Clinical Audit Relating to Falls Jeannette Kamar · Clinical Audit Relating to Falls Jeannette...
Transcript of Clinical Audit Relating to Falls Jeannette Kamar · Clinical Audit Relating to Falls Jeannette...
Clinical Audit Relating to Falls
Jeannette Kamar
Quality, Safety & Risk Unit; Northern Health
Using Clinical Audit to Support Quality Improvement Seminar
Monash University, School of Public Health and Preventive Medicine
The Alfred Medical Research and Education Precinct, Melbourne
Friday 26th February 2016
Clinical Audit is 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.
Today’s Presentation
Clinical Audit Relating to Falls
1. Identify problem or issue
2. Set criteria & standards
3. Observe practice / data collection
4. Compare performance with criteria & standards
5. Implementing change
Identify the Problem or Issue
Stage 1:
• Determine the issue / problem / audit topic₋ Focus on areas with greatest need to improve
₋ Include government or regulatory requirements
• Involve stakeholders₋ Staff & Patients delivering or receiving the care
₋ Staff with authority to support change
• Plan the delivery₋ Who will conduct the audit
₋ Who will collate / monitor progress
Falls - Identify the Problem
• Patient falls:
- World wide problem
- Common cause of harm in hospitals
• NSQHS Standards 10 - falls prevention: - National government regulatory requirements
• Currently: - An absence of high-quality evidence showing
the effectiveness of falls prevention strategies
across acute hospital wards
National Safety and Quality Health Service Standards, September 2012
Barker A, Morello R, Wolfe R et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial ,
BMJ 2016;352:h6781
Falls - Identify the Problem
• Currently:- There is evidence suggesting that some locally
developed hospital falls prevention programs have
been effective in the setting where is was developed
• Local programs are:- Developed, using local data
- Aim to address local issues
• Clinical audit:
- Assess local issues to improve patient care
Barker A, Kamar J, Morton A, et al. Bridging the gap between research and practice: review of a targeted hospital inpatient fall
prevention programme. Quality & safety in health care 2009;18(6):467-72.
A Barker, J Kamar, M Graco, V Lawlor, K Hill. Adding value to the Stratify falls risk assessment in acute hospitals. JAN volume 67, Issue
2, pages 450–457, February 2011.
Clinical Audit within a Service
• Helps to identify and measure areas of risk
• Creates a culture of quality improvement
• Is educational for the participants
• Offers an opportunity for increased job satisfaction
• Is increasingly seen as an essential component of
professional practice.
• Can improve the quality and effectiveness of care
Set Standards & Criteria
Stage 2:
• Identify related National Standard- Local committee
• Set the criteria₋ Measurable statements of what should happen
in line with National Standard and local policy
• Set targets & agree acceptable exceptions - Include expected performance levels and
action to be taken if level is not achieved
Set Standards & Criteria
Setting Targets
• Indicator Description
• Indicator Formula / Measurement Unit
Examples:
a) Number of Patient Falls by 1000 bed-days per month
- Falls per 1,000 occupied bed days: Divide the number of falls by the number
of occupied bed days for the month; then multiply this by 1,000
b) Percentage Risk Assessment Tools (RAT) completed within 24
hours for each patient admitted to a general inpatient Ward
- Number of RAT completed (within relevant time-frame) divided by number
of patient admissions (to relevant wards); then multiply this by 100
Set Standards & Criteria
Setting Targets
• Data Source, (i.e. Riskman / Clinical Audit)
• Baseline Measure
• Current Measure
• Target Measure: by percentage or rate and identify
expected performance levels, i.e.:
₋ Target / Good >=98%
₋ Moderate >=80%
₋ Poor <80
Set Standards & Criteria
Setting Targets
• Determine action required if below Target
• Primary Responsibilities:
₋ Conducting the audit
₋ Collating the data
₋ Accountable process owner
₋ Reporting cycle
₋ Governance Committee
Observe Practice / Data Collection
Stage 3:
• Audit Tool
₋ Data collected should be in relevant order and
relevant to the objectives / criteria
₋ Use clearly worded closed questions
₋ Limit free text or open questions: these are difficult
to code / analysis is very time consuming
₋ Include definition of terms
₋ Include space for comments to record exceptions
Audit Tool - Sample
• Purpose
• Instructions
• Tool:
- Yes / No questions
- Observing documentation
- Observing practice
- Includes question to
measure overarching aim
- Option to provide comment
PURPOSE
This audit is intended as an educational tool to help ensure:
• Documentation on the Patient Care Plan or Clinical Pathway is
correct, complete and complies with the 6-Pack Falls
Prevention Program
• Falls prevention strategies are implemented as indicated on
the documentation
• Issues are discussed and addresses at ward level
The tool may also be used following a fall to investigate the
circumstances of the fall and thus provide a basis for feedback to
staff.
Audit Tool - Sample
INSTRUCTIONS
• Audits are best undertaken towards the end of the shift to
ensure documentation is completed.
• Circle responses as appropriate and discuss issues arising
with the nurse caring for the patient.
• Note comments in the space provided in order to clarify
issues identified and suggestions for improvements.
• Forward completed audits to: (insert name and location).
Audit Tool - Sample
Observe Practice / Data Collection
Stage 3:
• Data collection₋ Collection of relevant data about current practice in
order to facilitate comparison
• Data analysis₋ Convert the facts / data into useful information in
order to identify the level of compliance with the
agreed standard
• Draw conclusions₋ Identify the reasons why the standard was not met
Compare with Standard / Criteria
Stage 4: - Present and discuss results
‘No further action required’• If target achieved, there should be an explicit
statement saying ‘no further action required’
‘Further action required’• If Moderate or Poor, identify areas for improvement
₋ Target / Good i.e. >=98%
₋ Moderate i.e. >=80%
₋ Poor i.e. <80
Compare with Standard / Criteria
‘Further action required’
• Change is often the most difficult part of the audit.
• When the audit team have developed the
recommendations, decisions should be made on how
changes can be introduced and monitored.
• Results should be used in conjunction with feedback and
local consensus to change clinical practice and to
improve standards.
• Priorities for action should be identified and these
should be clearly documented.
Implement Change
Stage 5:
• All audits should be accompanied by a quality
improvement plan in order to achieve the required
improvements in practice.
• Monitor implementation of changes
• Report on progress of implementation as required
• Re-audit to ensure changes have improved practice and
decide if further audit procedures are required
Overview
Summary
• Keep audits simple
• Get everyone involved
• Determine the topic
• Have a plan
• Do not collect needless data
• Take care with statistics
• Close all clinical audit loops
• Share learning
• Re-audit to ensure improvement in clinical care
Clinical Audit Relating to Falls
Jeannette Kamar
Quality, Safety & Risk Unit; Northern Health
Questions?