clinical governance and audit Flashcards
what is clinical governance?
framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish
what are the key components of clinical governance?
accountability and quality
who ensures clinicians are up to date and providing services of good quality?
Revalidation
what is NICE’s role?
is to improve outcomes for people using the NHS and other public health and social care services
how does NICE improve outcomes for people using the NHS and other public health and social care services?
- producing evidenced-based guideances and advice for health, public and social care practitioners- guidance on medicines /treatments /procedures and the treatment of medical conditions.
developing quality stds and preformance indicators- for those providing these services
providing a range of info services for commissioners, practitioners and managers across health and social care
what is the care quality commission?
ndependent regulator of health and adult social care in England
•Reviews the quality of care in the NHS against 13 fundamental standards
what does the CQC do?
- Regularly inspects hospitals, Care Homes, GP and dental practices, ambulance services and home care agencies
- Inspections consider whether services are safe, effective, caring, responsive and well-led
- Services are graded overall and also separately fo rthe five considerations above as inadequate, requires improvement, good or outstanding
- Can impose fines, give cautions, prosecute providers, limit activities or impose ‘special measures’ and, if necessary, withdraw registration (i.e. force closure of the provider)
what are the 3 key components of clinical governance?
1-patient development
2-professional development
3- organization development
what is an SOP?
An SOP is “a written specification of what should be done, when, where and by whom”
•Legal requirement under the Responsible Pharmacist Regulations 2008 (see separate lecture) •This is an important aspect of clinical governance within a pharmacy – to ensure the quality and consistence of service
•Should cover a number of procedures and processes in the pharmacy
how often should an SOP be reviewed?
at least every 2 years or when:
- changes in staff
- changes in law
- changes in the system/process
what are some of the benefits of SOPs?
- Assures the quality and consistency of the service at all times
- Ensure the achievement of good practice at all times
- Enable pharmacist to delegate, thus freeing time for other activities
- Help avoid confusion over who does what –useful for role clarification for staff and locums
- Provide advice and guidance to locums
- Useful tool tobeusedwhen training staff
- Useful tool to use for audit cycle
what is a dispensing error log?
It is good practice to keep a record of:
•Near misses
•Dispensing errors
how should dispensing errors be reviewed?
Errors should be reviewed individually and also with other errors to establish whether any patterns or similarities are occurring
•The important thing is to learn from errors made
what is a clinical audit?
Clinical audit is a quality improvement process that seeks to improve the patient care and outcomes through systematic review of care against explicit criteria and the implementation of change
how mant audits should a community pharmacy have every year?
The community pharmacy contract requires a pharmacy to undertake two audits per year
what is the working definition of a clinical audit?
improving the care of patients by looking at what you are doing, learning from it and, if necessary, changing practice
what are some of the benefits of audits?
- Improve quality of service
- Improve efficiency
- Improve the effectiveness of the service
- Improve the outcome for patients
- Minimise errors
- Maintain good professional standards
- Efficient use of resources (people, time, money)
- Supports change by producing objective information about quality of care or service provision
what is the difference between audit and research?
audit:•Aims to find out what is being done and what could be done better
•Reviews current practice
•Can be proactive or reactive
•Uses best practice as defined by research
•Results apply to sample only
research:•Seeks new knowledge
•Aims to find out the answer to a question where the answer is unknown
•Research defines future best practice
•Extrapolates from the sample to the wider population
what is the audit cycle?
1-identify problem or issue 2 set criteria and stds 3-observe practice/data collection 4-compare performance with criteria and standards 5-implementing change
where/how would you identify a problem or an issue in a clinical audit?-step 1 of audit cycle
- NICE or local guidance
- Areas of clinical priority or interest
- Critical incidents
- High volume
- High risk
- High cost
- Local issue
- Area identified by NHS England for pharmacy contract
what is the focus with clinical audits?
patient focus
what would be an example of clinical audits?
- High risk –warfarin, dual antiplatelets, methotrexate, lithium •High cost –NOACs, sip feeds, unlicensed meds
- High volume – aspirin
- Areas of concern – antibiotics, NSAIDs
- Safety incidents – ‘near misses’
how would you set standards for a clinical audit?
- Criteria- Should focus on a key point that is relevant
- Each criteria should have a target
- Target + criteria = standard. The standard should be:
- Realistic
- Measurable •Achievable
- Agreed
what is an example of a bad standard?
100% of patients over 55 years of age who take a NSAID should be taking a PPI- 100% is not achievable
how would you observe practice/ data collection?
- Keep data collection as simple as possible
- Consider carefully how (using what) and when (over what time period) you will do data collection
- Only collect appropriate data that you will need and use •Design and use a data collection form (
how would you compare what you found on an audit with preformance standards?
- Was all the information collected complete and accurate?
- Did anything exceptional happen during the audit that may have affected the results?
- What are the recommendations for change?
- Decide and get agreement on change of practice
how would you implement change after an audit?
- Ownership of the audit at the start is vital for this part to succeed
- If change in practice is needed, participants must be able to see why or commitment to change will not be present
what is the purpose of a reaudit?
should be doneto ascertain whether improvements in care have been implemented as a result of the clinical audit
•This will check: was the change successful?
what criteria do you use in the re-aduit
Use the same criteria and methodology
