SPVS Roadshows 2005

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SPVS Roadshows 2005

• Using clinical audit to optimise the provision of
  veterinary services

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SPVS Roadshows 2005

• Timetable
• 9.30 Introduction to clinical auditing in
  general practice Bradley Viner
• 10.00 Evidence based medicine Dr Peter
  Cockcroft
• 10.30 Interpreting and sharing data Dr. Dave
  Brodbelt
• 11.00 Tea
• 11.30 Monitoring standards of performance in
  medical primary care Dr Chris Jenner
• 12.00 The role of the VN in clinical audit Lisa
  Bluett VN
• 12.30 Introduction to workshop
• 12.45 Lunch
• 13.45 Workshop on the application of clinical
  auditing
• 15.00 Workshop presentations
• 16.15 Plenary session questions discussion and
  summary
• 17.00 End

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SPVS Roadshows 2005

• Introduction to clinical audit
• Bradley Viner BVetMed MSc(VetGP) MRCVS

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(No Transcript)
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Background

• London graduate 1978
• Own small animal practice since 1979
• MSc (VetGP) as part of SPVS group
• DProf with Middx Uni into clinical audit
• Facilitating MSc group
• www.vetgp.co.uk

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Clinical audit - what is it?

• Clinical Audit is a quality improvement process
  in clinical practice that seeks to establish
  protocols for dealing with particular problems,
  based on documented evidence when it is
  available, monitoring the effectiveness of these
  protocols once they have been put into effect,
  and modifying them as appropriate. It should be
  an ongoing upwards spiral of appraisal and
  improvement. (Viner,2003)

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Clinical audit medical practice

• National Institute for Clinical Excellence
• Principles for Best Practice in Clinical Audit
• www.nice.org.uk
• Healthcare Commission
• www.chai.org.uk

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Clinical audit vet practice

• Veterinary Institute
• for
• Clinical Excellence

VICE
V.I.C.E.
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THE CLINICAL AUDIT CYCLE
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Kolbs learning cycle (reflective practice)
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Clinical audit- why bother?

• Bring about change
• Assure our clients
• Promote our services
• Assure our employers
• Practice standards
• Professional satisfaction

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Clinical audit- obstacles

• Inertia
• Demands on time
• Cost
• Professional freedom
• Skills

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Stages in the audit cycle

• Preparation
• Establish protocols
• Selection of criteria
• Measure performance
• Review and modify
• Repeat

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Preparation

• Area to audit
• Define the problem
• Stakeholders
• Audit team
• Resource requirements

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Stages in the audit cycle

• Preparation
• Establish protocols
• Selection of criteria
• Measure performance
• Review and modify
• Repeat

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Protocols - EBVM

• Establish a protocol using EBVM
• The conscientious, explicit and judicious use of
  current best evidence in making decisions about
  the care of individual patients. This means
  integrating individual clinical expertise and the
  best available external clinical evidence from
  systematic research
• Handbook of EBVM, Cockcroft and Holmes (2003)

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Stages in the audit cycle

• Preparation
• Establish protocols
• Selection of criteria
• Measure performance
• Review and modify
• Repeat

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Selection of criteria

• Criteria are explicit statements that define what
  is being measured, and represent elements of care
  that can be measured objectively (NICE, 2002)

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Selection of criteria

• DREAM
• Distinct
• Relevant
• Evidence-based
• Achievable
• Measurable

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Stages in the audit cycle

• Preparation
• Establish protocols
• Selection of criteria
• Measure performance
• Review and modify
• Repeat

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Measure performance

• Can measure
• Processes
• Outcomes

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Measure performance

• Establish standards
• A statement which outlines an objective with
  guidance for its achievement given in the form of
  criteria sets which specify required resources,
  activities, and predicted outcomes. It decides
  the level of care to be achieved for any
  particular criterion.

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Stages in the audit cycle

• Preparation
• Establish protocols
• Selection of criteria
• Measure performance
• Review and modify
• Repeat

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Review and modify

• Assess the full impact of the solution, including
  issues such as compliance and audit design

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Clinical audit - summary

• Ongoing cycle of improvement
• Pick key areas of audit
• Build an audit team
• Create a positive working environment
• Define your criteria and standards carefully
• Use the best evidence available
• Exchange data with colleagues
• KISS

• (Keep It Simple, Stupid!)

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SPVS Roadshows 2005

• Timetable
• 9.30 Introduction to clinical auditing in
  general practice Bradley Viner
• 10.00 Evidence based medicine Dr Peter
  Cockcroft
• 10.30 Interpreting and sharing data Dr. Dave
  Brodbelt
• 11.00 Tea
• 11.30 Monitoring standards of performance in
  medical primary care Dr Chris Jenner
• 12.00 The role of the VN in clinical audit Lisa
  Bluett VN
• 12.30 Introduction to workshop
• 12.45 Lunch
• 13.45 Workshop on the application of clinical
  auditing
• 15.00 Workshop presentations
• 16.15 Plenary session questions discussion and
  summary
• 17.00 End

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Workshop

• Each group should submit a proposal for an audit
  of a clinical aspect of veterinary work, making a
  5 minute presentation on it to the rest of the
  participants at the end, and fielding questions
  on its value and feasibility. The example used is
  likely to be hypothetical, but the topic chosen
  and the environment in which it is applied should
  be real