Snap-Shot & Detailed Audits: Introduction and Procedure

1. Snap-Shot & Detailed Audits: Introduction and Procedure

2. ACCREDITATION CANADA 2010 VTE Prophylaxis ROP • The hospital has an organization-wide, written thromboprophylaxis policy or guideline. • Identifies patients at risk for VTE and provides appropriate, evidence-based VTE prophylaxis. • Establishes measures for appropriate thromboprophylaxis use, audit its implementation, and uses this for quality improvement. • Identifies major orthopedic surgery patients who require post-discharge prophylaxis and provides it. • Educates health professionals and patients about VTE and its prevention. www.accreditation.ca

3. Why do Audits? Audits and feedback are an effective strategy to identify gaps between evidence and practice, and should drive change in healthcare settings.

4. What will a VTE prophylaxis audit tell us? • It will help identify gaps between the evidence (embedded into the local thromboprophylaxis policy) and what is actually done in practice. • Will be used to guide where to implement quality improvement (QI) interventions. • Should assess the proportion of patients at risk for VTE who are prescribed appropriate (evidence-based) VTE prophylaxis • capturing correct option, dose, onset, compliance and, where possible, duration.

5. Resources and Considerations for an Audit • Data collection/generation • Computerized pharmacy system (ability to generate Drug Use Evaluation (DUE) reports) • Data Collection Tables • Supplemental Data Collection sheets • Staffing resources • Pharmacy staff: pharmacists, pharmacy students • Quality Improvement: QI personnel • Nurses • Research Personnel • Medical Students • Health Records Analysts • Other Health Personnel

6. Choosing an Audit Type

7. Audit Advantages & Limitations

8. Audit Steps • Where a pharmacy informatics system is in place generate a report indicating patients currently receiving any anticoagulant

9. Accounting for all the Patients

10. IMPORTANT: Audit tools should be aligned with policy/ guidelines of your institutionorconsistent with clinical order set

11. Frequency and Audit Sample • For real-time detailed audits, options are: • all beds on a given day or • audit different services/wards/nursing care units on consecutive days or • audit a single or limited number of nursing care units As rates of appropriate prophylaxis increase less time will be needed, with fewer chart audits required.

12. Snap-Shot Audit • Only patients who are determined NOT to be on an anticoagulant will require a chart review • All patients captured by the DUE as being on an anticoagulant can be classified as receiving therapeutic or prophylactic anticoagulation • Patients not appearing on the DUE report require a chart audit to determine if they are receiving mechanical prophylaxis or no prophylaxis and whether those decisions are appropriate

13. Data Collection Form

14. Data Collection Table

15. Putting it all TogetherThe Audit Report

16. Sample Audit Report

17. Sample Audit Report

18. Driving Change Toward Best Practices • To drive change the results must be shared/disseminated with stakeholders, including healthcare providers and administration. • Data should be broken down at various levels including: • Hospital Service • Ward Individual Physician • Wards/ service areas should be provided with outcomes from the audit to assist them with improving patient safety and care.

19. Dissemination and Feedback Drive Change

20. Dissemination of Audit Results Various methods of dissemination include: • Newsletters • Educational/in-service sessions • Department Head meetings • P&T • Organizational public newsletters

21. The Goal of every Hospital/Institute:100% appropriate prophylaxis for all patients at risk, when clinically indicated