Plan for Morning

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Plan for Morning

• Why Audit?
• What is Audit?
• The SA Process
• National Project Marking Scheme
• Example Projects
• Ideas for Projects

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• Why Audit?
• What is Audit?
• What is a Criterion?
• What is a Standard?

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Audit Project - Why?

• All GPs should be monitoring and improving the
  quality of care they provide.
• The ability to carry out an audit is therefore a
  skill of minimal competence for a GPR.

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What is Audit?

• The systematic and critical analysis of the
  quality of clinical care, including the
  procedures used for diagnosis, treatment, and
  provision of care, the associated use of
  resources, and the resulting outcome and quality
  of life for the patient.
• Are we doing what we do in the best way we can?

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Why a Special Session on Audit?

• Last years figures
• 22 projects submitted
• 15 passed at 1st level
• 7 went to 2nd level
• 4 passed
• 3 had to be resubmitted

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• Reasons for resubmission
• Lack of understanding of criterion
• Lack of understanding of standards
• Criteria not justified
• Results not compared with standard
• Overcomplicated confused results

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The Audit Cycle
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The Audit Cycle
Step 1 What should be happening?
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The Audit Cycle
Step 1 What should be happening?
Step 2 What is happening?
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The Audit Cycle
Step 1 What should be happening?
Step 2 What is happening?
Step 3 Introduction of change
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The Audit Cycle
Step 1 What should be happening?
Step 2 What is happening?
Step 4 Assessment of change
Step 3 Introduction of change
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National Office for Summative Assessment

• Proforma
• Marking Schedule

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What is the title of your audit project?Why did
you choose it?

• importance of planning
• personal interest Vs. interests of others
• common/significant/serious problem
• realistic/practical
• clinical/organisational
• support of practice

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• CHOICE OF AUDIT
• One popular misconception is that the audit
  submission will be disproportionately intrusive
  in the general practice year with all its other
  demands on both GP trainer and GP registrar. The
  intention is that GP trainers should try to
  dissuade their GP registrar from embarking on an
  audit, for this purpose, which is especially
  complicated or particularly time consuming.
•  

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Criteria Standards

• Why have them?
• To allow measurements and comparisons
• What are they?

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• Criteria
• measurable statement e.g. BP measurement in
  hypertensives DM eye checks

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Why did you choose it/them?Sources of Evidence

• within practice
• library/TARPC
• guidelines (SIGN)
• Internet/Medline
• Support from the literature

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• Standards/Targets
• degree to which the criterion should be met e.g.
  hypertensives should have BP checked 6
  monthly(80) DMs should have retinal exam
  yearly(90)
• How do you decide what it should be?

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What preparation and planning did you undertake
for your audit project?

• evidence of teamwork
• ID of population
• sample selection
• data collection
• use of computers
• time management

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1st Data Collection (Date)

• presentation of findings
• tables
• text
• graphs
• use of computer packages
• How does this compare to the standard?

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What change(s) are you implementing?

• often the most difficult - importance of forward
  planning
• problems of -
• resistance
• indifference

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2nd Data Collection (Date)

• As before with timescale and why that timescale
  was chosen
• Compare with data collection (1) and standard

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What conclusions have you drawn from this
completed audit cycle?

• Include
• Successes
• Problems
• with data collection
• With effecting change
• comparison with literature
• personalise

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Rules and Regulations (The Facts)VT SA Board
(National Body)

• Can submit at any time during 3 years of the VTS
  but not less than 3 months before the end of the
  training period
• Must be relevant to General Practice
• Registrars own work with appropriate support
  from practice team
• Audit declaration form must be completed by GPR
  and GPT
• Must be anonymous with candidate number on each
  page

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Summative Assessment

• Keep it simple and relevant
• Relate it to day to day work where change may be
  desired or expected
• Justify it with reference to current literature
• Data from a simple computer search - a computer
  is not always essential
• A search of a sample of patient records may be
  necessary

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Summative Assessment

• The audit should be capable of completion within
  approximately 10 hours!!
• A more ambitious audit may be chosen but it is
  not necessary for the purpose of summative
  assessment
• The work should be no longer than 3,000 words

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Assessment

• Audit Assessor Marking Schedule
• Marked Independently by 2 Assessors

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Summative Assessment-The National Project
Marking Schedule

• Questionnaire study
• Notes Review
• Literature Review
• Clinical Case Study
• Research study
• Plan for a new service in the practice
• Discussion paper