Clinical Audit is a method of confirming the quality of clinical services and identify the need for improvement. A skill hospital administrator should learn and practice.

1. What is clinical audit?
Clinical audit is a quality improvement process that
seeks to improve patient care and outcomes
through systematic review of care against explicit
criteria and the implementation of change.
This definition is endorsed by the National Institute
for Clinical Excellence.

2. Planning for Audit
Standard/Criteria
Selection
Measuring
Performance
Making
Improvement
Sustaining
Improvement

3. Preparing for audit
Selecting criteria
Measuring performance
Making improvements
Sustaining improvement
Using
Methods
Creating
Environment

4. Patients
•Improve quality of Care
•Improve Patient satisfaction
•Improve Patient Confidence in care delivery
HCO
•Improve out come of services
•Cost Effective Care
•Improve Brand Value
•Improve Bottom line
HCP
•Provide workable Standards
•Identify Training Needs
•Measure quality of care
•Solve Problems
•Ensure Appropriate Use of Resources

5. 1. Failure to participate and attitudes to audit
Those involved in organising audit programmes must consider various methods
of engaging the full participation of all health service staffs
2. Failure to provide a supportive environment for audit
Successful clinical audit requires the organisation to promote a culture in which audit
is supported and actively encouraged.
3. Lack of training in audit methodology and evidence-
based skills
Health professionals and audit support staff require adequate knowledge and skills for
undertaking audit and are keen to learn.
4. Cost:
High cost of conducting audit . It should be made cost effective.

6. Selecting a topic:
General guideline-Select topic of high risk
process, Seroius quality problem,
clinical evidence or guideline is available
1. Structure of organisation –
Man: Nurse Patient Ratio, Un authorised
absence,
Machine : Critical equipment down time,
Machine failure
Materials : Adequacy of Emergency drugs,
Stock out of drugs,

7. 2. PROCESS:
1. Initial Assessment
2. Periodic Assessment
3. PAC
4. Prophylactic Antibiotic
5. Rational use of antibiotic for Pneumonia,UTI,SSI,
Meningitis etc
6. Appropriate use of Blood components
7. Appropriate use of sedatives/Narcotics
8. Appropriate Pain control – Post surgical
9. Hand Hygiene Compliance
10. Effective CPR compliance
11. Bundles Compliance
12. Readmission
13. Medication error,Adverse effects of High Alert drugs

8. 3. Out Come:
Look for complications ,patients safety like :
1. Mortality of DRG
2. Ventilator mortality
3. Acute MI Mortality
4. Primary Angioplasty mortality
5. HAI
6. Pressure Ulcer

9. Explicit rather than implicit criteria should be preferred.
. Criteria should be derived from good-quality guidelines or from
reviews of the evidence.
Selected research evidence confirms that clinical care processes
have an influence on outcome, measurement of the process of
care is generally more sensitive and provides a direct measure of
the quality of care.
. Measurement of outcome can be used to identify problems in
care, provided outcomes are clear, influenced by process, and
occur within a short period.

10. . Adjustment for case mix is generally required for
comparing the outcomes of different providers.
. If the criteria incorporate, or are based on, the views
of professionals or other groups, formal consensus
methods are preferable.
. There is insufficient evidence to determine whether it
is necessary to set target levels of performance in
audit. However, reference to levels achieved in audits
undertaken by other professionals is useful.
. In some audits, benchmarking techniques could help
participants in audit to avoid setting unnecessarily low
or unrealistically high target levels of
performance.

11.  Data collection
Data Analysis
Interpretation /Analysis
Presentation Results

12. A systematic approach to implementation appears to be more effective. Such
an approach includes the identification of local barriers to change, the
support of teamwork, and the use of a variety of specific methods.
PDSA is an effecting tool for management.
Non
Compliance
Standard to
be achieved
Target Time Persons
responsible
Review

13. 1. What
Changes are
to be made
2. Next Cycle
?
1.Objective
2. Predictions
3.Plan for data
collections
4.. Four W
1..Carry out
plan
2.Documents
Observation
3.Record Data
1. Analysis Data
2. Compare
results to
prediction /
bench mark
3.Summary of
out come
PLAN
DO
STUDY
ACT

14. Improvements in care implemented as a part of clinical audit
must be monitored, evaluated, sustained, and reinforced within
a supportive environment.
Structures and systems must be developed to enable
organisations to integrate improvements within a planned
strategy.

