CLINICAL AUDIT TOOL:
Heart Failure with
Left Ventricular
Systolic Dysfunction –
Drug Therapy
Introduction
This clinical audit tool addresses the management of confirmed heart failure with left
ventricular systolic dysfunction (LVEF <45%) in the primary care setting.
It draws on best practice guidance summarised in the New Zealand Primary Care Handbook
2102 on Heart Failure and specific content from the source guideline New Zealand Guideline
for the Management of Chronic Heart Failure (2009 update).
See http://www.health.govt.nz/publication/new-zealand-primary-care-handbook-2012 for
content in the Handbook and www.heartfoundation.org.nz for the full guideline.
TOPIC
Heart Failure with Left Ventricular Systolic
Dysfunction – Drug Therapy
Why is this topic of interest or concern?
 Patients with heart failure and left ventricular systolic
dysfunction are frequently managed in primary care. This
caseload is increasing as the New Zealand population ages.
Key points on drug therapy from the guidance:

Patients often do not have a clear understanding of the importance or
rationale for taking drugs prescribed for heart failure.
Adherence to prescribed drugs can be as low as 20% after two years.

ACE inhibitors improve symptoms of heart failure, decrease hospital
admissions and improve LV function and survival. They should be used as
first-line agents.

Diuretics should be prescribed for the symptomatic relief of pulmonary
and systemic venous congestion. Aim to use the minimum diuretic dose
required to maintain optimal fluid status (in particular, avoid dehydration
from over-diuresis).

It is recommended that patients are treated with optimal doses of ACE
inhibitors and beta-blockers prior to considering the addition of an
angiotensin receptor blocker (ARB).
PLAN
Indicators
(elements of practice performance to be measured)
The practice provides appropriate drug therapy for the management of heart
failure with LV systolic dysfunction.
1.
Initial drug therapy prescribed for treatment of heart failure with LV systolic
dysfunction is appropriate.
2
2.
Appropriate diuretic therapy is initiated if there are clinical signs of fluid
overload and continued or modified as needed to achieve and maintain
optimum fluid status.
3.
Drug therapy prescribed is consistent with recommended intensification of
treatment for heart failure with LV systolic dysfunction.
Criteria
1.
(how the indicator will be measured)
ACE inhibitors are used as first-line agents in appropriate doses and with
appropriate monitoring for treatment of confirmed clinical heart failure
and LV systolic dysfunction.
ACE inhibitors should be started at a low dose and titrated up to doses
used in randomised clinical trials (recommended doses: captopril 50 mg
three times daily; enalapril 10 mg twice daily; cilazapril 5 mg once daily;
quinapril 10 mg twice daily. A higher dose may be indicated in some
patients (e.g. those with coexisting hypertension).
Blood pressure, serum potassium and renal function should be measured
prior to starting therapy and approximately 1 week after initiation or a
change in dose. Contraindications to ACE inhibitors should be considered
prior to commencing therapy.
ARBs may be used as an alternative to ACE inhibitors if the patient is
unable to tolerate an ACE inhibitor due to cough.
2.
Use of diuretic and agent and dose prescribed is appropriate for the
individual patient’s symptoms and degree of fluid retention. Monitoring of
serum creatinine and electrolytes is appropriate.
A thiazide may be sufficient in mild heart failure (e.g. bendrofluazide 2.55 mg daily initially).
A loop diuretic will usually be required in patients with moderate or severe
heart failure or if the patient has failed to respond to thiazide diuretics
(e.g. frusemide 40 mg daily initially). If greater diuresis is required the
dose can be doubled and given once daily. Careful clinical monitoring
(usually including patient monitoring of body weight) is required.
An identified “dry” (or target) body weight is suggested to assist optimum
diuretic dosing.
Serum creatinine and electrolytes should be measured at appropriate
intervals according to the clinical status of the patient.
3
3.
Drug therapy prescribed is consistent with recommended intensification of
treatment - starting with ACE inhibitor (ARB if not tolerated) and diuretic
as required; adding a beta-blocker if clinically stable on adequate doses of
an ACE inhibitor and a diuretic with mild-to-moderate symptoms (NYHA
functional class II-III); adding a low-dose aldosterone antagonist
(spironolactone 25 mg once daily) to ACE inhibitor and diuretic therapy for
patients with severe heart failure (NYHA class III of IV or who have been on
class IV within last 6 months). Titration of dose and monitoring of serum
creatinine and electrolytes is appropriate.
Beta-blockers should be initiated at a low dose, with dose titration weekly
or fortnightly and specific monitoring for signs of worsening congestion,
hypotension or bradycardia (HR <50 beats/minute) prior to upward dose
titration. Target doses: metoprolol controlled release 190 mg daily or
carvedilol 25 mg twice daily ( or 50 mg twice daily for patients weighing
>85 mg). Contraindications to beta-blockers should be considered prior to
commencing therapy.
Spironolactone is not recommended in patients receiving combined
treatment with an ACE inhibitor and an ARB. NSAIDS should not be coadministered with spironolactone. Serum creatinine and electrolytes
should be checked 3-4 days, one week and one month after initiation of
spironolactone and then as indicated by renal function.
ARBs may be used in patients who are symptomatic despite appropriate
treatment with ACE inhibitors and beta-blockers. Extra caution, with
monitoring for adverse effects is required.
See Fig 9 of the Handbook and pages 39-50 of the full guideline for full
details of recommended drug therapy, contraindications and appropriate
monitoring for side effects. Contraindications should be considered prior
to commencing therapy with a particular agent.
Standards
(the standards to be achieved)
Note that the focus is on improving standards of clinical practice, with 80%
achievement identified by the RNZCGP as an appropriate target and 100% as an
ideal. Individual GPs and practices may choose to set a differing target for a first or
subsequent audit/s, with a view to increasing standards over time.
1.
80% of patient notes indicate drug therapy for heart failure and LV systolic
dysfunction is initiated with an ACE inhibitor (ARB if not tolerated) at an
appropriate initial dose and with appropriate dose titration. 80% of patient
records indicate appropriate monitoring of blood pressure, serum
potassium and renal function.
4
2.
80% of patient records indicate patients requiring diuresis received an
appropriate diuretic agent and dose. 80% of patient records indicate
appropriate monitoring of serum creatinine and electrolytes.
3.
80% of patient records indicate prescribed drugs and doses consistent with
recommended intensification of treatment (see Criteria section). 80% of
patient records indicate appropriate monitoring for adverse effects.
DO
Discover what you are doing now

