AUDIT PROJECT FOR SUMMATIVE ASSESSMENT

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AUDIT PROJECT FOR SUMMATIVE ASSESSMENT

• Rob Stokes
• Scheme Organiser Bury VTS
• Level 1 Audit Marker

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DEFINITIONS

• What is an audit ?
• What is a project ?

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GROUP WORK

• Break into groups and define what is a medical
  audit and a medical project.
• 1 group to produce ideas for an audit
• 1 group to produce ideas for a project

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DEFINITIONS

• What audits have you undertaken previously?

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AUDIT

• Part of summative assessment to show that you can
  monitor and improve quality
• What can you audit ?
• Examples

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AUDIT

• Are we treating hypertension in accordance with
  NICE guidance?
• Do we monitor patients on methotrexate in line
  with published guidance?
• Are we offering appointments in line with our
  contractual obligations?
• Does our practice carry emergency drugs in line
  with established guidelines?

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AUDIT

• 8 Criteria to be considered
• Reason for choice of audit
• Must be relevant and have potential for change
• Why did you choose the audit?
• Must be primary care based
• References must be primary care relevant and
  recent
• AVOID QoF AUDITS!

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AUDIT

• What criteria have you chosen?
• Patients on methotrexate must have a monthly fbc
  and lft
• Why have they been chosen?
• Relevant to audit subject and be justified by
  current literature
• Avoid multiple criteria if possible

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AUDIT

• Standards set
• 90 of patients on methotrexate should have had
  a fbc and lft in the last month
• Why did you choose these standards?
• Sensible standard with some reasoned justification

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AUDIT

• Preparation and planning
• What planning did you undertake?
• Look for evidence of teamwork and appropriate
  discussion
• Involve the primary care health team members
  think widely as who could be of use

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AUDIT

• Data Collection 1
• 70 of patients on methotrexate had a fbc and lft
  in the month prior to a prescription being issued
• Compare results to standard
• If looking at a large sample number acceptable to
  limit sample size and random sample but size of
  sample must be justified
• Present data clearly table and graphically
• Include date that data collected

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AUDIT

• Change to be evaluated
• Removed methotrexate from repeat system so that
  prescription had to be issued by a GP
• Highlighted to all Drs the importance of
  checking bloods in these patients
• Put a warning note on the computer reminding
  prescribers of the need to monitor bloods
• Wrote to all patients reminding them of the
  importance of regular monitoring

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AUDIT

• Change to be evaluated
• What change did you implement?
• Actual example to be described

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AUDIT

• Data collection 2
• After DC2, 88 of patients on methotrexate had a
  fbc and lft in the month prior to a prescription
  being issued
• Discuss your findings
• Compare with DC1 and standard set
• If sample size different please explain the
  difference e.g. 1 patient left the list and 1
  went on to alternative medication
• We are not particularly interested in the actual
  numbers i.e. it is not too important to achieve
  your standard but if you do not please discuss
  why
• Make sure the sums add up !

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AUDIT

• What conclusions have you drawn from the
  completed audit cycle?
• Mention what the practice, patients and yourself
  have learnt from the audit
• Discuss main issues and also include what the
  follow plans the practice has to continue the
  audit

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AUDIT

• Include word count
• Must be original work
• Must be anonymised
• The 8 criteria must be highlighted
• Double spaced and pages numbered
• SA number to appear in top right hand corner
• Maximum 3000 words
• 3 copies and keep one for yourself
• Completed and signed COGPED Audit Declaration
  form
• Reach the deanery no later than 3 months before
  the end of your training year

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AUDIT

• What happens then?
• 2 level 1 markers if both pass all criterion
  then audit is passed
• If either marker has a concern about any part of
  the audit it is referred to level 2 markers
• The level 2 markers may pass the audit or ask for
  resubmission
• Very general advice is given to your trainer
• 40 are sent to level 2, 10 need to be
  resubmitted
• On resubmission marked by level 2 if both pass
  you are notified if ongoing concerns marked at
  a national level who can pass or fail the audit

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AUDIT

• Any questions ??

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AN ALTERNATIVE

• Are you enthused by the prospect of an audit?
  or does it sound tedious and a chore?
• If so, help is at hand THE PROJECT

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PROJECTS

• Introduced 2000
• Full guidance on www.nosa.org.uk
• What is a project?

