PROGRAMME

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PROGRAMME

• Audits for the PGA in Professional Skills
• Thursday 26 August, CSB UHCW
• 2.30 3.15pm PGA and Audit
  
• Dr Paul OHare
• 3.15 3.30 pm Break
• 3.30 4.30pm Workshops to review previous audits
  and
• reflective diaries
• Dr Paul OHare
• Dr David Bennett-
• Jones
• 4.30 5.00pm Discussion of audit
• Questions and ideas Dr Paul OHare
• Dr David Bennett-
• Jones

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POSTGRADUATE AWARD IN PROFESSIONAL SKILLS

• A stand alone qualification or 1 module (20 CATS)
  towards
• Masters (MSc) in Health Sciences
• Can use MRCP, FRCS, etc., as 2 modules (40) for
  Masters in Health Sciences

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• Designed around curriculum for generic and acute
  skills of Foundation Year 2.
• Course attendance and involvement recorded in
  reflective diary/personal development plan (1,000
  words)

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• Assessment PGA Professional Skills
• Communication Skills (40) (exam)
• Audit written assignment (40) (2,000 3,000
  words)
• Reflective Diary/PDP (20) (1,000 words)

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Deadlines for assessments

• Audit Wednesday, 25 May 2011
• Reflective diary Wednesday, 27 July 2011

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Audit -

• F2 curriculum . Has been actively involved
  in undertaking a clinical audit, and recognises
  how it relates to the improvement of clinical
  standards and addresses the clinical governance
  agenda.

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Assessment of Audit

• 1. Plan and carry out. Keep simple in area
  interested
• Manageable
• 2. Write up 2,000 3,000 words
• Structured
• 3. Follow criteria in writing up audit assignment
• 4. Meet deadline May 26 2010
• Present as soon as complete
• Need written agreement before if late

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Assessment of Audit (1)

• 1. Justify relevance and rationale of audit,
  clearly stating the reasons with reference to
  current clinical practice and literature
• 2. Clearly state objectives
• 3. Show evidence of teamwork in preparation,
  planning and carrying out audit and in discussion
  and presentation of findings
• 4. Justify your standards by clearly linking them
  to references in the scientific literature or to
  agreed written policies. Use clear, explicit,
  measurable quality criteria.

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Assessment of Audit (2)

• 5. Use clear methods, data collection and correct
  sampling strategies
• 6. Explain clearly and fully what you have learnt
  in completing the audit
• 7. Conclusions include thoughtful logical
  conclusions that demonstrate reflections on what
  you have learnt from the audit
• 8. References all material should be properly
  referenced using Vancouver system (BMJ)
  (preferred) or Harvard formats

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Reflection on experience(NHS Foundation Learning
Portfolio)

• 1. Describe interesting, difficult or
  uncomfortable experiences. Try to record both
  positive and not so positive elements. What made
  the experience memorable?
• 2. How did it affect you?
• 3. How did it affect the patient?
• 4. How did it affect the team?
• 5. What did you learn from this experience and
  what (if anything) would you do differently next
  time?

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• What do you understand by clinical audit?

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Defining clinical audit (post Bristol)

• A quality improvement process that seeks to
  improve patient care and outcomes through
  systematic review of care against explicit
  criteria and the implementation of
  changeaspects of the structure, process and
  outcome 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

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• What do you understand by the audit cycle?

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• In audit what do you understand as
• Aims
• Objectives
• Standards?

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What is the aim of the audit?

• Aims are broad statements of intent
• - e.g., to improve local practice in the
  management of leg ulcers
• - e.g. to improve the referral process top
  smoking cessation services
• - e.g. to improve the reporting process of
  laboratory results
• - e.g., to improve the management of observations

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After topic comes your aim and objectiveAlways
know your aim and objective!

• a project without clear objectives cannot
  achieve anything a clear sense of purpose must
  be established before appropriate methods for
  audit can be considered
• ..once the topic for audit a clinical audit
  project has selected the purpose of the project
  musty be clearly defined so that your method
  chosen is the most suitable for your project
• Objective of audit quality of care

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Common question

• But isnt audit the same as research?
• whats the difference?

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Why does audit get confused with research?

• Both involve collecting/accessing information to
  achieve an objective
• Both involve observing practice to achieve an
  objective
• Both have a data analysis component
• Both produce written reports/findings/summaries

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Audit versus research (1)

• Calling something audit does not make it an
  audit its the objective of the project that
  counts
• Objective is the most useful factor for
  distinguishing between the two activities
• For example, research answers the questions what
  should we do? the objective of research is to
  create new knowledge, e.g., test a hypothesis

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Audit versus research (2)Audit answers the
question are we doing what we should be doing in
the way we should be doing it e.g., Objective is
to measure the quality of care provided against
agreed ways of working/evidence based
medicine/guidelines/standardsAudit is not
poor or weak research it is a totally
different activityAudit is not a quick fix for
research to avoid ethical implicationsAudit is
not an easy way to conduct research
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Audit versus research (3)

• In general, the objective of audit is to evaluate
  the quality of local practice by sharing
  findings locally one can improve local practices
• Local audit would not necessarily benefit the
  wider health economy as it relates to a Trust and
  the practices of that Trust
• In general, the objective of research is to
  create new knowledge that can be shared with
  others
• Sharing this information (research) may benefit
  the wider health economy

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Summary what makes an audit a good audit?

• Involve all concerned e.g., other departments,
  professional groups
• Clear rationale/purpose
• Explicit aims and objectives
• Measurement against which to compare evidence
  base/standards
• Sound methodology best approach, sampling
  techniques, proforma design
• Data analysis that reflects the aims objectives
• Reported and presented to reflect aims
  objectives
• Reported presented to reflect
  measures/standards utilised
• Birmingham Clinical Audit Assessment Framework
• More likely to change practice if
  methodologically rigorous
• Spurgeon P, Walshe K (1997). Birmingham Clinical
  Audit Assessment framework. HSMC University of
  Birmingham
• Walshe, K (1999). BRI Inquiry on medical and
  clinical audit in the NHS. HMSO London

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What makes audit change practice?

• Perception, attitude, motivation
• Organisation and environmental factors
• Choice of audit topic, adequacy of audit method
  and understanding the reasons for deficiencies
  identified
• Extent to which audit is systematically
  integrated into routine management of care
• Involve/Inform the Change Makers
• Walshe, K (1999). BRI Inquiry on medical and
  clinical audit in the NHS. HMSOI London

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