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WHAT
HOW
WC
WHY
INTRODUCTION
Quality is not an accident, it is the result of
high intentions,
sincere efforts,
intelligent direction and
skillful execution
Clinical Audit
Research
Audit Cycle
Re-audit to
look for
improvement
Review
standard
Implement
change to
improve
Collect data
on current
practice
Compare data
collected with
standard
STAGES IN
CLINICAL AUDIT
Stage 1: preparation
Good
The
Ref: Principals for best practice in clinical audit. National Institute for
Clinical Excellence. 2002. Radcliffe Medical Press Ltd.
2 areas to be considered in
preparation
Project management
Team
Leader
topic selection,
planning and resources,
communication
Project methodology
Study design
Data issue: collection,
analysis, storage
Implementability
Stakeholder
involvement: patients,
other HCW
Support for local
improvement
Stage 1: Step 1
PROJECT MANAGEMENT
The team
1.
2.
3.
4.
5.
6.
Identifying the skills and people needed to carry out the audit, and
training of staff and encouraging them to participate.
Involve the right people with the right skill from the start.
Certain skills are needed, which include:
Project leadership, Project management, project organization
Clinical, managerial, and other service input and output
Audit method expertise
Change management skills
Data management: data collection, data entry, data analysis, &
data presentation
Facilitation skills.
The Team
1.
2.
3.
4.
5.
6.
The leader
The leader
Topic selection
1.
2.
1.
2.
3.
4.
5.
1.
2.
3.
4.
Purpose of audit
What aspects of care that concern us?
Which aspect of care that you would like to
audit?
Effectiveness
Efficiency
Equity
Purpose of audit
Accessibility
Appropriateness
Acceptability
Timeliness
2.
Communication
Inform all those who are going to be involved.
Platforms for communication include:
memo/letter, e-mail, meeting
Stage 1: Step 2
PROJECT
METHODOLOGY
Project methodology
2.
Data collection
What: collect data that is related to audit criteria
Who(samples) from whom these data is gathered?
Patients? Healthcare providers? Inclusion/Exclusion
criteria
Who: by trained staff.
Where: unit/department
Data collection
An Audit on the
Use of Granisetron Injection for
Chemotherapy-Induced Nausea and Vomiting
in Hospital Sultanah Bahiyah
Pharmacy Department
Supervisor : Malathi Sriraman @ Jayaraman
Group Leader : Chan Huan Keat
Group members: Khor Seau Ting
Tan Say Li
Quality of Care
Criteria
Standard
1.
Indication of
granisetron
injection
100 %
Dose of
granisetron
injection
100%
Ref. Systemic Therapy of Cancer 2nd Edition, Ministry of Health Malaysia, 2007.
34
Study
Design
Prospective study:
To check prescriptions for adherence to the
recommended indications & doses.
Inclusion
Criteria
Exclusion
Criteria
Population
Size
N = 432 prescriptions.
All included.
Data
Collection
Data
Analysis
SPSS 16:
(a) Descriptive analysis.
35
Data collection
Cross-sectional study:
To study the prescribers perception using a
validated questionnaire modified from
Tajunisah M.E. et al (Cronbachs = 0.72). 8
Inclusion
Criteria
Sampling
Method
Convenient sampling.
Sample
Size
n = 63 doctors.
Data
Collection
Data
Analysis
SPSS 16:
1. Descriptive analysis.
2. Inferential analysis: Chi Square tests.
8. Tajunisah M.E. et al, Physicians Perception and Adherence to Guideline on the Management of Chemotherapy
Induced Nausea & Vomiting (CINV).
Hospital Pulau Pinang, 2009.
37
Names of Auditors:___________________
Ward/Department:____________________
Date:_______________
1.
2.
3.
4.
5.
6.
7.
8.
BHT
1
BHT
2
BHT
3
BHT
4
BHT
5
BHT
6
3 August 2009
BHT
7
BHT
8
BHT
9
BHT
10
Total %
Data protection
Stage 2
SELECTING CRITERIA
& STANDARD
Criteria
1.
2.
3.
Classified into:
Structure: what you need
Process: what you do
Outcome: what you expect
Criteria
1.
2.
3.
Structure: include
staff: no. of staff, skill mixed, ratio of staff to patients.
Equipment: technology, number of equipment
Space provided: number of OT functioning, room for
counseling
Criteria
1.
2.
3.
4.
5.
6.
7.
8.
Department
KPI
Anesthesiology Percentage of
Elective And
Emergency Surgery
Patients Who
Receive Acute Pain
Service
Standard
Achievement
>10%
5.1%
(204/4001 x
100%)
Criteria
Outcome Criteria
Department
Dietetic &
Catering
NIA
Standard
Incidence of Physical
Contamination of Food
Served to Patients
Sentinel events
Indicator: Delay in
Response to In-patient
Referral by Dietitian
(for critical case)
Achievement
2 cases
Standard : 5
%
6.1%
(25/407 X 100%)
(Repeat SIQ. 11.8%:
Jul-Dec 2009)
1.
2.
3.
4.
5.
6.
1.
2.
3.
Stage 3
MEASURING LEVEL OF
PERFORMANCE
Data storage
Data analysis
Comparing performance with standard
Any gap in performance (short fall in quality, SIQ)
Indication of
granisetron
injection
Low Emetogenic
(Level 1&2)
38.0%
(164 Rx)
Criteria
Standard
100 %
Moderate Emetogenic
(Level 3)
19.9%
(86 Rx)
38% non-compliant to
indication
42.1%
(182 Rx)
High Emetogenic
(Level 4)
52
Dose of
granisetron
injection
Criteria
Standard
100%
Granisetron 3mg
53
Stage 4
MAKING
IMPROVEMENT
SIQ
n=63 prescribers
There are no association between prescribers perception and all the factors tested including
departments and clinical experiences (p>0.05).
58
What to
change
How to
change
When to
change
Who is
responsible
AWARENESS
What to change?
How to change?
At INDIVIDUAL level:
When to change?
Who is responsible?
GUIDELINE AVAILABILITY
What to change?
How to change?
When to change?
Who is responsible?
GUIDELINE ENFORCEMENT
What to change?
How to change?
At SERVICE level:
When to change?
Who is responsible?
Implement strategies
Strategies for CHANGE is all about CHANGE
Observe the stages for change
Awareness
Agreement
Acceptance
Assimilation
Accountability
Action
4 kinds of motivation
Do this clinical audit
& youll get a bonus
+
Intrinsic
You want to do it
Extrinsic
Someone wants you to do it
Positive
Motivations towards a goal
create positive,
sustainable
motivation