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Angela Grainger explains the development, purpose and practice of clinical audit, and the value to nurses of understanding and using audit tools
Summary
Healthcare organisations undertake quality assurance to produce safe and effective patient care systems. Statutory quality assurance requirements are met through external reviews, monitoring and inspection processes, and each NHS trust must produce a corporate annual quality account. However, this can result in approaching audits as if they are 'tick-box activities'. This article discusses how organisations can avoid this trap by applying audit results to practice.
Keywords
Audit, quality assurance, external monitoring
IN TODAY'S management environment, the need for formal monitoring of quality assurance processes to produce data for annual quality accounts is constant and is likely to remain so in the foreseeable future.
The purpose of audits is to generate findings that will benefit patients and their programmes of care. Patient welfare is at the heart of audits so, from both professional and ethical perspectives, healthcare organisations should not stint on audit activities (Nursing and Midwifery Council (NMC) 2008).
The sizes of nursing workloads, particularly when healthcare organisations are under financial pressure, are such that nurses may undertake audits simply to be seen to do them and to keep services going. In these circumstances, audits can become tick-box activities rather than learning processes leading to service improvements.
A tick-box approach to audits is especially likely to be taken when they must be completed to meet the requirements of overall external monitoring exercises, such as corporate risk management exercises or the routine monitoring of waiting times.
By taking a tick-box approach, nurses can show that they have undertaken auditing activities but not that audit findings have received their full attention.
Audits are time consuming, and if staff perceive them as chores required by management that attract little or no feedback, they can become demoralised.
In such cases, staff will not perceive any benefits in audits and will engage in them only reluctantly, while managers may not receive the audit data they need for management-led performance reports. This leads to frustration all round.
Nurses must therefore focus on realigning the audit process so that they can not only generate sufficient data for reports and monitoring purposes, but also analyse the data and make...