Clinical audit

What is a clinical 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. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery.

What are the 7 pillars of clinical governance?

• Clinical audit

• Clinical effectiveness

• Risk management

• Use of information

• Education and training

• Staffing management

• Client experience and involvement

Why is a clinical audit important?

• Plays a part in risk management

• Identify risks or benchmark a service/treatment for a particular condition

• Patient care and safety, and the development and improvement of your professional practice

• Helps demonstrate services and identify areas where for real improvement

What are the aims of a clinical audit?

• Continuous cycle of quality improvement

• Seeks to improve patient care and outcomes through systematic review of care against explicit standards and best practice, and to use any shortfalls in standards of care to enable improvements to be made

• Determine whether a current service or procedure reaches a specified standard

• Information used to inform improvements in care, and then evaluate those changes by re-auditing

How often should each type of pharmacist do a clinical review?

• Community pharmacist with an NHS contract are required to conduct at least 2 a year

• Hospital pharmacists are required as part of practice to conduct/be involved in clinical audits to contribute to the national priorities for the performance of your trust. NHS Trusts are required to support audit work from central funding.

• Primary Care audits to improve quality/safety/cost effectiveness of prescribing

What are the steps for an audit?

• Identify audit topic

• Set the standard

• Design the method

• Collect data

• Analyse data

• Implement change

• Repeat

Examples of community pharmacy audits

• Asthma – Use of salbutamol therapy

• Owings Audit – Common drugs (improve stock levels)

• Smoking Cessation – Quit Rates/Product Recommendations

• Waste Medicines – What are patients returning to pharmacy

• NSAID Rx, without PPI

• Supply of EHC – PGD/OTC requests

Examples of hospital pharmacy audits

• Insulin Prescribing audit – Drug Chart

• Snapshot antibiotic Audit

• Missed Dose Audit

• Prompt switching of intravenous antimicrobial treatment to the oral route of administration as soon as patients meet switch criteria (60-40%)

Examples of primary care pharmacist audits

• Prescribing of antidiabetics in-line with NICE criteria

• Prescribing of DOACS and renal function

• Monitoring of ACEI – appropriate bloods?

• Cost Effective Prescribing of Gliptins