Clinical Audit Relating to Falls. Jeannette Kamar

Transcription

1 Clinical Audit Relating to Falls Jeannette Kamar Quality, Safety & Risk Unit; Northern Health Using Clinical Audit to Support Quality Improvement Seminar Monash University, School of Public Health and Preventive Medicine The Alfred Medical Research and Education Precinct, Melbourne Friday 26th February 2016 Clinical Audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change.

2 Today s Presentation Clinical Audit Relating to Falls 1. Identify problem or issue 2. Set criteria & standards 3. Observe practice / data collection 4. Compare performance with criteria & standards 5. Implementing change Identify the Problem or Issue Stage 1: Determine the issue / problem / audit topic Focus on areas with greatest need to improve Include government or regulatory requirements Involve stakeholders Staff & Patients delivering or receiving the care Staff with authority to support change Plan the delivery Who will conduct the audit Who will collate / monitor progress

3 Falls - Identify the Problem Patient falls: - World wide problem -Common cause of harm in hospitals NSQHS Standards 10 -falls prevention: - National government regulatory requirements Currently: -An absence of high-quality evidence showing the effectiveness of falls prevention strategies across acute hospital wards National Safety and Quality Health Service Standards, September 2012 Barker A, Morello R, Wolfe R et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial, BMJ 2016;352:h6781 Falls - Identify the Problem Currently: -There is evidence suggesting that some locally developed hospital falls prevention programs have been effective in the setting where is was developed Local programs are: - Developed, using local data -Aim to address local issues Clinical audit: - Assess local issues to improve patient care Barker A, Kamar J, Morton A, et al. Bridging the gap between research and practice: review of a targeted hospital inpatient fall prevention programme. Quality & safety in health care 2009;18(6): A Barker, J Kamar, M Graco, V Lawlor, K Hill. Adding value to the Stratify falls risk assessment in acute hospitals. JAN volume67, Issue 2, pages , February 2011.

4 Clinical Audit within a Service Helps to identify and measure areas of risk Creates a culture of quality improvement Is educational for the participants Offers an opportunity for increased job satisfaction Is increasingly seen as an essential component of professional practice. Can improve the quality and effectiveness of care Set Standards & Criteria Stage 2: Identify related National Standard - Local committee Set the criteria Measurable statements of what should happen in line with National Standard and local policy Set targets & agree acceptable exceptions - Include expected performance levels and action to be taken if level is not achieved

5 Set Standards & Criteria Setting Targets Indicator Description Indicator Formula / Measurement Unit Examples: a) Number of Patient Falls by 1000 bed-days per month -Falls per 1,000 occupied bed days: Divide the number of falls by the number of occupied bed days for the month; then multiply this by 1,000 b) Percentage Risk Assessment Tools (RAT) completed within 24 hours for each patient admitted to a general inpatient Ward -Number of RAT completed (within relevant time-frame) divided by number of patient admissions (to relevant wards); then multiply this by 100 Set Standards & Criteria Setting Targets Data Source, (i.e. Riskman / Clinical Audit) Baseline Measure Current Measure Target Measure: by percentage or rate and identify expected performance levels, i.e.: Target / Good >=98% Moderate >=80% Poor <80

6 Set Standards & Criteria Setting Targets Determine action required if below Target Primary Responsibilities: Conducting the audit Collating the data Accountable process owner Reporting cycle Governance Committee Observe Practice / Data Collection Stage 3: Audit Tool Data collected should be in relevant order and relevant to the objectives / criteria Use clearly worded closed questions Limit free text or open questions: these are difficult to code / analysis is very time consuming Include definition of terms Include space for comments to record exceptions

7 Audit Tool - Sample Purpose Instructions Tool: -Yes / No questions - Observing documentation - Observing practice -Includes question to measure overarching aim -Option to provide comment Audit Tool - Sample PURPOSE This audit is intended as an educational tool to help ensure: Documentation on the Patient Care Plan or Clinical Pathway is correct, complete and complies with the 6-Pack Falls Prevention Program Falls prevention strategies are implemented as indicated on the documentation Issues are discussed and addresses at ward level The tool may also be used following a fall to investigate the circumstances of the fall and thus provide a basis for feedback to staff.

8 Audit Tool - Sample INSTRUCTIONS Audits are best undertaken towards the end of the shift to ensure documentation is completed. Circle responses as appropriate and discuss issues arising with the nurse caring for the patient. Note commentsin the space provided in orderto clarify issues identified and suggestions for improvements. Forward completed audits to: (insert name and location).

9 Observe Practice / Data Collection Stage 3: Data collection Collection of relevant data about current practice in order to facilitate comparison Data analysis Convert the facts / data into useful information in order to identify the level of compliance with the agreed standard Draw conclusions Identify the reasons why the standard was not met

10 Compare with Standard / Criteria Stage 4: - Present and discuss results Target / Good i.e. >=98% Moderate i.e. >=80% Poor i.e. <80 No further action required If target achieved, there should be an explicit statement saying no further action required Further action required If Moderate or Poor, identify areas for improvement Compare with Standard / Criteria Further action required Change is often the most difficult part of the audit. When the audit team have developed the recommendations, decisions should be made on how changes can be introduced and monitored. Results should be used in conjunction with feedback and local consensus to change clinical practice and to improve standards. Priorities for action should be identified and these should be clearly documented.

11 Implement Change Stage 5: All audits should be accompanied by a quality improvement planin order to achieve the required improvements in practice. Monitor implementation of changes Report on progress of implementation as required Re-audit to ensure changes have improved practice and decide if further audit procedures are required Overview

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13 Summary Keep audits simple Get everyone involved Determine the topic Have a plan Do not collect needless data Take care with statistics Close all clinical audit loops Share learning Re-audit to ensure improvement in clinical care Questions? Clinical Audit Relating to Falls Jeannette Kamar Quality, Safety & Risk Unit; Northern Health Jeanette.kamar@nh.org.au