Devising a multidisciplinary audit tool

Discusses the audit processes in health care from the existing perspectives and argues the need to extend the current unidimensional approaches which include medical, clinical and managerial quality. Argues that one way of expanding these approaches is to develop an audit instrument based on the views of service users. The implementation of audit has been a process with regional variations, which have created centres of excellence and centres where there is very little happening. Considers elements that are involved in devising an audit tool which is based on customers' perceptions of service quality, and reports on an empirical study which is still in progress and which aims to develop a tool which is effective, efficient and based on patients' views.     

Epilepsy: a disease audit

An audit was made of the management of epilepsy in an Australian general practice using a computerized medical record system. The aim was to determine whether disease audit is practical and worth the effort involved. It was concluded that even a sophisticated medical record system can be an inefficient tool for the monitoring of chronic illness. A specific diagnostic and management protocol suitable for later computerization is required. A number of audit objectives were identified: (1) Has the practice diagnosed all cases of epilepsy as predicted by community prevalence studies? (2) Has it correctly classified these diagnoses and supported them by evidence from neurological referral and appropriate investigations (EEG and CT scan)? (3) To what extent has the practice adequately managed these patients? In particular, what percentage of patients have remained free of fits in the previous 12 months? (4) Has the doctor used the simplest drug regimen possible, preferably monotherapy, and avoided side effects? (5) Does the medical record allow analysis and effective audit? Audits of this type in a practice of this size requires a suitable practice register to identify the medical records to be analysed, otherwise a manual search of every record is a major deterrent to audit. Computerized records of the future should be designed so that data and analyses can be produced by automated printout.     

Report of a nutritional screening audit

Background: Malnutrition in hospitals has been widely documented and nutritional screening forms part of the National Professional Standards for Dietitians. As a result of this concern, a nutrition screening tool has been incorporated into the nursing care plan documentation. Aims: To audit the use of the screening tool in nursing care plans for elderly patients and examine the communication methods concerning the need for individual nutritional care. Methods: A standard chart was used to audit patient notes. In addition, a short informal interview was conducted with nursing staff. Results: Use of the screening tool was variable and fewer than half of those identified by this tool as in need of nutritional care were referred to the dietitian. Conclusion: Ward staff are prioritizing patients referred for dietetic care, even when they have been identified by the screening tool, but this is not always done systematically. Improvements could be made in the relevant documentation. Further training of ward staff and a follow-up audit should be undertaken.     

Nutrition audit at a community hospital

Background: The Department of Health (DoH) guidelines on hospital catering recognize the benefits of good nutrition in the reduction of medical complications and length of stay. Audit checklists are available to monitor implementation of these guidelines. Aims: To describe current feeding practice in a community hospital; evaluate qualitative aspects of patients’ mealtimes and to audit the food provided in relation to DoH guidelines and reference nutrient intakes. Methods: Qualitative data were collected at mealtimes by observation and recorded on a standard proforma. Nursing staff completed short questionnaires concerning food availability and support for patient feeding. Menus were compared with DoH guidelines using a standard checklist. Food intake data were collected over a 48-h period for a group of patients (n=8) and comparison made with Reference Nutrient Intakes. Results: Qualitative aspects of mealtimes were satisfactory, mealtimes were relaxed and pleasant. Using the DoH checklist, menus met national guidelines for vitamin C, fibre, iron and folate. However, analysis of dietary intakes showed low intakes of iron, fibre, vitamin D and folate. Conclusion: Some aspects of food provision require attention and this would be facilitated by the setting up of a hospital food committee to set goals and monitor progress.     

Perinatal mortality audit in a Zimbabwean district

Perinatal deaths were systematically investigated over a 25-month period in a Zimbabwean district and were classified into pathological subgroups according to Wigglesworth. There were 319 perinatal deaths (a rate of 30.6 per 1000) including 83 normally formed macerated stillbirths, 28 cases of congenital malformation, 79 deaths associated with immaturity, 111 due to asphyxial conditions developing in labour and 18 specific problems. Syphilis infection was a contributory factor among 27 cases, hypertension in 39 cases, amniotic fluid infection in 31 cases and diabetes in 11 cases. An avoidable factor was detected among 242 cases (75.6%) involving the mother in 120 cases, the maternity centres in 28 and the hospital in 94. These data suggest that educational programmes should try to convince all the pregnant women to attend an antenatal clinic at least once. A further perinatal mortality reduction might be obtained through treatment for syphilis, hypertension, diabetes and amniotic fluid infection, closer monitoring of the fetal condition during labour and skillful management of dystocia.     

Electrosurgical safety: conducting a safety audit

ECRI detailed some of the lesser-known risks of electrosurgery in a collection of articles published in the August 2005 Health Devices. However, it's also important to recognize that even hazards that are well understood by clinical personnel can lead to injury if appropriate safety measures aren't applied consistently. In this follow-up to our August 2005 articles, we offer guidance to help healthcare facilities conduct a safety audit that examines critical aspects of the facility's use of electrosurgical technology. ECRI recommends that healthcare facilities periodically conduct such an audit to ensure that the appropriate equipment and procedures are in place to protect patients and staff from injury. This article reviews some of the key questions to ask during a safety audit, and it includes detailed guidance for developing an electrosurgical safety checklist.     

Nursing audit as a professional marketing strategy

This study relates an audit experience with an interdisciplinary team in public health services at Fortaleza-CE and aims to describe the functional dimension of these audit actions and the its importance for nursing; to define a model with a professional marketing strategy for the nurse. Theoretical bases of contemporary Administration were used to converge with the audit practice experiences. One proposes a new audit nursing strategy in favor of the professional significance, because the nurse currently conducts actions with a scientific marketing identity, but at the unconscious level.     

Using audit in a district-wide management system

As a consequence of the NHS reforms, the budgeting and competitive tendering of clinical services between districts requires accurate accumulation of data. John Mosley and Roger Fairbanks describe how data obtained by clinicians from their own audit has been used to construct a casemix solution that provides the necessary financial information for a district.     

An audit of paediatric audit in Scotland.

We undertook a retrospective review of the Scottish Clinical Audit Project Register (SCAPR). This generated information on audit activities in Scotland relating to children aged 0-15 years over the period 1992 to 1997. All healthcare specialties (including dentistry) in both acute and community sectors were included. Of the 7,073 registered entries, 613 (9%) relating to children were identified. Greater Glasgow contributed a third of entries despite having only 18% of the child population. Over half the projects were conducted in secondary care settings and only 5% in primary care. Medicine and nursing appeared the most audit active professional groups. Our findings suggest that children (who comprise 19% of the Scottish population) are an under-audited group in Scotland. Secondary care (especially surgery) seemed over-represented and primary care under-represented as audit settings. We were unable to use the SCAPR to identify specific service deficiencies or improvements that may have been stimulated in the course of "closing the audit loop." Future refinements to the way data are collected and recorded on the SCAPR will clearly require to address this shortcoming.