Clinical audit is a process that is completed by most healthcare professionals as part of their daily practice. Audit is a key part of the Clinical Governance. Clinical audit in its simplest form involves improving patient care by reviewing current care (procedures and services) and comparing this against standards and/ or best practice. Any identified shortfalls indicate required improvements.
Essentially this means:
- Reviewing current practice
- Comparing current practice to best practice, national or local guidelines
- Assessing whether current practice matches expected practice and whether desired outcomes are being achieved
- Adapting current practice where necessary to ensure the desired outcome is achieved
- Re-auditing to confirm current practice meets expected practice
NICE defines clinical audit as “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.
Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery”
The overriding aim when undertaking clinical audit is to improve practice and patient care.
Clinical audit and the NHS Contract
Pharmacy contractors are required under the terms of the NHS Community Pharmacy Contract to undertake two audits each year, these are:
- Pharmacy practice audit where the topic is determined by NHS England. The results of this audit must be submitted to NHS England within the agreed timetable and by the specified route(s)
- Clinical audit where the topic can be determined by the contractor. The results of the clinical audit do not need to be submitted to NHS England but may be requested during a contract monitoring visit
PSNC advises that contractually both the pharmacy practice and clinical audits should be completed within 5 days of pharmacist time although it is worth remembering that effective clinical audit is not a “one off” event but a continuous cycle of improvement in patient care.
Benefits of clinical audit
There are many potential benefits from undertaking a clinical audit, these include:
- Providing evidence of current practice against NHS standards or national guidance e.g. NICE or SIGN
- Provide information about a specific health service and the patient outcome
- Comparison of local practice against recommended practice
- Confirm the pharmacy is carrying out the procedures intended i.e. do we actually do what we think we do
- Provide evidence of the quality of care provided
- One of the criteria for receiving Quality Payments is an ongoing audit of prescribing bronchodilators for 6 occasions without a corticosteroid within a 6 month period.
To achieve these benefits audit must be carried out in a methodical way through effective planning, implementation, analysis, implementation of change and re-audit- this is called the audit cycle.