Audit in General Practice

Adam Hay Thursday 2nd October 2014

What is Audit?

• A method to aim to improve patient care• Mentioned in Good Medical Practice• Important for:

– GP appraisal & revalidation• Can demonstrate both leadership and

teamwork

• Audit is a requirement of GPST training

What is the Audit Cycle?Choose a topic

Decide criteria and standards

Data collection one

Compare against criteria and standards

Implement change

Data collection two

Summary &

conclusions

Repeat data collection?

How to Choose a Topic

How to Choose a Topic

• Need to identify an important topic for where you are working– Discuss with trainer– Discuss at practice meeting

• Aim to involve others of process• Short, simple audits are more easily

manageable and therefore more likely to be successful

Examples of Audit Topics

• Stroke prevention in patients with AF• Use of emergency slots dealing with UTIs• Diclofenac prescribing at X Health Centre• Prescribing the OCP to women aged 35+ years• Audit of allergy documentation in records

Recording your audit

• Please use the NES template• Go to:• http://www.gpcpd.nes.scot.nhs.uk/peer-revie

w/criterion-audit.aspx

Reason for Audit

• Write a short summary of why the audit topic was chosen

• If done due to a change in guidelines or other event then state this and add a reference

Criteria

• Examples– The GP’s medicine bag should contain in-date adrenaline– Patients with chronic asthma should be reviewed

annually– Patients with a previous MI should be prescribed aspirin,

unless contraindicated– Surgeries should start within 5 minutes of their allotted

time

Precise, logical statements used to define and measure an item in healthcare

Standards

– 100% of GP’s medicine bag should contain in-date adrenaline– 80% patients with chronic asthma should be reviewed annually– 90% patients with a previous MI should be prescribed aspirin, unlesscontraindicated– 95% surgeries should start within 5 minutes of their allotted time

The measureable level of quality of careThe target for each criterionOften a result of clinical opinion

Preparation and Planning

• Who did what? • When?• How?

Initial Data Collection

Initial Data Collection

• Demonstrate your results clearly• Compare against standards• Often need to quote actual numbers with

percentage too• Use tables or graphs when possible

CriterionPatients with previous MI

Patients contraindicated

Patients on aspirin

Standard

Patients with previous MI should be prescribed aspirin, unless

contraindicated53 3

30/50(60%)

80%

Description of the Change Implemented

• “If nothing changes... nothing changes”

• Often audits are discussed at practice meetings• Letters may be sent to patients• New guidelines adopted

• Need to discuss these in your report• If possible include a copy of letters used

Data Collection Two & Comparison

• Many audits stop after the first data collection and are not completed

• Second data collection timing depends on many factors– Clinical decisions– Placement in GP surgery

• Need to choose a time which will allow change to take effect

• Repeat the same process as you used for Data Collection One

Conclusions

• After comparing second data collection to standard assess:– Has the standard been met?– If not, why not?– Would further changes need to be implemented?– Would another cycle of data collection be useful?

How is your audit assessed?

• Audits are sent to June.morrison@nes.scot.nhs.uk• Two reviewers receive your audit with any

information that could identify individuals removed• Each area of the audit cycle is assessed separately• Score each area from 1 (very poor) to 7

(outstanding)• A global assessment +/- satisfactory or unsatisfactory

score

Summary

Summary

• Decide on audit topic• Use the NES audit template form• Set criteria and standards• Collect initial data• Compare results to criteria and standards• Implement change after discussion in practice• Collect second data collection• Summarise audit findings• Send off audit to NES for review & feedback

– june.morrison@nes.scot.nhs.uk

Short Exercise on Criteria and Standards

• Work in small groups to decide if the statements are either:– Criteria– Standards– Neither

• Explain your reasoning

End.Questions?