A PPT ON AUDIT

7/29/2019 A PPT ON AUDIT

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Medical AuditPresenter: Dr. Preeti Thaware


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Frame work1. What is audit?

2. What is medical audit?

3. Why audit?

4. Audit versus research

5. The quality cycle

6. Stages of medical audit


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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.


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What is medical audit

A quality improvement process that seeks to improve

patient care and outcomes through systematic review of

care against explicit criteria and the implementation of

change.

An audit is a cyclical process

-defining standards,

- collecting data,

- identifying areas for improvement,

- making necessary changes

- back round to defining new standards.


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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


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Audit: - are we doing the best thing in the

best way?

Measures current practice against specific standards

Never experimental

Uses data in existence by virtue of practice

May require ethical approval

Aims to improve delivery of patient care


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Research:- What is the best thing to do/the

best way to do it

Provides sound basis for medical audit

Involves experimental trials

Uses detailed data collection

Needs ethical approval and registration

Aims to add to body of scientific knowledge


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Quali ty cycle

Identify

barrier

Correct

the

problem

Preventfuture

problems

Identify

problems


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F ive stages of cl inical audit


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Stage 1: Prepar ing for audit

Involving users

Selecting a topic

Defining the purpose Planning


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Stage 1: Preparing for audit continue.

I nvolving 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 fromfocus groups-Direct observation of care-Direct conversations


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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


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Selecting a topic:

Tool for priori tise audit topics questions:

Is the topic concerned of high cost, or risk to staff orusers?

Is there evidence of a serious quality problem?

for example patient complaints or high complicationrates?

Is there potential for involvement in a national auditproject or pertinent to national policy initiatives?

Is the topic a priority for the organisation?Is good evidence available to inform standards?

for example systematic reviews or national clinicalguidelines?


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Defining the purpose

- purpose must be established before appropriate methodsfor audit can be considered.

- Once topic selected, purpose define then suitable audit

method can be chosen.- The following series of verbs may be useful in defining

the aims of an auditto improve

to enhanceto increaseto changeto ensure


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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.


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Stage 2: Selection cr iter ia

Defining criteria

Sources of evidence

Appraising the evidence


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Stage 2: Selection criteria continue

Defini tion of cr i ter ia:

- 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 careand be measurable.


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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.


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Appraising the evidence:-Evidence needs to be evaluated to find out if it is

valid, reliable and important

oAim /objectivesoMethodology

oResults /conclusions

oApplicable to your patient group

oBias/ causes for concern


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Stage 3: Measur ing level of

performance

Planning data collection

Methods of data collection

Handling data


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Stage 3: Measuring level of performance continues.

Planning data collection:

- the data collected are precise

- Essential

- User group to be includedExamples

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


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Methods of data collection:Do not try andcollect too many items,keep it simpleaand short.

-Computer stored data,Case notes/Medical

Records,Surveys , Questionnaires, InterviewsFocus Groups, Prospective recording of specific

data

- How will this be done?-Compare performance against the criteria

-Keep focused on the objective of the audit


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Handling data:

- ethical implications of and their

responsibilities under the Data Protection Act(1998) when collecting data and presenting

results.


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Stage 4: Making improvements

Identifying barriers to change

Implementing change


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Stage 4: Making improvements continues..

I denti fying barr iers to change

-Fear

- Lack of understanding

- Low morale

- Poor communication

- Culture

- Pushing too hard

- Consensus not gained


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Stage 4: Making improvements continues..

Implementing Change:

- systematic approacho identification of local barriers to change

osupport of teamwork

o use of a variety of specific methods


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Stage 5: Sustaining improvement

Monitoring and evaluation

Re-audit

Maintaining and reinforcing improvement


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Stage 5: Sustaining improvement continues..

Moni tor ing and evaluation

-systematic approach to changing professional

practice should include plans to:o monitor and evaluate the change

o maintain and reinforce the change


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Re-audit

-Review evidence

-Measure effectiveness

-Decide how often to re-audit- Ongoing process monitoring

-Adverse incidents

-Significant events audit


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Maintaining and reinforcing improvement

- reinforcing or motivating factors built in by the

management .

- integration of audit

- strong leadership


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References

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India Hospital Association Delhi; Jan 1990.

2. George M. The Hospital Administration. New Delhi: Jaypee; 2003.

3. Srinivasan A. Managing modern hospital by Medical audit and its administrations. New

Delhi\London: Response books. 2005

4. Sarkharkar B, Principles of hospital administration and planning. Jaypee brothers medical

publishers.1999.

5. World Health Organization. Medical record documentation audit

instructions[online].Available from URL:http://www.who.int.medical audit6. 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.

7. 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).

8. Bhatnagar T, Mishra Cp, Mishra Rdrug prescriptionpractices: Ahousehold study in ruralvaranashi.Indian Journal Preventive Medicine.2003:34(1&2).

9. 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.

10. . 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

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http://www.who.int.medical/http://www.who.int.medical/

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