Quality Education for a Healthier Scotland

Audit

Fiona McMillanLead Pharmacist Educational

DevelopmentNHS Education for Scotland.

Quality Education for a Healthier Scotland

Learning outcomes

• Demonstrate an understanding of the audit process

• Demonstrate and understanding of the various factors required to achieve a ‘satisfactory’ audit

• Demonstrate an understanding of comments provided as feedback by the reviewers

• Be able to submit an audit for review as part of the NES national CPD project

• Be able to teach a member of your team about audit for submission as part of the NES national CPD project

Quality Education for a Healthier Scotland

NES Pharmacy and audit

NES Pharmacy accepts for review audit from pharmacists and registered technicians

• Audit is a good way of achieving CPD and is included in VT training

• Audit enables change and improvement in practice through a review of processes

Quality Education for a Healthier Scotland

What is Audit ?

• Quality Improvement process• Identification of the need for a change ideally using the

evidence base as a reference• Assessment of current practice against best practice using

- Specific criteria against set standards with a set timescale over which a change is expected

to take place• Enables the implementation of a change to improve the

standard of practice and ultimately patient care.

Quality Education for a Healthier Scotland

What documents are involved?

• Audit reporting form (on NES website CPD pages)

• The feedback form (used by the reviewers , on NES website CPD pages)

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Why do you wish to undertake this audit?

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Criteria and Standards

Criteria“used to describe a definable and measureable item of

health care”

• Patients with type II diabetes should have a fundoscopy every 12months

Standard“describes the level of care to be achieved for any

particular criterion”

• 90% of patients with type II diabetes should have a fundoscopyevery 12-months

Quality Education for a Healthier Scotland

Criteria and Standards

Criteria (poor example)– to identify the number of times staff have

to use ladders to reach stock items

Criteria (good example)– all stock should be placed in the most

ergonomically suitable position

Quality Education for a Healthier Scotland

Criteria and Standards

Standard (poor example)staff should not be expected to climb shelves or use ladders to reach stock

Standard (good example)at least 90% of dispensed items should have been accessible without the need to climb or use ladders

Quality Education for a Healthier Scotland

Preparation and planning

Methods section• How was data identified?• Was the data collection form piloted?• How was data analysed?• How was the data disseminated to others?

Team approach• Who helped you with the project?• Did you involved the work of those that you were

auditing?

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Data collection

• Cycle 1• Simple descriptive statistics• Graphs and pie charts• Anonymised!• Include actual numbers and % (not just %)• Only report data that is relevant to the

criteria and standards set!• Re-audit (Cycle 2)• Present in a way that compares before and

after implementation of changes and then draw conclusions

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Conclusions

Summarise• What was achieved ?• What were the main learning points?• What were the benefits that were encountered• What were the problems to be overcome?• Any limitations?• What are the plans for a future audit?

Quality Education for a Healthier Scotland

Example

• Look at the audit in pairs. Use the scoring sheet that the reviewers use.

• How would you advise someone to improve the ‘ the reason ‘ for the choice of audit?

• Is the audit relevant to practice? Is there reference to the evidence base? Do they describe a change that needs to take place?

• How would you advise improving the criterion?• Are they SMART? Are they relevant to the audit ? Are

they specific and will they enable results to be reported against each criteria?

Quality Education for a Healthier Scotland

Example

• Read through and score the rest of the audit

• Discuss as a group each aspect of the audit and come to a concensus as to the score and nay feedback that you would give.

• Was the audit at the end of the day satisfactory?

• Should the author be encouraged to resubmit ?

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AuditHints and tips

• Usually 2 cycles undertaken (VT generally 1, but if simple, could do 2 cycles) ..... a few months apart

• Don’t complicate the issue – audit is not a research project

• Pilot the ‘data capture’ form and amend, based on feedback from others

• Keep criteria simple and SMART• Keep standard simple and SMART• Link standard to criteria • Team approach - discuss with others who will be

involved in the audit – can provide good ideas

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Audit hints and tips

• Report findings as detailed by the stated criteria and standards... Do not report interesting things along the way

• Complete your conclusions from undertaking the audit• Results need to link back to criterion and standards.• Do not ‘report’ extra interesting things along the way • Present data graphically, simply using numbers and

percentages (not just percentages)• Complete your conclusions from undertaking the audit• Keep anonymous! Don’t mention your health board even

in your references!• Submit to NES – feedback takes ~ 3weeks.

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Feedback

• The reason for the audit was described fairly well

• The audit criteria are clearly written but are also a bit confusing

• The standard is clear and flows from the criteria as stated

• There is evidence of team working

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Feedback• The results are clearly presented ....• 55% adhering to the criteria as set• The results also report on the inappropriate route

prescribed but there is no mention of this in the criterion or standards

• To strengthen the audit the criteria, standards and results need to be comparable

• The results of the audit have been reported to different groups which is good

• The limitations for the audit are listed which is again good

• You do state clearly that the standard wasn’t met, however you report the results in a format that details adherence to the guidelines which is confusing............

Quality Education for a Healthier Scotland

Learning outcomes

• Demonstrate an understanding of the audit process

• Demonstrate and understanding of the various factors required to achieve a ‘satisfactory’ audit

• Demonstrate an understanding of comments provided as feedback by the reviewers

• Be able to submit an audit for review as part of the NES national CPD project

• Be able to teach a member of your team about audit for submission as part of the NES national CPD project