Table 3 Guiding principles for clinical audit.[4]
Stage | Recommendations | Addressed within Cochrane Review? |
|---|---|---|
Preparing for audit | Securing stake-holder interest and involvement (e.g. professionals, patients or carers) | No |
| Â | Selection of appropriate topic, according to whether: | Â |
|  | • Topic concerned is of high cost, volume, or risk to staff or users | No |
|  | • Evidence of a serious quality problem | Yes: effects greater if low baseline |
|  | • Good evidence available to inform quality standards | No |
|  | • Amenability of problem to change | No |
|  | • Potential for involvement in a national audit project | No |
|  | • Topic is pertinent to national policy initiatives | No |
|  | • Topic is a priority for the organisation | No |
| Â | Clear definition of purpose of audit, e.g. to improve or ensure the quality of care | No |
| Â | Provision of necessary support structures, i.e. | Â |
|  | • Structured audit programme (committee structure, feedback mechanisms, and regular audit meetings) | No |
|  | • Sufficient funding (audit staff, time of clinical staff, data collection, feedback) | No |
| Â | Identification of skills and people needed to carry out the audit | No |
Selecting criteria | Definition of criteria (structure, process and outcome) | No |
| Â | Validity and potential to lead to improvements in care | Â |
|  | • Evidence based | No |
|  | • Related to important aspects of care | No |
|  | • Measurable | Yes (implicitly) |
Measuring level of performance | Planning data collection | Â |
|  | • Definition of user group (and exceptions) | Can't tell |
|  | • Definition of healthcare professionals involved | Yes (implicitly) |
|  | • Definition of time period over which criteria apply | Yes (implicitly) |
Making improvements | Identification of barriers to change | No |
| Â | Implementing change | Â |
|  | • Establishing the right environment (at individual, team and organisational levels) | No |
|  | • Considering external relationships (e.g. with patients or other agencies) | No |
|  | • Use of other supporting interventions (e.g. educational outreach, reminders) and / or multifaceted interventions | Yes: not supported by evidence |
Sustaining improvement | Monitoring and evaluating changes, e.g. continuing audit cycle, use of performance indicators | No |
|  | • Appropriate organisational development (e.g. cultural change, adequate training) | No |
|  | • Use of existing strategic, organisational or clinical frameworks | No |
|  | • Leadership | No |