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Training and educating the Training and educating the clinical team in effective clinical team in effective
clinical audit practiceclinical audit practice
Gaynor SmithGaynor Smith
Dr Anthony ChoulesDr Anthony Choules
Burton Hospitals NHS Foundation TrustBurton 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 ForumS 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?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!
Sounds great! I’ll definitely come along, I think every hospital should have a group like this!
What do you do there?
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/programme-improve-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
Clinical Audit Department
Burton Hospitals NHS Foundation Trust
Postgraduate Clinical Tutor
Burton Hospitals NHS Foundation Trust
