Understanding how we're doing - a pragmatic guide to clinical audit
Audit doesn't need to be complicated and NICE provides some help and advice.
- Why do we need to know?
- How to prioritise topics for clinical audit
- Approaches to clinical audit
- Help from NICE and others
Not all guidance needs to be formally audited. But whenever the practice plans to make a change, there should be a check that the changes have been made, and that they are having the effect that you intended.
Other methods of checking that NICE guidance has been adopted could include:
- Evidence that a template has been changed
- Attendance at, and feedback from a recognised training event
- Organising a practice learning session
- Feedback from a patient group
Clinical audit is a structured process - although not necessarily a complex or time-consuming one - that enables you to measure the amount of change that has happened, take any necessary action to improve your service, and measure again to check the results. Professional revalidation requires that general practitioners complete two full cycle clinical audits during a revalidation period.
You are not expected to audit every area of practice. It may therefore be worth considering the following issues when deciding on which pieces of NICE guidance you wish to audit:
- Does this guidance affect a large proportion of the patients in this practice?
- Is it a subject raised by your practice patient group?
- Does a member of the practice team have a special interest in this field?
- Does the guidance have a high cost of implementation?
- Are there significant cost savings to be made?
- Have any clinical issues arisen recently for this condition?
- Is this an area where you are uncertain of your current practice?
- Is this an areas of care that do you not review via other processes such as the Quality and Outcomes Framework (QOF)?
Clinical audit does not have to be a complex process, it can in fact be very simple. There are a number of different approaches that may be appropriate in general practice.
Extracting data from your information system
You may be able to extract data from your clinical system that relates to current practice and NICE guidance. Use the audit support documents that NICE provides for many of its guidelines to identify the criteria you should be testing.
You can use a simple form to collect data about a sample of recent patients with a certain illness or condition. This need not be a large exercise and could be as simple as reviewing your last 10 cases or all the cases in the last month at a practice meeting. This is particularly useful for topics involving the multidisciplinary team as it gives everyone a chance to learn from the audit and be involved in making improvements to practice.
As with retrospective audit, this can be a very simple approach or something more complex if you wish. Agree a time period or number of cases to review and collect the information as you go along. This may be easier to do by collecting data electronically, for example on a shared spreadsheet or database, or by using some agreed Read Codes and entering the data into your practice clinical computer system.
NICE support for clinical audit
NICE's baseline assessment tools help you to gain a snapshot of current practice when guidance is published, and to identify whether you need to make changes.
If you do make changes, and want to assess your progress, NICE provides audit support for all technology appraisals, clinical guidelines and selected interventional procedures and public health guidance. The aim of the audit support is to make the process of developing clinical audit projects easier through the provision of ready-to-use criteria and data collection tool.
The audit support for a particular piece of guidance covers all sectors of care but you can copy and paste the recommendations and criteria that apply to general practice to create a tailored version.
Royal College of General Practitioners - Clinical Audit in Primary Care
The RCGP provides guidance to approaching clinical audit in primary care. This includes help to structure an audit, hints for each stage of the audit process and signposting to other resources.
Healthcare Quality Improvement Partnership (HQIP) resources
HQIP provide a wide range of resources to support clinical audit professional and clinicians including guides to reporting audit results
Your local Medicines Management facilitator will also be able to provide helpful information and support for implementation of technology appraisals and other guidance from NICE. Further information about medicines management is available from the National Prescribing Centre.
This page was last updated: 28 November 2012