Professional Documents
Culture Documents
A PPT On Audit
A PPT On Audit
Frame work
1. What is audit? 2. What is medical audit? 3. Why audit? 4. Audit versus research 5. The quality cycle 6. Stages of medical audit
What is audit?
Evaluation of data, documents and resources to check performance of systems meets specified standards.
Audit in the wider sense is simply a tool to find out what you do now; this often to be compared with what you have done in the past, or what you think you may wish to do in the future.
Why audit?
Maintain participant and staff safety. Maintain data quality . Protect reputation of staff, host and sponsorer Protect current and future funding Improve quality. It does not involve experiments It uses data that already exists
Quality cycle
Prevent future problems Identify problems
Identify barrier
Stage 1: Preparing for audit continue. Involving users: - genuine collaborators - sources of data The concerns of users can be identified from various sources, including: -Letters containing comments or complaints -Critical incident reports -Individual patients stories or feedback from focus groups -Direct observation of care -Direct conversations
Stage 1: Preparing for audit continue. Selecting a topic: - starting point - careful thought and planning
There seems little point in trying to audit a rare condition, with a cheap intervention with a fairly superficial outcome
Stage 1: Preparing for audit continue. Planning: o Involve ALL the people concern. o Time and resources o Access the evidence o Methodology o Pilot o Report and Action o Re-audit o Data collection instrument o All these should be documented.
Stage 2: Selection criteria continue Definition of criteria: - an individual, a team, or an organisation - This can include assessment of the process and/or outcome of care - The choice depends on the topic and objectives of the audit. - They should relate to important aspects of care and be measurable.
Sources of evidence: - Systematic methods should be used . good-quality guidelines . reviews of the evidence . previously use criteria for same purpose . Measurement of outcome
Can develop own standards. reference to levels achieved in audits undertaken by other professionals is useful.
Stage 2: Selection criteria continue Appraising the evidence: -Evidence needs to be evaluated to find out if it is valid, reliable and important o Aim /objectives o Methodology o Results /conclusions o Applicable to your patient group o Bias/ causes for concern
Planning data collection: - the data collected are precise - Essential - User group to be included Examples 1.All children under 16 years diagnosed with asthma and registered with the primary healthcare team. 2. All women receiving treatment for breast cancer in M.G.I.M.S
Methods of data collection: Do not try and collect too many items,keep it simpleaand short. - Computer stored data,Case notes/Medical Records,Surveys , Questionnaires, Interviews Focus Groups, Prospective recording of specific data - How will this be done? -Compare performance against the criteria -Keep focused on the objective of the audit
Handling data: - ethical implications of and their responsibilities under the Data Protection Act (1998) when collecting data and presenting results.
Identifying barriers to change - Fear - Lack of understanding - Low morale - Poor communication - Culture - Pushing too hard - Consensus not gained
Implementing Change: - systematic approach o identification of local barriers to change o support of teamwork o use of a variety of specific methods
Monitoring and evaluation - systematic approach to changing professional practice should include plans to: o monitor and evaluate the change o maintain and reinforce the change
Re-audit -Review evidence -Measure effectiveness -Decide how often to re-audit - Ongoing process monitoring -Adverse incidents -Significant events audit
Maintaining and reinforcing improvement - reinforcing or motivating factors built in by the management . - integration of audit - strong leadership
References
1. 2. 3. 4. 5. 6. 7. Francis C. Hospital administration selected reading in hospital administration: New Delhi: India Hospital Association Delhi; Jan 1990. George M. The Hospital Administration. New Delhi: Jaypee; 2003. Srinivasan A. Managing modern hospital by Medical audit and its administrations. New Delhi\London: Response books. 2005 Sarkharkar B, Principles of hospital administration and planning. Jaypee brothers medical publishers.1999. World Health Organization. Medical record documentation audit instructions[online].Available from URL:http://www.who.int.medical audit Jepson R,Weller D, Alexander Freda, Walker J.Impact of UK colorectal cancer screeing pilot on Primary care. Bitish Journal of general Practice. Jaunary 2005. Graham W, Wagaarachchi P, Penney G, MacCaw BinnsA, Antwi K,Hall M. Criteria for clinical audit of th quality of hospital based obstetric care in developing countries.Bulletin of the world Health organization. 2000. 78 (5). Bhatnagar T, Mishra Cp, Mishra Rdrug prescriptionpractices: Ahousehold study in rural varanashi.Indian Journal Preventive Medicine.2003:34(1&2). Srishyla M, Krishnamurthy M, Nagarani M, MaryC, C Andrade, BV Venkataraman. Prescription audit in an Indian hospital setting using the DDD (Defined Daily Dose) concept.Indian journal of pharmacology.1994 .Volume : 26 ( 1 ). 23-28. . Neville R, Hoskins G. ,. McCowanC, Smith B. Pragmatic 'real world' study of the effect of audit of asthma on clinical outcome. Primary care respiratory Jouranal. 2004 Dec Vol 13 (4 ).
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