rcpch.ac.uk; research@rcpch.ac.uk Maintains database of clinical audit projects. Gives advice and assistance with project methodology. Published Clinical Audit in Paediatrics and Child Health Some Examples (Scrivener et al, 1997). ROYAL COLLEGE OF PSYCHIATRISTS 17 Belgrave Square, London SW1X 8PG Tel: 0171 235 2351; http://www.rcpsych.ac.uk Provide publications and workshops. The research unit has developed evidence-based clinical practice guidelines. 124

CLINICAL FORMS In order for there to be a continually updated record available of the clinical audit activity within a department it is important to document clinical audit projects. This will ensure that important information is not lost when individuals responsible for a particular project leave the department. It also acts as a prompt to re-audit at the appropriate time, and provides information on past activity to new members of staff. The two forms included at the end of this book were devised for different purposes. The one-page Clinical audit project summary record form was designed to provide a précis of projects, requesting key information that can be accessed at a glance. We would recommend that this form be completed at the end of each clinical audit project. When a topic is re-audited a new form should be completed. The Clinical audit detailed report form was primarily developed for the purpose of the FOCUS database. It serves both as a useful template for writing-up clinical audit projects in more depth, and as a check-list of the stages involved in the clinical audit process (which may be helpful at the planning stage). For this reason we would suggest filling in this form during the clinical audit process, completing each section as and when the relevant information becomes available. Disks with copies of these forms are available from FOCUS (a small charge will be made for this). FOCUS CLINICAL DATABASE An initial survey of members of the FOCUS network revealed interest and enthusiasm in the development of clinical audit in child and adolescent mental health services, and a willingness to share ideas and experiences with regards to this area. FOCUS has therefore decided to establish a database of clinical audit projects undertaken in child and adolescent mental health services. This information will serve as a resource for clinicans who are designing clincial audits in their own service and may then be used to develop a second book of examples. If you would like to contribute to this database and/or join the FOCUS network please contact: Carol Joughin, The Royal College of Psychiatrists Research Unit, 11 Grosvenor Crescent, London SW1X 7EE.Tel: 0171 235 2351 ext. 256; Fax: 0171 235 2954; e-mail: carol.joughin@virgin.net Clinical audit resources 125

CLINICAL PROJECT SUMMARY RECORD FORM Project title: Date started: Date completed: Audit lead: Other individuals involved: Standards set Target: % Target: % Target: % Target: % Target: % Source/evidence based on: Key findings Changes in practice which occurred Re-audit date: 126

FOCUS C FOCUS CLINICAL DATABASE ABASE CLINICAL PROJECT DETAILED REPORT FORM Project title: Date started: Date completed: Audit lead: Name: Professional title: Member of FOCUS network? Yes / No (If no, please complete and return FOCUS joining form) Other individuals involved: Name of organisation: Address of organisation: NHS Trust: Work telephone number: Background rationale for clinical audit project How was the topic chosen? Why was it considered to be important? Overall aims Objectives To improve: Patient health outcome Delivery of care Patient satisfaction Staff satisfaction Use of resources NB: How will you achieve these aims (i.e. what are the main questions asked of the clinical audit)? contd... Clinical audit resources 127

FOCUS C FOCUS CLINICAL DATABASE ABASE CLINICAL PROJECT DETAILED REPORT FORM (CONTD CONTD) Literature review Search strategy (how was literature found?): Conclusions reached from the literature: Source of standards Professional organisations guidelines Local guidelines/protocol National standards Systematic review(s) Own literature review Professional experience (team consensus) Observation of current practice Standards set 1. Target: % Exceptions: 2. Target: % Exceptions: 3. Target: % Exceptions: 4. Target: % Exceptions: 5. Target: % Exceptions: If more than 5, continue on separate sheet. contd... 128

FOCUS C FOCUS CLINICAL DATABASE ABASE CLINICAL PROJECT DETAILED REPORT FORM (CONTD CONTD) Data collection Source of data (e.g. case notes, patients, observation of sessions): Sample Type of population: Size: Sample selection (e.g. every other new referral of two-month period): Data collection process Data collection tool (e.g. interview, questionnaire, record form): Who collected the data? Please attach blank copy of data collection tool. Data analysis How were the data analysed? Please outline your method. Key findings contd... Clinical audit resources 129

FOCUS C FOCUS CLINICAL DATABASE ABASE CLINICAL PROJECT DETAILED REPORT FORM (CONTD CONTD) Feed back of findings To whom were the results communicated and how? Suggestions for change What suggestions for changes in practice were made as results of the clinical audit, and who made them? Action plan implementing and monitoring change Date started Activity and person responsible Date finished Re-audit Date planned for/carried out: Key findings of re-audit (if conducted): How regularly do you plan to re-audit this area? contd... 130

FOCUS C FOCUS CLINICAL DATABASE ABASE CLINICAL PROJECT DETAILED REPORT FORM (CONTD CONTD) Resources Total staff time (total hours to complete cycle): Other assistance required (e.g. audit assistant, help of statistician): Costs involved (other than staff time): 1. = 2. = 3. = TOTAL = Additional points Problems encountered (if any): Ways in which the clinical audit design could have been improved: Strengths of clinical audit design: Benefits experienced from clinical audit: Advice to others attempting a similar project: We permit the details included on this form to be stored on the FOCUS database and shared with members of the network who are interested Yes / No Clinical audit resources 131

FOCUS N FOCUS NETWORK JOINING FORM The network FOCUS recognises that changes and improvement in CAMHS can only be effected by a multi-disciplinary approach. At the time of going to press the FOCUS network consisted of over 600 professionals working in CAMHS who have expressed particular interest in the work of the project. Membership of the network is free and benefits include a newsletter, reduced conference rates and the opportunity to contribute to the work of FOCUS. To join the FOCUS network, please complete the form and return it to Carol Joughin at the address below. Your details Title: First name: Surname: Job title: Address: Postcode: Tel: Fax: e-mail: Please return to: Carol Joughin FOCUS The Royal College of Psychiatrists Research Unit 11 Grosvenor Crescent London SW1X 7EE Tel: 0171 235 2351, ext. 282; Fax: 0171 235 2954; e-mail: Kirsty. MacLean_Steel@virgin.net 132