Block 16

Question 1

What is an audit?

Answer 1

A QIP which involves a systematic review of care against explicit criteria and the implementation of change to improve patient care and outcomes

Question 2

What are the five / six key steps of performing an audit?

Answer 2

1. Identify a problem or issue
2. Set the criteria and standards
3. Observe practice and data collection
4. Compare performance against criteria and standards
5. Implement change
6. Re-evaluate…

Question 3

In an audit, when identifying a problem or an issue:

• What are the strengths of this?
• What are the pitfalls / barriers of this?

Answer 3

• Strengths:
  By identifying a problem, we can highlight an area for improvement, improve patient satisfaction and prevent near misses
• Weaknesses:
  Problems may not always be easy to identify, especially if people do not fill out incident forms. Plenty of things do not meet guidelines - does this necessarily mean it is a problem?

Question 4

In an audit, when setting the criteria and standards:

• What are the strengths of this?
• What are the pitfalls / barriers of this?

Answer 4

• Strengths:
  If based on NICE Guidelines, this means it is evidence based which is good. If it is a common goal people can agree with, they are more likely to work towards it
• Weaknesses:
  When setting criteria and standards, you will need information of the current practice beforehand. Also will need clinical expertise on whether criteria / standards are effective. Will also need fiscal expertise to make sure it is feasible. Some criteria will be hard to quantify if they are qualitative

Question 5

In an audit, when observing practice and data collection:

• What are the strengths of this?
• What are the pitfalls / barriers of this?

Answer 5

• Strengths:
  It will show how well your practice is currently performing
• Weaknesses:
  Experimenter bias → If people are aware you are performing an audit, staff will change their practices around you, skewing data. Need impartial observers. Time constraints of data collection → May not get the full picture. Data collection itself may be difficult → Ineligible handwriting, lost notes, poor filing, patients lost to FU

Question 6

In an audit, when setting the criteria and standards:

• What are the strengths of this?
• What are the pitfalls / barriers of this?

Answer 6

• Strengths:

- Weaknesses:

Question 7

In an audit, when comparing performance against criteria and standards:

• What are the strengths of this?
• What are the pitfalls / barriers of this?

Answer 7

• Strengths:
  May actually identify that current practice needs to improve. Similarly, may be reassured when current practice is running perfectly and nothing needs to change. May be able to grade performance
• Weaknesses:
  May be difficult to compare performance against current guidelines. If guidelines say a specific target must be achieved, how can this be measured?

Question 8

In an audit, when implementing change:

• What are the strengths of this?
• What are the pitfalls / barriers of this?

Answer 8

• Strengths:
  It will improve practice, hopefully
• Weaknesses:
  Takes time for people to carry out properly - will this fall within your data collection frame? Resistance in changing people’s habits. Change may not fit with national guidelines even if you know it will improve the current situation. Re-training staff to implement change → time and money

Question 9

In an audit, when re-evaluating after change:

• What are the strengths of this?
• What are the pitfalls / barriers of this?

Answer 9

• Strengths:
  Lets you know if you should continue. Demonstrates whether change has been good, bad, indifferent. You are constantly improving practice based on new evidence = good
• Weaknesses:
  Difficult to know how long to leave it. Difficult to know how many times to repeat a cycle. Guidance may change again after implementation → making it futile