The clinical audit
It is important to understand what is meant by the term 'clinical audit'. Jones et al (2007) state that clinical audit is a quality improvement process that aims to improve patient care and outcomes by carrying out a systematic review and implementing change. They go on to state that this definition is endorsed by NICE.
The next two factors to consider are that individuals within the organisation may well misunderstand the intentions and the processes of clinical audit as well as possessing certain attitudes towards these processes and their own personal practice which may effect their reaction to audit results.
Looking at the first point, if an individual is unable or unwilling to understand the process and intentions of clinical audit and equally unable or unwilling to understand or analyse the results, they will not be able to modify their practice appropriately. Some individuals may view clinical auditing as the organisation's 'big brother' approach towards maintaining clinical standards, or they may view the process as a 'paper process' for management purposes which doesn't intrude on their working lives.
The second factor is likely to be more difficult to overcome. If an individual views their clinical practice as being excellent and doesn't believe they require reflective practice or clinical audit to highlight potential areas of improvement, education regarding clinical audit may well go unheeded. An individual may be of the attitude that they have been in the job for many years and don't regard clinical audit as a valid tool and will stubbornly continue with their version of clinical practice regardless of current research and findings.
Individuals may also misunderstand what is meant by being an 'autonomous practitioner' and the obligations that being a registered professional (in the case of paramedics) brings to the job.
Maintenance of the highest possible standards of clinical and patient care by reading current research and using evidence-based practice in conjunction with the clinical guidelines to maintain their personal standards of care is essential.
Another important aspect to consider, which the author believes is not fully appreciated by some staff is that under the terms of Agenda for Change, staff are responsible for their own on-going training and will be soon obliged to demonstrate this in conjunction with the NHS Key Skill Framework (KSF) to qualify for yearly pay increments.
The vast majority of staff, when presented with evidence from clinical audits will adjust their practice to improve clinical and patient care. One area which has been highlighted to the author whilst performing the clinical audits is that of completing comprehensive documentation for each patient.
A minority of cases which were audited showed a lack of clear documentation which could result in misunderstanding especially when considering treatment which has not been administered, or treatment which has been administered but not documented. The phase 'if it's not written down, it didn't happen' is very important to bear in mind especially if the practitioner is called to answer questions regarding their quality of care in court.
It is essential to document all treatments, pertinent negatives and reasons for withholding treatment for every patient. This will be the biggest single factor that the author has appreciated during the audit cycle.