academic and clinical governance questions

Question 1

what is clinical audit?

Answer 1

audit is looking at current practice to see how well we are performing against set standards as a team or individual. It can be used to make improvements and then see if change has occurred by looking at current practice again. This can be thought of as a cycle.

Question 2

why are audits important?

Answer 2

1. as a key pillar of clinical governance, it ensures that quality of care is maintained at an agreed standard
2. can encourage better use of resources and better efficiency
3. a good exercise to train and develop trainees with service improvement

Question 3

what are the problems associated with the audit process?

Answer 3

1. audits are a local process and therefore it may not be possible to transfer them to other trusts. Resolutions for one trust may not work in another
2. audits are based on retrospective data- often patient notes and therefore the process of collecting it for an audit may be challenging
3. certain team members may feel targeted by audit measures
4. audits may not be done in order of priority but rather in order of what’s easy in terms of resources

Question 4

what is the difference between audit and research?

Answer 4

audit compares clinical practice to set standards whereas. Research however, does not check whether you are complying with standards. Research is instead about discovering new things and creating new knowledge.
essentially, research can help to establish best practice whereas audit checks that best practice is being applied in practice.

Question 5

why is research important?

Answer 5

research creates a pool of knowledge that can be translated into better patient care. translation of new discoveries into patient care is however, slow.
As an individual research is important as it enables us to be evidence based practitioners.

Question 6

what do you understand by the term research governance?

Answer 6

governance refers to ‘a set of rules that govern the way a particular activity should be undertaken’
set out in 2005 document by the department of health: research governance framework for health and social care.
1. ethics e.g. informed consent should be sought
2. science e.g. a review of current research should be undertaken before any research is carried out to avoid duplication. All proposals should be peer-reviewed.
3. information- positive and negative outcomes should be made available to the public in user friendly language
4. health and safety
5. finance

Question 7

what is evidence based dentistry?

Answer 7

use of current best evidence in making decisions about the care of individual patients. the evidence should be applied taking into account patient values

Question 8

what are the different levels of evidence?

Answer 8

1. SR or meta-analysis of RCTs
2. RCT
3. controlled study without randomisation
4. quasi-experimental study such as a cohort study
5. descriptive such as case-control. case series
6. expert committee reports, opinions

Question 9

can you describe what clinical governance is?

Answer 9

a quality assurance process designed to ensure that standards of care are maintained and improved and that the NHS is accountable to those using it

ACE RIPS p201

1 audit
2 clinical research
3 education and training
4 risk management
5 IT and using information e.g. accurate and confidential patient data
6 PPI (patient and public involvement) E.G. local patient feedback questionnaires
7 staff management

PIRATES (T for training)

the 4 care pillars that are more relevant are 
Clinical effectiveness
audit
risk management
education and training

Question 10

what is your experience of clinical governance?

Answer 10

think CARE

1. audits undertaken
2. clinical effectiveness- played a role in implementing a set of guidelines in your department- FPM audit. Research on dental nurses providing RA.
3. education- PDP, journals
4. risk management- extraction checklist, knowing when to get second opinions etc
5. IT- anonymise patient data for audit and case presentation purposes
6. PIP- patient satisfaction surveys
7. staffing- improving morale with IHS nurses project

Question 11

what is the difference between a standard, a guideline and a protocol?

Answer 11

1. standard: is a defined level of quality that must be achieved. through clinical audit, clinicians compare their own practice to the standards set by NICE . etc
2. guidelines are statements which are designed to assist clinicians in making decisions. they are recommendations for clinical practice based on evidence
3. a protocol is a systematic approach to dealing with an issues such as managing a patient, ensuring that the correct tooth is taken out, dealing with a complaint. Protocols are used to ensure that there is a systematic approach to dealing with important issues.

Question 12

how do you critically analyse a paper?

Answer 12

purpose is to determine how useful and valid published evidence is
1. title/journal (is it peer-reviewed)/authors/submission
2. introduction- aims?
3. methods e.g. case control snap shot or cohort- following up people over a period of time. Study design. Was the data collected retrospectively or prospectively.
MORE p212
4. results- are results for all end points clearly stated, what statistical methods are used?
5. discussion/conclusion- discussed in terms of the association of the intervention or risk factor with the outcome measure