This guide gives a brief introduction to the

This guide gives a brief introduction to the principles of clinical audit and information about how to undertake a clinical audit at Great Ormond Street Hospital. For further information please contact the Clinical Audit Team ext 5892 Pearsa@gosh. nhs. uk or Magne. C@gosh. nhs. uk ext 5176 http: //97. 0. 0. 55/corporate/safety. Clin. Audit. htm http: //97. 0. 0. 55/corporate/clinical_audit 4/ Oct 10 Clinical Audit Team 1

What is Clinical Audit? Clinical Audit was first introduced in the NHS in 1993 although the term "medical audit" has been known In the NHS for many years. Great Ormond Street recognises the NICE definition of Clinical Audit; "A quality improvement process that seeks to improve patient care and outcomes through systematic reviews of care against explicit criteria and the implementation of change" (Principles for Best Practice in Clinical Audit, 2002, NICE/CHI. http: //www. nice. org. uk/pdf/Best. Practice. Clinical. Audit. pdf Clinical Audit is not research. It is true that research and clinical audit share similarities. They both involve answering specific questions, which relate to the quality of care. They can both be carried out retrospectively, prospectively, involve careful data collection design principles and should be professionally led. However, the truth is there also important differences between the two disciplines. Research is about obtaining new knowledge and about finding out what is best practice. Clinical Audit is about measuring quality of patient care. The clinical audit team have a number of resources to help you decide what type of project you are conducting, please contact the team for further information. The component parts of clinical audit, known as the clinical audit cycle, have been highlighted as; ØChoosing an audit topic ØSetting Standards ØMeasuring against current practice ØComparing results with standards ØChanging practice ØRe-auditing to make sure practice has been improved Oct 10 Clinical Audit Team 2

Undertaking a clinical audit project at GOSH The clinical audit team supports clinical audit at Great Ormond Street Hospital. Before you undertake any clinical audit within the trust, you should discuss your proposed audit with a member of the clinical audit team and complete the clinical audit registration form (also available on the GOSH web). The steps you will then need to go through are summarised below, further information is available in the clinical audit advice pack. 1. Choose an audit topic Clinical audits at GOSH usually focus on measuring adherence to healthcare investigations, treatments and/or procedures that have been shown to produce the best outcomes for patients. Audit topics should focus on; An identified problem (e. g. from complaints or incidents) High volume, high risk or high cost areas of practice Areas with high variation in practice Published evidence about clinically effective treatment The availability of clinical guidelines (e. g. NICE and Royal Colleges) If you are keen to undertake an audit but are unsure about an appropriate topic to chose the clinical audit team will be able to assist you to identify key areas in your clinical area, for example, relevant NICE guidance, infection control issues or Royal College guidance and/or standards that need to be audited or re-audits that should be undertaken. 2. Develop an audit team Clinical audit at GOSH should be multidisciplinary (i. e. involving more than one group of staff). If an audit has implications for other teams or clinical areas they should be involved or consulted at the initial planning stage of the audit. If your audit is looking at the patient journey across different care sectors please ensure all staff representatives from all organisations are involved. Oct 10 Clinical Audit Team 3

3. Consider your aims and objectives Decide what your objectives of doing the audit are and write this either as a statement or question which best describes what you want your audit to achieve/answer. Consider the steps you will need to take to achieve these objectives and write this either as a series of tasks or as different aspects of quality that your audit will focus on. Collectively these will form your audit aims and objectives. 4. Agree audit standards Audit standards define the aspects of care to be measured, in order to find out whether we are doing what we should be doing. Your audit standards should flow from or be related to the audit aims and objectives. Ideally you should look to use standards that already exist locally or nationally in the form of evidence based guidelines, procedures or protocols. If there are no locally or nationally developed standards you may have to write the standards yourself. These should always be based on best available evidence and you should ensure there is consensus agreement with your standards in the relevant clinical areas before you audit against them. Agreement is absolutely necessary if you wish to eventually improve practice. The clinical audit team and/or staff at GOSH/ICH library can help you to carry out a literature search to find relevant evidence in order to develop your audit standards. 5. Consider Ethics Although clinical audits at GOSH do not have to be approved by the ethics committee they still need to be undertaken to the highest professional standards. This means considering the principles of data protection and confidentiality in every clinical audit undertaken. If you have concerns about ethical issues regarding your clinical audit, please contact the clinical audit team who will assist you. 3. • Select an audit sample 4. You need to ensure that the information you collect from a sample will be representative of the whole population. A small sample from your particular patient group will be sufficient for an audit project. Please refer to the clinical audit advice pack for further information regarding sample selection. Oct 10 Clinical Audit Team 4

