Unit 5 – Prescribing in Practice

Auditing, Monitoring and Evaluating Prescribing Practice

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 met
  • If they are not, taking steps to improve practice and quality of care.

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 and monitoring.

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 the changes.

Clinical 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 audit
  • 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.

Make Notes

Write down whether standards are in place for this chosen area.

Are they being met? If not, what action needs to be taken to improve performance?


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?

What 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 the audit.

Further Reading

Further reading

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.

Reflective Activity

Reflective activity

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.

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