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July 12 2012
Optometrists Trevor Warburton and Barbara Ryan discuss clinical audit
How do we as optometrists know that we are performing to an adequate standard clinically? Are our records okay? Is that new varifocal any good? Does that new enhanced service
deliver the goods? Can we change what we do to improve the quality of care we provide? Clinical audit can help us answer these questions and provide the mechanisms for reviewing the quality of care we provide to our patients.
Clinical auditing is widespread in other areas of health care but not in optometry. Indeed, a big problem for optometry in developing enhanced services is a lack of data from existing schemes.
Practitioners may confuse clinical audit with the Post Payment Verification, which is an audit conducted by the NHS on GOS claims. Others may think it is something to be feared; someone judging their clinical practice or something difficult or time- consuming. In this article, we hope to dispel any fears you may have, as well as explain what clinical audit is.
What is a clinical audit?
The NHS Executive, 1996, provides the following definition: “Clinical audit is a clinically-led initiative which seeks to improve the quality and outcome of patient care through structured peer review, whereby clinicians examine their practices against agreed explicit standards and modify their practice where indicated.” So for the optical profession, clinical audit is about optometrists (ourselves or another optometrist) examining their clinical practice and deciding if and how we could do it better. It isn’t about other people judging us.
Some clinical audits, involving a number of practices, can be complex and time-consuming, and require input from an NHS audit team. But a clinical audit can be as simple as you reviewing 10 of your own records.
There are a number of logical steps to implementing a clinical audit. They include:
- Decide on the topic
- Find the standards for that area of clinical practice
- Collect the data
- Analyse the data and review the findings
- Implement any changes to improve the practice/service.
Clinical audit is a continuous process; and once you have made changes, you should re-audit to see if they have effected the desired improvement – this is the ‘audit cycle’ (see Figure 1).
You may have your own ideas about what you would like to audit. If not, a good place to start for a personal audit is record keeping. There is lots of guidance at www.qualityinoptometry.co.uk
(see Level 1, question 13.5).
Over the next few months, OT
will publish examples of different optometry clinical audits, which it hopes readers will find interesting. After that, the hope is that practitioners will submit audits to keep the series going. If you have any results that you feel would be of interest to others, then get in touch. Send them to firstname.lastname@example.org
. Mr Warburton and Ms Ryan will review submissions and give you guidance on writing them up for publication in OT
About the authors
Trevor Warburton is an optometrist in practice, clinical adviser to the AOP legal services and an honorary tutor at Cardiff University. Barbara Ryan is an optometrist in practice, clinical lead for the Low Vision Service Wales and a director of WOPEC. Together, they run Cardiff University’s MSc module on clinical audit.
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