Matter for Discussion: Clinical audit

Clinical audit is a cyclical process in which service delivery, clinical practice and other interventions are systematically reviewed against evidence-based, or other agreed best practice standards or key performance indicators. These may be nationwide (national clinical audits), or locally determined. All four countries of the UK participate in clinical audit, using data to inform action and to provide information on the quality of services to service users and the public. With the overarching aim of enabling change and learning for quality improvement, and ultimately improving patient outcomes and enhanced patient safety (NHS England, no date).

There is an increasing use of data within health care and whilst monitoring of performance is important, audit should not be solely for the purposes of measurement. The focus should lie on quality improvement (Foy et al., 2020), as well as the identification and celebration of existing good practice.

To be successful, clinical audit needs well defined and clearly stated aims and objectives (Health Quality Improvement Partnership, 2020), so staff understand the purpose. Otherwise, the benefits to patient care risk being overshadowed when trying to juggle competing priorities.

Developing a plan is crucial, with ‘SMART’ (specific, measurable, achievable, relevant, time limited) recommendations and actions developed in consultation with those responsible for implementation and, if different, those with relevant clinical knowledge. However, regular feedback and progress evaluation are also vital.

Clinical audit delivery methods vary. Many organisations now employ designated teams, who provide expertise and support to the process. However, without effective collaboration, this approach risks alienating clinical staff and the project not benefitting from their expertise and local knowledge.

Nursing staff registered with the Nursing and Midwifery Council, or Scottish Social Services Council, for example, can use participation in clinical audit as evidence for revalidation although, despite concerns being raised, time for this remains unprotected (Florence Nightingale Foundation et al., 2022; Jones-Berry, 2016). This, and the ever-increasing demands on the workforce, may make it more difficult for all staff, including non-registered staff who wish to share and develop their knowledge and skills, to become involved in the process and to invest the time following the audit on quality improvement.

Health and care services are facing significant pressures, yet the need – and commitment – to deliver quality, safe and effective care remains. So, whether audit is embraced or endured is probably less about the ‘who’ and more about the ‘how’?

Reading list for this debate available at rcn.libguides.com/congress2023.

References

Bristol Royal Infirmary Inquiry (2002) Recommendations. London: Stationery Office, pp.433-462. Available at: https://www.bristol-inquiry.org.uk/final_report/recommendations.pdf (Accessed 15 March 2023).

Florence Nightingale Foundation, Foundation of Nursing Studies, Point of Care Foundation and The Queen’s Nursing Institute Scotland (2022) Regular protected time for reflective practice in nursing and midwifery, Florence Nightingale Foundation, 23 March. Available at: https://florence-nightingale-foundation.org.uk/regular-protected-time-for-reflective-practice-in-nursing-and-midwifery/ (Accessed 15 March 2023).

Foy R, Skrypak M, Alderson S, Ivers N M, McInerney B, Stoddart J, Ingham J and Keenan D (2020) Revitalising audit and feedback to improve patient care, BMJ, 368, p.213. Available at: https://www.bmj.com/content/368/bmj.m213 (Accessed 15 March 2023).

Healthcare Quality Improvement Partnership (2020) Best practice in clinical audit. Available at: https://www.hqip.org.uk/resource/best-practice-in-clinical-audit (Accessed 15 March 2023).

Jones-Berry S (2016) Nurses call for protected time for revalidation CPD, Nursing Management, 23(2), pp. 8-9. Available at: https://rcni.com/nursing-management/newsroom/analysis/nurses-call-protected-time-revalidation-cpd-55476 (Accessed 15 March 2023).

NHS England (no date) Clinical audit. Available at: https://www.england.nhs.uk/clinaudit/ (Accessed 15 March 2023).

NHS Wales (2022) National clinical audit and outcome review plan 2022 to 2023. Available at: https://www.gov.wales/national-clinical-audit-and-outcome-review-plan-2022-2023 (Accessed 15 March 2023).

NHS Wales Shared Services Partnership (no date) Clinical audit. Available at: https://nwssp.nhs.wales/a-wp/governance-e-manual/putting-the-citizen-first/clinical-audit/ (Accessed 15 March 2023).

Royal College of Nursing (2021) Nursing Workforce Standards: Supporting a safe and effective nursing workforce. Available at: https://www.rcn.org.uk/professional-development/publications/rcn-workforce-standards-uk-pub-009681 (Accessed 15 March 2023).

Scrivener R, Morrell C, Baker R, Redsell S, Shaw E, Stevenson K, Pink D and Bromwich N (2002) Principles for best practice in clinical audit. Abingdon: Radcliffe Medical Press Ltd. Available at: https://www.nice.org.uk/media/default/About/what-we-do/Into-practice/principles-for-best-practice-in-clinical-audit.pdf (Accessed 15 March 2023).