In a A
First Class Service, clinical audit is defined as 'the systematic,
critical analysis of the quality of clinical care, including the procedures
used for diagnosis and treatment, the use of resources and the resulting
outcome and quality of life for the client' (DH, 1998).
All the principles of audit can be applied to nurse prescribing.
Clinical audit is about:
- Setting standards
- Measuring practice to see whether the standards are being
- If they are not, taking steps to improve practice and quality
Audit is an ongoing process and aims to improve standards continuously.
Clinical audit: what it is and what it is not
Sometimes healthcare staff have difficulty in understanding
the differences between clinical audit, research, surveys
The following is from The RCGP Quality Practice Award for Practice
Teams (Ring, 2002), which is a practical guide for nurses and midwives
working towards the quality practice award (QPA).
Clinical audit is about
- Finding out what is currently happening in an
area of practice
- Seeing whether standards based on best available evidence
are being met or exceeded
- Changing practice: the underlying principle of clinical
audit is improving the quality of care when audit results
indicate that current practice is not as good as expected
- Being committed to completing the full audit cycle and,
where changes have been made to practice, reauditing to
find out whether standards have been met as a result of
audit is not about
- Finding out what future practice should be: finding new
evidence on which to base future best practice is research,
not clinical audit
- Simply collecting and presenting data: isolated lists
or tables of data that are not linked to standards are
survey or monitoring information rather than clinical
- Collecting data without using them to show whether standards are
being met or not: collecting and presenting data without gauging them
against standards is a common reason for an audit cycle being considered
incomplete. Without changes being made, where necessary, the audit
cycle has not been completed (Ring, 2002).
With reference to your
clinical area, think about an aspect of prescribing practice where
you and/or your colleagues could contribute to improving performance.
Write down whether standards are in place for this
Are they being met? If not, what action needs to be taken to
Can you see the benefits that audit may bring to
patients and the healthcare team?
An example could be the record keeping of prescribing.
The standards for this have already been stated.
You can refresh your memory of these standards by clicking on
the NMC Guidelines for Records and Record Keeping (2005)
How could you audit your record keeping, as a team,
to ensure you are meeting these standards?
action could you take to improve current performance?
It may be the case that the audit you propose to perform has
been carried out previously, and for many common audits audit
templates are available. Therefore, it is a good idea to contact
the audit specialist in your trust, as they may be able to
assist you in planning your audit. This will not only save
you time but will also hopefully give you confidence in performing
Irvine, D., Irvine, S. (1997) Making Sense of
Audit: the business side of general practice.
Oxford: Radcliffe Medical Press.
University of Dundee (1994) Moving to Audit: An educational
package for nurses, midwives and health visitors. Dundee:
University of Dundee and CRAG.
Consider how the material studied in this unit influences your
practice, and take the opportunity to discuss this with your supervisor
and to review your personal learning plan accordingly.
You may find it useful to record your discussions and use these
as evidence in your portfolio.