(collect data)
Retrieve records for 15-20 random patients with heart failure and LV systolic
dysfunction.

Review patient records using copies of the Individual Patient Record Review
Sheet.
STUDY
Next steps: what do the results tell you (interpret the data)

Collate the data from patients according to the standards set and compile a
brief summary for each indicator.

What are you doing well?

What needs improving?

What gaps between standards and performance do you want to close?

Identify possible solutions.
5
Clinical Audit Tool: Heart Failure with Left Ventricular Systolic
Dysfunction: Drug Therapy
Patient Record Review Sheet
Date:
Patient 1 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
6
Patient 2 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
7
Patient 3 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
8
Patient 4 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
9
Patient 5 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
10
Patient 6 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
11
Patient 7 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
12
Patient 8 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
13
Patient 9 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
14
Patient 10 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
15
Patient 11 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
16
Patient 12 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
17
Patient 13 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
18
Patient 14 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
19
Patient 15 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
20
Patient 16 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
21
Patient 17 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
22
Patient 18 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
23
Patient 19 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
24
Patient 20 (add initials/NHI):
ACE inhibitor used as first-line
Diuretic therapy -
Drug therapy intensification
agent (or ARB if not tolerated)
appropriate agent and dose?
consistent with
Yes/No
Yes/No/NA
recommended titration and
treatment regimens
BP, serum potassium and renal
Yes/No
function checked before
Appropriate monitoring
initiation of drug therapy?
(including patient monitoring
Appropriate monitoring?
of body weight as
Yes/No
appropriate)?
Appropriate monitoring (one
Yes/No
Yes/No
week after initiation and with
any change of dose)?
Yes/No
Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed):
ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
Rationale/comments re. initial and subsequent drug therapy:
Rationale/comments re. monitoring/adverse events:
Other comments:
25
RNZCGP Summary Sheet
Continuous Quality Improvement (CQI) Activity
Topic:
Heart Failure with Left Ventricular Systolic
Dysfunction – Drug Therapy
Doctor's name: ________________________________________________________________
First cycle
Data: Date of data collection:
Check: Describe any areas targeted for improvement as a result of analysing the data collected.
Action: Describe how these improvements will be implemented
Monitor: Describe how well the process is working. When will you undertake a second cycle?
Second cycle
Data: Date of data
collection:
Check: Describe any areas targeted for improvement as a result of analysing the data collected.
Action: Describe how these improvements will be implemented.
Monitor: Describe how well the process is working.
Comments:
27