Previously known as a medical audit, the name changed to clinical audit in the early 1990s. It involves reviewing the delivery of healthcare practices to ensure patients receive the best possible care.
Put simply, a clinical audit is a way to find out whether healthcare services are being provided in accordance with certain standards. It also lets healthcare providers and their patients know where their services are lacking or performing well.
Why Is Clinical Audit Necessary?
A clinical audit is all about improving patient care by looking at what healthcare providers are doing and helping them learn from it. In some cases, it also encourages a change in practice if required.
In fact, Florence Nightingale conducted the first-ever clinical audit during the Crimean War. It allowed her to nearly eliminate patient mortality rates from British Army hospitals by implementing better sanitation measures in field hospitals. She was able to use her influence to measure and monitor existing practices and change it for the better.
A clinical audit is an integral part of working healthcare practice and ties in directly with the requirements of the Pharmacy Contract as a necessary means of quality assurance. In community pharmacy, it ensures that the practice offers patients and customers the best possible service. While it’s near impossible to avoid risk completely, a clinical audit can help minimise it.
How Does The Clinical Audit Work?
The clinical audit process is also knowns as the “Audit Cycle” as it follows a continuous cycle of quality improvement. It involves six stages which we will cover briefly.
Stage 1: Identify Problems Or Objectives
The first step in any clinical audit is identifying potential problems or objectives. As the audit is essentially a quality improvement process, it should focus on problem areas where there may be room for improvement. Choosing an audit topic should always focus on patient care while ensuring it’s a priority for the entire team. Where possible, all pharmacy team members should be encouraged to suggest audit topics.
Stage 2: Criteria Agreed And Standards Set
Many healthcare professionals confuse the term ‘criteria’ with ‘standards’ but here is a clear definition. A criterion is an item of care or an aspect of practice that is examined. Criterion relevant to pharmacists is ensuring that the medicine they supply to a patient is in date. Standards are given in percentage terms with a relevant example being, 100% of medicine supplied to patients should be in date.
Stage 3: Clinical Audit Data Collection
This stage involves collecting information that helps determine whether the criteria and standards have been met. Data can be collected in the form of paper-based documents or electronic records. All clinical audit data must be relevant, accurate and representative. Don’t include too many questions and do a pilot audit first. Draw up five to ten questionnaires and test the effectiveness of the process.
Stage 4: Identifying Areas For Improvement
Data analysis is the process of interpreting data from the clinical audit. It will inform pharmacy teams of how the practice and their performance measure up to the agreed upon standards. The data collected and analysed will identify poor performance as well as areas of excellence. All results should be shared with every member of the team to encourage them to change processes and practices.
Stage 5: Make Any Necessary Changes
Once teams have identified areas that need improvement, the changes should aim at ensuring they deliver better care in order to meet the standards. Typically, audit results relate to specific circumstances but it can often lead to the following:
- Additional staff training
- Introducing more guidelines or protocols
- Develop new ways of working within the pharmacy
Stage 6: Re-Audit
The re-audit is the final stage in the cycle and links back to identifying problems or objectives. This process involves collecting a second set of data to analyse and see whether those results have made a difference in quality improvement. Re-audits are usually carried out 3-12 months after all the changes have been implemented and the data sets compared.
Clinical Audit And The Pharmacy Contract
In 2005, clinical audits became a contractual obligation for all Community Pharmacists. Today, all healthcare professionals are expected to take part in clinical audit work.
As part of the Community Pharmacy Contractual Framework (CPCF) requirements, pharmacy contractors must do 2 clinical audit annually. They must complete an audit on a topic determined by NHS England and NHS Improvement (NHSE&I) as well as a second audit that the pharmacy can choose themselves.
NHS England and NHS Improvement Determined Audits
This year, the national clinical audit focuses on antimicrobial stewardship. More specifically, it aims at advice provided to patients on upper respiratory tract infections. The audit documentation was published on 13 February 2020 and is available on the NHSE&I website. All pharmacy contractors must use the documentation in March 2020 to participate in the audit.
The clinical audit must be completed by 31st of March 2020 and the data submitted to NHSE&I via the NHSBSA Manage Your Service (MYS) portal. The portal will open for submission on 1 March 2020 and closes at 11.59pm on 28 April 2020.
VirtualOutcomes compiled a handy training module on the clinical audit to help all pharmacy contractors and their teams. The audit will take place over five working days where contractors collect data from a minimum of 10 patients. If necessary, the data collection period can be extended to ten working days.
At the the end of the audit the pharmacy team will need to review their results and any learnings from them so that they can improve their standards next year.