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PROJECTS

• A Project
• Addresses a defined problem
• Is related to previous work
• Presents qualitative or quantitative findings
• Interprets these findings
• Demonstrates skills in producing a written report
  of practical work on primary care
• Draws conclusions from the evidence described

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PROJECTS

• How is the National Project Marking Schedule
  different?
• Allows a wider range of subject material
• Increased emphasis on the use of literature
• Is marked on a scale rather than pass or fail
• Encourages higher levels of achievement rather
  than minimal competence

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PROJECTS

• 8 Types of projects
• Questionnaire study
• A patient survey on a new service
• Notes review
• A commentary on 10 patients with erectile
  dysfunction

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PROJECTS

• Literature Search
• Plan for a new service introduction
• A plan to introduce practice based
  echocardiograms
• Could also include a business plan / how to
  implement change
• Clinical Case Study / SEA
• A couple with infertility
  

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PROJECTS

• Research
• May be over ambitious
• Discussion paper
• Why do we refer patients to secondary care?
• Any other ideas discuss with the Yorkshire
  Deanery

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PROJECTS

• 2 competencies are being assessed
• Effective communication
• The ability to review and critically analyse your
  own working practice and to manage change
  effectively

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PROJECTS

• How to structure the project
• Aim state and discuss the background and reason
  behind the project
• Literature at least 6 relevant references must
  be used and to be clearly referred to in the text
• Method - must give enough information to allow
  the reader to repeat what was done

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PROJECTS

• Structure
• Results of findings clearly related to the
  project and the method, use alternative ways to
  present numerical data
• Discussion summarise, evaluate strengths and
  weaknesses of project, what are the implications
  for your practice? What change would you advise?
• Conclusion sum up the main points and any
  further work that may be needed

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PROJECTS - HINTS

• Plan carefully
• What is the purpose of your project?
• What are your aims and objectives?
• What is your question and hypothesis?
• Relevant literature must be evidence based and
  literature referenced, if you cannot find any
  literature think again !
• Present data clearly and figures must tally

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LITERATURE REVIEW

• Review not just a search
• Be clear about your question e.g. What is the
  evidence for the Rx of head lice in general
  practice?
• Describe your search and critical appraisal
  methods
• How do the findings answer the question?
• How does this relate to practice?
• Will it change your practice?

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CLINICAL CASE STUDY

• A case or series of cases where you have a
  knowledge gap e.g. how do we treat Bells palsy
  leading to an evidence based treatment protocol
• Make the reason for the choice clear
• Discussion should include reflections and lessons
  learned

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NEW SERVICE TO THE PRACTICE

• Substantial innovation e.g. a new practice clinic
• Discuss the evidence to support the need for the
  new service, how will it improve patient care
• Should include a SWOT
• What did you learn?

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DISCUSSION PAPER

• Different from a literature review
• Gather the evidence from several sources media
  / internet / opinion leaders
• Discuss how you gathered and assessed the
  information
• Discuss the evidence from several view points and
  do not include your own prejudices

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PROJECT SUMMARY

• Wider choice of formats
• Clear aim or question
• Refer to relevant literature
• Evaluate change
• What have you learned and has it changed your
  practice

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PROJECT SUMMARY

• Title page to include type of project
• Typed double spaced 1 side A4 paper
• SA number to appear on every page
• Pages to be numbered
• Word count between 1500 and 3000
• Word count at the end of the project
• Must be anonymised no name, locality, hospital
  name, pct etc.
• Send 5 copies and a floppy disk

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Marking of projects

• 6 Criterion
• Scored 0 5
• Must score at 18 or more
• Minimum of 2 in each criteria

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Marking of Projects

• Aims / question / problem clearly stated
• Relevant literature cited
• Method appropriate

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Marking of Projects

• Relevant findings presented
• Discussion appropriate
• Conclusions appropriate

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Marking of Projects

• 3 Level One markers pass or if 1 refers
• 2 Level Two markers pass or refer, if referred
  will include agreed level 2 marks for each
  criterion
• Resubmission marked at Level 2 pass or national
  referral pass / fail decision is final

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PROJECT

• Any questions ?