Auditing Dr. Amany R. AboSeoudProf. of Community MedicineZagazig university. EGYPT

Auditing المتابعة - المراجعةAuditing means official examination.

Originally it was related to accounts. Recently it has been used in relation to quality management. It is an important step in the quality assurance cycle.

Audit is an evaluation of a person, organization, system, process, project or product. Audits are performed to ascertain the validity and reliability of information, and also provide an assessment of a system's internal control.

In QA we talk about error or defect prevention.

Primary prevention is reflected by doing the things right the first time. This is achieved by conforming to STANDARDS.

Secondary prevention is by avoiding repetition of defects to do the things right every time. This is achieved by AUDITING.

 

Audit Systematic, independent and

documented process for obtaining evidence and evaluating it objectively to ensure compliance to standards.

Audit client or auditee: organization or person requesting an audit

Audit evidence: documents & recordsAuditor: person who conduct an audit

Auditing is done periodically whether there is a defect or not.

or it is done when something goes wrong: as malpractice, adverse event, or sentinel event.

“Audit is a fact finding mission not a policing operation”

Auditing can be considered as a way for problem solving

This process must involve everyone who might have contributed to the problem.

Ask everyone to sit down and analyze:

·     What went wrong?·     Why?·    What actions need to be taken

in order not to repeat the problem?

Auditing needs measurementIt is based on a scientific approach to

reach a decision based on information .it depends on people interview, records, documents, observation(watch, listen, smell, touch)

Auditing involves the whole systemStructure process OutcomeAuditing can be Internal or External

Internal auditor- are employees of a company hired to assess and evaluate its system of internal control. To maintain independence, they present their reports directly to the Directors or to Top Management. They provide functional operation to the concern. Internal Auditors are employees of the company so that they can easily find out the frauds and any mishappening.

External auditor are independent staff assigned by an auditing firm to assess and evaluate financial statements of their clients or to perform other agreed upon evaluations. Most external auditors are employed by accounting firms for annual engagements. They are called upon from the out side of the company.

Clinical audit is the process formally introduced in 1993 into the United Kingdom's National Health Service (NHS), and is defined as "a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change".

Stages of audit:Stage 1: Identify the problem or issueThis stage involves the selection of a topic or

issue to be auditedStage 2: Define criteria & standardsDecisions regarding the overall purpose of

the audit, either as what should happen as a result of the audit, or what question you want the audit will answer, should be written as a series of statements or tasks that the audit will focus on.

Stage 3: Data collectionTo ensure that the data collected are precise,

and that only essential information is collected, certain details of what is to be audited must be established from the outset.

Ethical issues must also be considered; the data collected must relate only to the objectives of the audit. Staff and patient confidentiality must be respected - identifiable information must not be used

Stage 4: Compare performance with criteria and standards

This is the analysis stage, whereby the results of the data collection are compared with criteria and standards. The end stage of analysis is concluding how well the standards were met and, if applicable, identifying reasons why the standards weren't met in all cases.

Types of non conformityMajor : must be corrected, must

be re-audit to guarantee correction. Usually in product quality. Corrective action

Minor: indirect effect on quality. It is nice to correct. Preventive action.

Remark: as minor, without evidence.

Stage 5: Implementing changeOnce the results of the audit have been

published and discussed, an agreement must be reached about the recommendations for change. Using an action plan to record these recommendations is good practice; this should include who has agreed to do what and when. Each point needs to be well defined, with an individual named as responsible for it, and an agreed timescale for its completion.

Re-audit: Sustaining Improvements

After an agreed period, the audit should be repeated. The same strategies for identifying the sample, methods and data analysis should be used to ensure comparability with the original audit. The re-audit should demonstrate that the changes have been implemented and that improvements have been made

Audit procedures1- Pre-audit management:

(preparation & planning), formation of audit team, documents, check lists, standards to compare to, determine the date of visit.

2- The audit: opening meeting, the actual audit, report, closing meeting.

3- Subsequent actions: submit report, follow up of corrective actions, maintain records

Collect data and check validity of evidence

(by asking for knowledge, by observation, by evidence)

Define what went wrongDecide on likely causesImmediate notification to concerned

persons to take actionRecording the findings and outcomesReport to everyone concerned to

prevent recurrence.

Good auditorDon’t ask more than 1 question at a

timeDon’t answer the questionsBe friendlyDon’t criticize, be positiveSpeak clearlyLook at persons they are talking to youListen carefullyVerify evidence

Don’t trust memoryRecord what you actually seeWrite clearlyBe conciseUse words of standardsBe there on timeDon’t forget thanks after auditing

Thank you