Quality & Safety - A Practical Guide to Clinical Audit

A column by Maureen Flynn

This month we focus on the ‘Practical Guide to Clinical Audit’. The HSE Quality and Patient Safety Directorate developed the guide to equip healthcare professionals with the necessary knowledge to plan, design and conduct a clinical audit. It provides a reference guide for healthcare professionals already involved in clinical audit and a learning resource for those who are new to the process.

What is clinical audit?
Clinical audit is the systematic review and evaluation of current practice against research-based standards with a view to improving clinical care for service users. It is about evaluating practice against a defined ‘best practice standard’ and making changes if current practice is not in line with best practice.

A clinical audit aims to ensure quality – that we are doing the things that we should be. Measuring practice against known standards is not a new idea. During the Crimean War in the 19th century, Florence Nightingale measured, monitored and used her influence to improve hygiene standards in the field hospitals thus leading to an improvement in mortality rates.

Why clinical audit?
Clinical audit facilitates a reliable way of:

Involvement in clinical audit can expose us to new knowledge and provide evidence of our reflection and commitment to continuing professional development. Clinical audit involving the multidisciplinary team can also assist in improved communications among multidisciplinary team members.

Stages of clinical audit
Clinical audit is a process that is often described as a continuous ‘cycle’ with stages that must be undertaken to ensure that the audit is systematic and successful. The image used throughout the document aims to illustrate this ‘cycling’ through the five stages - see figure above.

These stages are planning for audit; standard/criteria selection; measuring performance; making improvements and sustaining improvements. Each stage is broken down into steps providing a practical guide to the methodology of clinical audit.

The clinical audit guide and resource
The practical guide provides direction on carrying out clinical audit for both individuals and clinical teams. It lists current drivers in the Irish health service and describes the five stages approach to clinical audit.

The document discusses the resources required to support clinical audit and the need to consider ethical and data protection issues. Further resources in the form of sample templates, checklists and summaries are contained in the appendices.

The guide also provides links to more detailed information resources.

Opportunity to get involved
Clinical audit is intended to help you measure the extent to which your day-to-day practice is consistent with best practice. This improves practice if required, with the objective of improving the quality of care and treatment provided.

Why don’t you reflect on your area of practice and identify possible audit topics? Clinical audit is most effective when it is carried out as a team activity. Initiate a discussion with colleagues; start small.

The guide can be accessed at www.hse.ie/go/qps or http://hse.ie/eng/about/Who/qualityandpatientsafety/Clinical_Audit/

We welcome feedback on your experience of the clinical audit resources, and about how they might be improved.

Maureen Flynn is the director of nursing (national lead for quality and safety governance development) at the Office of the Nursing and Midwifery Services Director, Quality and Patient Safety Directorate, HSE

With thanks to Dr Ian Callanan, clinical audit coordinator at St Vincent’s Healthcare Group (chair); Joan Malone, clinical midwife manager 3 (project manager) and members of the HSE Clinical Audit Advisory Group, who prepared the guide and resources. The INMO and the HSE are signatories to Patient Safety First - the initiative through which healthcare organisations declare their commitment to patient safety. Through participation in this initiative, those involved aspire to play their part in improving the safety and quality of healthcare services. This commitment is intended to create momentum for positive change towards increased patient safety. For further information see www.patientsafetyfirst.ie

Quality & Safety - A Practical Guide to Clinical Audit


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