Tony Duffy clinical audit presentation april 24th 2013

Clinical Audit Master Class Tony Duffy April 24th 2013

By the end of the session you will be able to:

ďƒ˜Outline the stages of Clinical Audit ďƒ˜Highlight ethical issues

What Clinical Audit is not:

Activity analysis Research

Clinical Audit is......

Comparing your actual practice against the gold standard of practice to identify variances so that you can implement changes to close the gap.

TOPIC MAKE AND SUSTAIN CHANGES

STANDARDS

DATA ANALYSIS (ROOT CAUSE ANALYSIS)

DATA COLLECTION

Start with the change in mind

Clinical Audit project proposal plan ďƒ˜Plan of action for your project Stakeholders, support, ethics, change management

ďƒ˜Start with a clear achievable aim and supporting objectives

Example: Aim: To improve patient care by measuring compliance with documentation guidelines and changing practice where necessary Objectives: To measure compliance with: Entry signing Date recording Entry timing etc.

Identify your stakeholders Anyone who is affected by a process, has a part to play in it or needs to be aware of it

Ethics •Permission for the project •Freedom of Information Act

•Data protection Act •Confidentiality –

during data collection, analysis and reporting

ďƒ˜Selecting your topic

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Team consultation Service priorities Not just ‘pet’ topics High volume High risk High cost High volume of complaints High volume of incidents reports Wide variation Known problem Cause for concern

ďƒ˜What are you measuring your practice against?

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Professional bodies e.g An Bord Altranais Literature Guideline development organisations e.g.

NICE, SIGN Develop our own- should be based on evidence, related to relevant aspects of care and measurable

Population & Sampling Convenience sampling

< 100 = Take all > 100 = Take a sample

â&#x20AC;˘Sample size can depend on: â&#x20AC;˘Resource constraints ( time, staff, access to data, costs)

  

 

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Keep it simple?

Are validated tools already available?

Do you need to develop your own data collection tool – paper, laptop. iPad etc Make sure to test it Pilot it Timeframe – retrospective, concurrent Data sources

Documentation Audit Data collection tool ID Number:

Data Collector ID number:

Location ID number:

1. Is each entry dated?

Yes

No

2. Is each entry signed?

Yes

No

3. Is each entry legible?

Yes

No

ď&#x192;&#x2DC;Data analysis Pen, Paper and calculator?

Frequencies and percentages.

Documentation Audit Data analysis (n=100) 1. Is each entry dated?

Yes (85%)

No (15%)

2. Is each entry signed?

Yes (90%)

No (10%)

3. Is each entry legible?

Yes (75%)

No (25%)

ď&#x192;&#x2DC;Individual item analysis ď&#x192;&#x2DC;Cumulative analysis eg ( number of cases where all standards are met)

Clinical Audit report

 Record of the project Action plan

ď&#x192;&#x2DC;Changing practice - implementing changes that can be sustained.

Insanity is doing the same thing over and over again and expecting different results (Albert Einstein)

It is hard to remember that your original intention was clean up the swamp when you are up to your ass in alligators

Question: How would you eat an elephant?

Answer: A small bit at a time

Why do people resist change?

Resistance to the change itself Resistance to the change strategy Resistance to the change agent

Thank you for your attention Tony Duffy www.cqi.ie

cqi@eircom.net