Training and educating the
clinical team in effective
clinical audit practice
Gaynor Smith
Dr Anthony Choules
Burton Hospitals NHS Foundation Trust
If something’s worth doing…
• Developing a clinical audit training
programme for the clinical team
• Empowering junior doctors to take an
active interest in clinical audit and
coordinating activity into an integrated
audit programme
• Developing a directorate clinical audit
programme in practice
Burton NHS Foundation Trust
Junior Doctor Patient Safety Forum
S Wren, D Clutton, G Dimitropoulos
What’s this then?
It’s a collaboration between the
patient safety lead, audit
department, clinical education
team and junior doctors, we meet
once a month though we get
support throughout
Why?
What do you do
there?
Sounds great!
I’ll definitely
come along, I
think every
hospital should
have a group
like this!
Because too often we become
bogged down with repetitive
tasks and don‘t see the bigger
picture!
It’s brilliant, we’ve covered
some really important topics
already like venous
thromboembolism prophylaxis,
oxygen therapy and IV cannula
care. We’ve had talks from
airline pilots as well as
consultants and we actually
feel like we make a difference!
Special thanks to Dr Choules, Dr Vickers & Ruth Turner, medical photography
Why do QA projects ?
• Trusts need quality
improvement/audit projects to be
done
–To ensure patient safety
–To improve patient care
–To satisfy monitoring processes
Why do QA projects ?
• Junior doctors are required to do quality
improvement projects
– To learn how important they are
– To pass their training
– To show leadership skills
• But:
– They rotate frequently
– They don’t always understand what they are
looking at
– The are not always well placed to lead change
The Plan
• Meaningful audits
– Trust wide
– Large scale
– Longer timescale
• Enthusiastic supervisors
• Good logistic support
• An opportunity to implement change and
improve patient care
• Fulfilling requirements of Trust and trainee
doctors
Topics
• Communication of DNAR
• Communication of deceased patients
• VTE prophylaxis
• Handovers
• Documentation
• Consultant First review
• Self harm in Emergency Department
• Consent
Timeline
• Aug/Sept: Assign topics/groups
Introduction to audit
• Sept/Oct: Meet supervisor, plan and obtain
approval
• Oct/Nov: Gather data and process
• Dec: Clinical Audit Showcase
– Presentation
– Plans
– Prizes
Timeline
• Jan/Feb/Mar: Implement changes
• Apr: Re-audit
• May: Clinical Audit Showcase
–2nd Presentation
–Prizes
Results
• High standard of audits
• Feedback demonstrated the effectiveness
of the training and understanding of the
clinical audit process
• Some changes were made…
• Good publicity (Inside and outside the Trust)
• eportfolio sign-off/publications
• Leadership skills
Results
• Handover audit - Standardized
handover order of proceedings Implementing poster in handover room
• Consultant First Review - PTWR
proforma to become part of a generic
notes – better recording of EDD and
diagnosis, VTE prophylaxis etc…
Poster for the
handover room
PTWR proforma
PTWR proforma cont
“They have helped to engage us,
as junior doctors, in the audit
process of the trust and,
therefore, instilled in us the
skills and enthusiasm to play
an active role in quality
improvement projects in the
future.”
Publicity
• Joint Foundation Programme Sharing
Event
• The National Association of Clinical
Tutors (NACT)
• Clinical Audit Support Centre winners!
• NHS local website
• International presentations
Our poster
for the FP
shared event
Publicity
• www.learning.nhslocal.nhs.uk
/best-practice/medicine/programmeimprove-audits-junior-doctors
Taking things forward
•
•
•
•
•
•
Smaller groups
Access to eportfolio
FY2’s
New topics
More consultant supervisors
Wider interest across the Trust
Workbooks
Just one
workbook –
As a tool
New Topics for 2012-13
•
•
•
•
•
•
•
•
•
Surgical Handover
IV vs Oral drugs
Catheters and incidences of UTI
Frequency of common pathology blood tests
Urgent Cancer referrals
Documentation
Oxygen prescribing
Re-Admissons
Use of Gentamicin
Key benefits
•
•
•
•
Trainees learnt leadership skills
Consultants got a willing workforce
Rekindled enthusiasm for audit/QA
Developed relationship with Trust
chairman/NEDs/board
• Junior staff felt valued
Key Messages
• A Trust wide, collaborative approach
allows focus on more meaningful audits
and better opportunity for re-audit
• Generates enthusiasm across the Trust
• Enhanced experience for juniors
• Training junior doctors properly in audit
is an investment for the future
What’s next?
More great quality Audits/Quality
improvement projects
Gaynor.Smith@burtonft.nhs.uk
Clinical Audit Department
Burton Hospitals NHS Foundation Trust
Anthony.Choules@burtonft.nhs.uk
Postgraduate Clinical Tutor
Burton Hospitals NHS Foundation Trust