What is …a clinical audit?

A clinical audit is an assessment of processes or systems involved in the clinical aspects of care, and is an important tool for monitoring and improving quality within hospitals.

It is used to review existing practice and to establish a benchmark of results. The audit process should be cyclical, with initial results leading to changes in practice, which are re-assessed with a follow-up audit.

The first step to a clinical audit is choosing a topic. Common audit topics include compliance with NICE guidelines for specific disorders such as schizophrenia; the appropriate physical monitoring of patients; or staff following infection control procedures.

A set of criteria for a topic will be drawn up, which should be based upon national or local guidelines. A standard is then set for each criterion, indicating the level that must be reached to comply with best practice. Clinical audit usually requires compliance of 100%, but an appropriate level should be set for each standard.

Thought is then given to the sample of patients to be included or excluded in the audit. The methods of data collection also needs to be determined. Often this will be by review of patients’ medical notes.

Once collected, the data is compared against the relevant standards. Where standards are not met, recommendations should be made about the required changes and their implementation.

After any changes have been implemented, it is important to repeat the audit to ensure improvement is achieved. It is important that enough time is given for changes to be implemented and maintained; often there is an initial improvement in the period after an audit, followed by a gradual return to previous levels.

Clinical audit can have huge benefits. Completing robust clinical audit cycles helps hospitals identify areas where best practice is not occuring, implement change and ensure that quality improvement is maintained.

A good place to start clinical audit would be with medicine management, as data is readily available from your visiting pharmacist’s regular audits, and improvements in practice could have significant effects in reducing clinical risk.

A book with examples of clinical audits has been published by the The Royal College of Psychiatrists, further details:
http://tinyurl.com/m3sb8hh