125855783 clinical audit
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7/28/2019 125855783 Clinical Audit
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Dr. Mukesh Sharma
Manager- Quality & Operations
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Audit- Process of reviewing of delivery of
care to identify deficiencies so that they
may be remedied
Clinical Audit- Peer review for evaluation of
medical care through retrospective and
concurrent analysis of medical record
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To improve the quality of healthcare
services to the patient
Clinical audit is not- A fault finding
A punitive action
An external quality control
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Measure Baseline
Review standard if
required
Evaluete Change
Assessment ofperformance against
standard
Measure practice
through data collection
and analysis
Set standards
Implement Change
Suggestchange Identify opportunity
for improvement
The Audit cycle
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Clinical Audit Committee/ Medical Record
and Audit Committee
Members Medical Administrator
Administrator
Representative from all discipline
Nursing Director
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Should be common (high risk/high cost)Have local clinical concern/wide variance
in clinical practice
Well defined and focusedExamples
Long/Short stay cases
Disease/operations
Groups (Vulnerable) Increase incidence of some disease
Post operative infections etc
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A) To be set prior to the studyB) Criteria to be based on objective measures
Criterion is an item of care or sure aspect of care that
can be used to assess quality. It is a written statement
for example.
All Patients requiring urgent appointment will be seen
that day only.
All patients with epilepsy should be seen once a year.
All Patients on oral anticoagulants should have theirINR within recommended limits
C) Criteria should be well justified
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D) Target should be set at realistic level for defined patientgroups and take into account local circumstances. A target describes the level of care to be achieved for any particular
criteria . for example
98 percent of patients requesting for urgent appointment will be seen onthat day
90 percent of patient s with epilepsy must be seen at least once a year
100 percent of patients on oral anticoagulants will have the INR withinrecommended level
E) Objective criteria are explicit-The problem with implicit criteria is that important deficienciesin care may be overlooked an rates may differ in theirassessment of the acceptability of management .
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Structure Process Outcome
Criteria Staffing of ICU BT during
surgery
Case fatality
Target Not < 1 per two
occupied beds
Not 20
percent of
average cases
Not to exceed
0.1 percent for
specified
procedures
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A. Simplest for the purposeB. Only essential data is collectedC. Suitable sample size is to be selected
Random sampling generate
Stratified samples Systematic sampling Cluster sampling
D. Probability of bias is to be considered Non-response to a survey Unavailability of certain type of case note
Selective referral of ce4rtain types of patients Failure of patient to turn up for follow up
4. Tabulation of evaluation
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A) Deficiency of care recognizedB) Specific solutions are proposed . they
may not be possible every time
E.g. a study of the way cervical screening isorganized identified deficiencies but concluded
only that other schemes needed to be examined
C) Education impact is appreciated- Training
& education regarding outcome & probablesolutions
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A. Planned programme for change
B. All staff is involved
C. Active feed back
D. Audit is evaluated
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Professional Motives Social Motives Pragmatic Motives
Legal Motives
CPA Negligence Malpractice
To identify deficiencies
Educational needSelf-correction & Self-
regulation
To ensure safety of public
To present patient from
inappropriate or suboptimal
care
To reduce
patients suffering
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What do we do?
Do we do what we think we do?
What should we do ?
Are we doing what we should be doing ?
How can we improve what we do?
How we improve?
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(a)Professional benefits Change in prescribing behavior
Updation of clinical knowledge
Increase in staff enthusiasm and satisfaction
Teamwork
(b)Patient care and service delivery
Improvement inpatient care Improved patient satisfaction
Better patient feedback
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Lack of resources
Lack of expertise in design and analysis
Lack of an overall plan for audit
Relationships problem
Organisational impediments disputes
between views of clinicians and mangers
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1. Foster an environment for audit Audit is a valued activiry
Can augment both career and professional development
Provision of protected time for audit
Commitment from staff to provide a request and act on timestudy findings
2. Tackle the problems of multidisciplinary audit Can be seen as threatening
Exposing one mistakes to another
Staff training in interpersonal skills and in dealing withconflict
Benefits outweigh disadvantage
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3. Review staff training programme Importance of planning
Benefits of pilot study
4. Emphasis audit facilitation5. Establish Confidentiality of finding
6. Ensure all relevant staff are involved
7. Establish evaluation programme
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