clinical governance and audit

Question 1

what is clinical governance?

Answer 1

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

Question 2

what are the key components of clinical governance?

Answer 2

accountability and quality

Question 3

who ensures clinicians are up to date and providing services of good quality?

Answer 3

Revalidation

Question 4

what is NICE’s role?

Answer 4

is to improve outcomes for people using the NHS and other public health and social care services

Question 5

how does NICE improve outcomes for people using the NHS and other public health and social care services?

Answer 5

• 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

Question 6

what is the care quality commission?

Answer 6

ndependent regulator of health and adult social care in England
•Reviews the quality of care in the NHS against 13 fundamental standards

Question 7

what does the CQC do?

Answer 7

• 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)

Question 8

what are the 3 key components of clinical governance?

Answer 8

1-patient development
2-professional development
3- organization development

Question 9

what is an SOP?

Answer 9

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

Question 10

how often should an SOP be reviewed?

Answer 10

at least every 2 years or when:

• changes in staff
• changes in law
• changes in the system/process

Question 11

what are some of the benefits of SOPs?

Answer 11

• 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

Question 12

what is a dispensing error log?

Answer 12

It is good practice to keep a record of:
•Near misses
•Dispensing errors

Question 13

how should dispensing errors be reviewed?

Answer 13

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

Question 14

what is a clinical audit?

Answer 14

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

Question 15

how mant audits should a community pharmacy have every year?

Answer 15

The community pharmacy contract requires a pharmacy to undertake two audits per year

Question 16

what is the working definition of a clinical audit?

Answer 16

improving the care of patients by looking at what you are doing, learning from it and, if necessary, changing practice

Question 17

what are some of the benefits of audits?

Answer 17

• 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

Question 18

what is the difference between audit and research?

Answer 18

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

Question 19

what is the audit cycle?

Answer 19

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

Question 20

where/how would you identify a problem or an issue in a clinical audit?-step 1 of audit cycle

Answer 20

• 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

Question 21

what is the focus with clinical audits?

Answer 21

patient focus

Question 22

what would be an example of clinical audits?

Answer 22

• 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’

Question 23

how would you set standards for a clinical audit?

Answer 23

• 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

Question 24

what is an example of a bad standard?

Answer 24

100% of patients over 55 years of age who take a NSAID should be taking a PPI- 100% is not achievable

Question 25

how would you observe practice/ data collection?

Answer 25

• 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 (

Question 26

how would you compare what you found on an audit with preformance standards?

Answer 26

• 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

Question 27

how would you implement change after an audit?

Answer 27

• 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

Question 28

what is the purpose of a reaudit?

Answer 28

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?

Question 29

what criteria do you use in the re-aduit

Answer 29

Use the same criteria and methodology