15. A clinical audit of cardiopulmonary resuscitation.
McIntyre AS, et al. J R Coll Physicians Lond. 1993.
The structure, process and outcome of cardiopulmonary resuscitation
(CPR) at one hospital have been reviewed to determine where failings
in the system could be improved, whether the existing training
programme was adequate and well directed, and whether survival
rates were reasonable
. The audit revealed a need to improve telephone connections to the
hospital switchboard, modify some equipment, and improve
knowledge of the geography of the hospital site. Changes in emphasis
in the training programme will alter the process of resuscitation.
Outcome measures indicate that survival figures are comparable with
published data, including recent data which act as a benchmark for
quality control

16. An audit of documented preoperative evaluation of surgery patient
The aim of the study was to audit the documented preoperative
anaesthetic evaluations of surgery patients
Methods: For this retrospective study a sample of 81 patients, who
openedunderwent surgery during May 2013, was randomly
selected. The information obtained from the standardised PAR form
in each patient’s file was audited using a self-generated checklist,
based on the measures and criteria incorporated in the Global
Quality Index

17. CLINICAL AUDIT ON COMPLIANCE TO VAP BUNDLE

18. Objective : To measure compliance of HCP with elements of VAP Bundles
Evidence of quality
care
(criterion)
Standard
( % of Compliance )
Exceptions Definitions &
Instruction for data
collection
Elevation of head of
bed 30-45 degrees
100% Spinal Injury All ventilated Adult
patients in ICU
Oral hygeine with
chlorhexidine
100% Oropharyngeal
Trauma
All ventilated Adult
patients in ICU
Hand Hygiene 100% NONE All ventilated Adult
patients in ICU
Circuit Change Only
When needed
100% NONE All ventilated Adult
patients in ICU
Sedation Review &
Vacation
100% HFO,High ICP,Difficult
to ventilate
All ventilated Adult
patients in ICU
Subglottic Suction
ETT
100% Not Available All ventilated Adult
patients in ICU
TABLE :AUDIT STANDARDS & CRITERIA

19. 1. Data Collection from Medical Record
Table – Summary of Results
Evidence of quality
care
(criterion)
Exception Compliance Percentage
Elevation of head of
bed 30-45 degrees
3 81/85 95.2
Oral hygeine with
chlorhexidine
Zero 88/88 100
Hand Hygiene Zero 77/88 87.5
Circuit Change Only
When needed
Zero 88/88 100
Sedation Review &
Vacation
1 57/88 65.5
Subglottic Suction
ETT
88 0/88 0

20. RECOMMENDATION :
1. Education
2. Awareness by poster,reminders,
3. Reward

21. The audit report should follow a standard audit report template. For example:
Introduction
Explain the reasoning why the audit was undertaken.
Outline when the audit undertaken and how many people/items were surveyed.
Outline the aims and objectives of the audit.
Method and Sample
Briefly explain the method used and how the sample was chosen.
This section should include enough detail to allow anyone re-auditing to use the
same approach and methodology.
It should include: Who was involved; what type of data collection tool or scale was
used; any difficulties experienced; timescales and any expectations

22. Results
There should be no commentary in this section.
Anonymity should be heeded i.e. don’t refer to
specific people.
Where possible use visual aids such as tables or
charts. All tables and figures
should have a title and be understood without
reference to the text.
Be consistent with data presentation, e.g. decimal
places, percentages, format.

23. Discussion
This section should not contain any new data.
It should draw on the results and make careful
interpretation of the findings.
Compare the results to other audits.
Discuss the strengths and weakness of the
audit, are there any discrepancies?
Discuss the meaning of the findings and possible
implications for health care
professionals.

24. Conclusion and recommendations :
Use this section to summarise.
Put forward recommendations for change, for
example, better documentation, training
requirements, change of practice.
Recommendations should be realistic and
achievable.
Suggest areas for further works and plans for re-
audit if appropriate.

25. TAKE HOME MESSAGE
1. Keep audits simple
2. Get everyone involved
3. Determine the topic
4. Have a plan
5. Do not confuse clinical audit
with research
6. Do not collect needless data

26. 7. Take care with statistics – errors can lead
to inaccurate
conclusions
8. Close all clinical audit loops
9. Keep data only for as long as it is needed
10. Share learning - tell everyone about your
audit
11. Tell ‘The Organisation’ about your audit
12. Re-audit to ensure improvement in
clinical care