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An Introduction to Audit – part 1

An Introduction to Audit – part 1. Alex Sweeney Clinical Lead Pharmacist, UHCW NHS Trust. What is Audit?. Taking note of what you are doing, learning from it and changing it if necessary, or Making sure that what should be done is being done. Historical Perspective.

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An Introduction to Audit – part 1

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  1. An Introduction to Audit – part 1 Alex Sweeney Clinical Lead Pharmacist, UHCW NHS Trust

  2. What is Audit? • Taking note of what you are doing, learning from it and changing it if necessary, or • Making sure that what should be done is being done

  3. Historical Perspective • From the Latin to hear. • First used in biblical times when the landowner would hold a hearing with his stewart. • Florence Nightingale and the Crimean War.

  4. Where it fits today?

  5. Clinical Audit Review of clinical performance Measured against agreed standards To refine clinical practice Multi-professional process Patient focused Requires a culture of continuous improvement Evidence Based Practice Clinical effectiveness Clinical Governance

  6. Reasons for Audit • National standards/guidelines • GPhC requirement • Issue is a common problem • Relevant to professional/clinical practice • Realistic potential for improvement • Benefit patients • Medicines Optimisation – safety, effectiveness, experience, routine practice

  7. The Audit Cycle6

  8. 1. Plan What exactly am I trying to achieve? • Identify topic • Think about topic in relation to desired outcome • Focus on improving practice • From the outset ask yourself - is it achievable? • Make it SMART!

  9. Planning continued… 2. Set criteria and standards: • General Statements about the delivery of service – i.e. what should happen • Specific statements which are measurable • Criteria • Standards

  10. Planning continued…. • Patients supplied with warfarin should be counselled about aspirin • 100% of Patients supplied with warfarin must be counselled about aspirin • Criteria • Standard

  11. Standards • What is measurable, measure; what is not measurable, make measurable. • Galileo

  12. Planning continued… 3.Think carefully about your methodology • Try to avoid bias • Think about your data collection tool • Think about sampling • Think about your data output/analysis • Will it provide a good narrative? • E.g. what was your patient population, when did you do the audit, what was the background, how serious was an error, grade the impact. • Tell patient stories amongst the numbers

  13. Planning continued… 4. Gain Commitment • The difference between involvement and commitment is the same as the difference between egg and bacon - the chicken is involved, the pig is committed • Stormin’ Norman Schwartzkopf

  14. 2. Audit • Do a pilot! • Review: • Structure (e.g. what resources are needed?) • Process (what happened?) • Outcome (what results are you getting?) Am I achieving exactly what I set out to do? • If not why not?

  15. Audit continued… 2. Set a date for data collection 3. Collect data as per methodology Highlight anomalies – describe in discussion 4. Analysis stage Are findings acceptable? Agree reasons for failure to reach standard

  16. 3. ACTION • Report – visualise/make accessible • Recommend change – agree with stakeholders • Develop action plan • What can I do to make things better? • Implement change • Re-audit…

  17. Types of Audit in Pharmacy • Waiting times • Errors • Use of POD’s • QIPP • Use of Antibiotics • Use of Infliximab • NPSA • National audits • Service audit • Therapeutic/NICE

  18. Example audit6 6http://www.rpharms.com/audit-support-and-guidance/how-do-i-start-.asp

  19. Poster What did you do? How did you do it? What were the standards? What did you find? How did things changed? Recommendations Re-Audit? Keep it focused and keep it interesting!

  20. References [1] The Bristol Royal Infirmary Inquiry. Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984 -1995. The Stationary Office, 2001.[2] National Institute for Clinical Excellence. Principles of Best Practice in Clinical Audit. Radcliffe Medical Press Ltd, 2002.[3] Department of Health. Trust Assurance & Safety: Regulating health professionals in the 21st Century. Department of Health 2007.[4] Department of Health. Equity and excellence: Liberating the NHS. Department of Health, 2010. [5] NHS England website; Clinical Audit: http://www.england.nhs.uk/ourwork/qual-clin-lead/clinaudit/ [6] Royal Pharmaceutical Society website support on Clinical Audit: http://www.rpharms.com/audit-support-and-guidance/how-do-i-start-.asp

  21. Workshop............

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