Pharmacy: Criterion audit

Quality Education for a Healthier Scotland

Pharmacy

Audit

Criterion audit

Valerie Reilly for

Pharmacy Directorate

NHS Education for Scotland


Pharmacy

Objectives

After listening to this presentation you should be able to;• Discuss the meaning of the term ‘Criterion Audit’• Describe the Criterion Audit proforma for submitting an audit for peer

review• Describe 3 aspects of what a Criterion Audit involves• Decide how to choose a subject to audit• Define the terms ‘Criteria’ and ‘Standards’• Describe the Peer Review Process• Discuss with others how you can you integrate this into your practice

and the benefits of completing and submitting an audit for peer review.


PharmacyDefinition of audit

‘ Clinical audit is a quality improvement process that seeks to improve patient care and outcome, through the systematic review of patient care against explicit criteria and the implementation of change.

Aspects of the structure, processes, and outcomes of patient 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 National Institute for Clinical Excellence


Pharmacy

Audit versus Research

Research asksWhat should we do?

Service Development asksHow do we put our research into practice?

Audit asks Are we doing what we should be doing (or what we think we are doing)


PharmacyAudit cycle

Define criteria/standards

Implement change Measure practice

Compare with criteria/standards


Pharmacy

It’s really more a continuous spiral process…..

Define criteria/standard

Assess practice

Repeat audit

Re audit

Compare practice with criteria/standard and change

if necessary


PharmacyWhat is a Criterion Audit ?

• Structured audit process

• Audit pro forma available on NES Pharmacy website

• 5 or 8 parts

• 8 parts completed comprise the full audit /re-audit cycle

• Part of our GP colleagues accreditation process


PharmacyThe sections of a Criterion Audit

Reason for the Audit

Criteria to be measured

Standards set

Preparation and Planning

Data Collection 1

Description of Change

Data Collection 2

Conclusions


Pharmacy

The Reason for the Audit

Explain why the audit topic was chosen and that as a result of this choice

there is the potential for change to be introduced which is relevant to the

practice or you as an individual practitioner.


PharmacyPotential reasons for an audit

• National priority• Common• High risk – • Clinical concern/ problems – risk of ADRs, interactions • Changes in practice - new development/evidence• High cost • Evidence base• Potential for change


Pharmacy

Defining Criteria

Criteria are simple, logical statements used to describe a definable andmeasurable an item of health care.

e.g. Patients with type II diabetes should have a fundoscopy every 12-months.

See Audit Guidance for examples of criteria if greater understanding isrequired.

Focusing on one or two criteria makes data collection more manageableand the introduction of small changes to practice less challenging.

Where available, evidence should be cited in support of criteria eg. nGMSContract or a clinical guideline.

A single criterion is acceptable for Appraisal purposes.


Pharmacy

Defining Standards

An audit standard describes the level of care to be achieved for any

particular criterion

• 90% of Patients with type II diabetes should have a fundoscopy every 12-months.

Standard levels may be influenced by the target levels contained in the nGMS

contract or by discussing and agreeing the desired or ideal level of care with

colleagues.

State how long you estimate it will take you to reach your chosen

standard(s) eg. 3 months.


PharmacySelecting and defining criteria

• Patients should be prescribed aspirin 75mg and clopidogrel 75mg, if clinically appropriate after an angioplasty, for no longer than 12 months post procedure.

• Patients should have their prescribed medicines dispensed within 48 hours of presenting a GP10 at a community pharmacy.


PharmacySelecting and defining standards

• 90% of patients being prescribed concomitant aspirin 75mg and clopidogrel 75mg should have their notes assessed every six months to determine the reason for the therapy and the length of time they have been prescribed it.

• 95% of all prescriptions presented to a pharmacy should be available for collection by the patient, if required, within 48 hours.


Pharmacy

Preparation and planning

Explain briefly who was involved in discussing and planning the audit.

How the data were identified, collected, analysed, and disseminated ?

Who gave you assistance at any stage of the project ?

-with a literature

-review or with collecting or analysing data (if this was required).

Teamwork is essential to audit and evidence of this should be provided in

the report.


Pharmacy

Results 1

Initial data collected should be presented using simple descriptive statistics

as part of the text, in table format or using graphs (e.g. bar charts, pie

charts)

Quote actual numbers (n) as well as the percentages (%).

There is no need to quote irrelevant data (e.g. age, gender, or past

medical history) if it bears no relation to your chosen audit criteria.

Compare and contrast your initial data with the standard(s) you set.


Pharmacy

Description of change

Presentation of data should be as Data One.

In this section, compare and contrast the results of the second data

collection with data collection one and the standard(s) you originally set.

Has your standard been met or surpassed? If not, comment on why you

think that is the case.


Pharmacy

Results 2

Second set of data collected should be presented using simple descriptive

statistics as part of the text, in table format or using graphs (e.g. bar

charts, pie charts).

Compare to Results 1.


Pharmacy

Conclusions

The final section should briefly and simply summarise what the audit

Achieved.

What were the main learning points gained from this

exercise?

In doing this, the benefits achieved through the audit should be

discussed along with any problems encountered with the process or

findings.

Some thought should also be given as to whether the audit will be

repeated in future and if so when.


PharmacyThe Peer Review Process

• A small network of trained pharmacists

• Returned with educational feedback

• Outcome of peer review & educational feedback collated and sent to submitting individual

• Focus of feedback is on individual/author


Pharmacy

Reason for the choice of audit


Pharmacy

Criterion chosen and standards set


Pharmacy

Preparation and planning


Pharmacy

Data Collection


Pharmacy

Changes to be evaluated


Pharmacy

Project conclusions


PharmacyBenefits of conducting an audit

Patients benefit from improvements to clinical practice

Staff benefit from improvements to working practice

Supports individual learning and CPD

Builds teamwork

Supports team learning

Demonstrates commitment to clinical governance


PharmacyHow do I integrate audit into my practice?

Undertake as part of evaluation process

As part of junior staff development

Form part of CPD

As a KSF objective

As part of regular quality assurance processes


PharmacyFinally…………….

Conducting audit delivers benefits

NES criterion audit has added value

Can be integrated into working practice

Key to success is teamwork