7. Data collection. A well designed data collection tool will save time and can help with the data analysis. Always ensure that you are collecting enough data to answer your audit question or to establish whether you are meeting your audit standards. Consider whether you should be collecting your data; Retrospectively – for example looking at past treatments. Prospectively – for example, looking at the time of treatment. Concurrent – for example, looking at the here and now. Consider who and how you are going to collect your data. Will you use a proforma, questionnaire or enter the data straight into a computer? Ensure that the method you chose is appropriate for the audit topic. Always ensure that you conduct a pilot before starting the main data collection. This will enable you to discover any faults with your data collection method, identify ambiguous questions and/or difficulties in completing the data collection tool. By identifying these problems at this stage will enable you to rectify them saving you time in the long run. 8. Data analysis Compare the data you have collected to your standards. Ensure that you analyse how well you have met those standards. If you are comparing compliance to a particular guideline and/or protocol ensure that you analyse your data to demonstrate this. The analysis of your data should be linked back to the audit aims and objectives. If you require further support please contact the clinical audit team. 9. Present your findings Your audit findings should be initially presented to those individuals required to agree recommendations and implement an action plan. The results should then be presented to other colleagues. A summary of your findings should also be submitted to the clinical audit team for posting on the sharing knowledge website. When presenting your audit results ensure that you include your recommendations, think about “what does the team need to change to improve practice? ” raising this question will also aid discussion at the end of your presentation. Oct 10 Clinical Audit Team 5

10. Draft Audit Report Please ensure that you write up your audit in a report format. This will provide an official report of your audit and enough information for future re-audits. The team have a number of templates available to assist you at this stage of your audit. Your audit report should be well structured and include; Introduction – essential describes why you are doing the audit. Aims and Objectives – describes the purpose of the audit Standards – if you are measuring against standards or guidelines these should be stated at this stage of the audit report. Methodology – detailing data collection. For example, how you collected the data, the size of the sample and your chosen population. Results - data analysis, descriptive graphs and tables demonstrating the audit results Conclusion – make objective statements supported by your findings. Recommendations - make recommendations for change based on your audit results. Action Plan – this refers to specific action that need to be taken to achieve the recommendations. References and Appendix 11. Implementing change If your audit results demonstrate a need for improvement, making changes in current practice is therefore very important. Audit results should be used in conjunction with feedback, local consensus and opinion to achieve change in clinical practice. Ensure that the changes you make are essential to improving the standard of care and within your resources. Don’t make changes for the sake of change. All changes need to be implemented in a systematic way, using an action plan enables staff to do this. The clinical audit team and the trust’s improvement facilitators can assist you with the process of implementing change. 12. Re-audit The final stage of the clinical audit cycle is re-audit. A re-audit should be carried out at an appropriate time to ensure implemented changes have lead to an improvement in the service. Re-audit involves repeating every stage of the clinical audit cycle using the same methodology and comparing current practice against the same audit measures using the same data collection tool. Oct 10 Clinical Audit Team 6

13. Final Report Writing Once completed the re-audit should be the final stage of your audit report. The final audit report should contain all of the sections in the draft report and; Results – a comparison of findings should be made and reported Recommendations – if necessary (if there has is no significant improvement) new recommendations should be agreed and reported. A summary and action plan must be completed at this stage. The summary of your audit will be posted on the Sharing Knowledge website if deemed to be a good example of best practice in clinical audit. Once agreed a copy of your action plan and final report should be sent to the clinical audit team. 14. Publish Your Work If you have produced a piece of work which is a good example of best practice in clinical audit consider sharing this work outside of the trust by getting it published in a professional journal. Remember you should have completed the audit cycle i. e. a re-audit should have been conducted demonstrating that you have successfully improved practice. If you have completed the audit cycle your findings are more likely to be published as people can learn from your methodology and the changes you have made. Please ensure that if you do present your audit outside the trust or have an audit published you contact the clinical audit team to let them know. Further Information and Advice Please Contact the Clinical Audit Team for Further Information and Advice contact Andrew Pearson Ext 5892 or Charlie Magness ext 5176 Oct 10 Clinical Audit Team 7