Assessment 1: Clinical Audit Critique

Clinical governance is defined as “a system through which…organisations are

accountable for continuously improving the quality of their services and safeguarding
high standards of care by creating an environment in which excellence in clinical care
will flourish”(Scally& Donaldson, 1998, p.62)1.

Task

There are 7pillars of clinical governance which include:

1. Service user, carer and public involvement.

2. Risk management.
3. Clinical audit.
4. Staffing and staff management.
5. Education and training.
6. Clinical effectiveness.
7. Clinical information.

You are required to write an essay examining and appraising how a clinical audit in
your specialty practice area can impact education & training, clinical effectiveness,
staffing & staff management, and risk management. This appraisal is to include
benefits and limitations of undertaking a clinical audit, and draw upon resources from
your specialty practice area to substantiate your argument.

Using the following headings, complete the task above:

Headings Task
Title State the title of your appraisal in terms of your area of

1Scally,
G., & Donaldson, L. (1998). Clinical governance and the drive for quality
improvement in the new NHS in England. BMJ, 317, 61-65. Doi:
10.1136/bmj.317.7150.61
 practice
Introduction Describe the structure of your essay, outlining your
argument and the points you will develop in the essay
Background Provide a background summary of clinical audits
Impacts of clinical audits Explain the impact of clinical audits on your area of specialty
practice using the subheadings as shown
 Education & Training
 Clinical Effectiveness
 Risk Management
 Staffing & Staff
Management
Examine the benefits of clinical audits as they apply to your
Benefits and Limitations
area of specialty practice
Reach a conclusion in relation to the application of the topic
Conclusion and Implications
to your specialty practice.

Preparation

Preparation for this assessment includes the completion of the appropriate modules in
this unit. Additionally, you should contact the clinical audit coordinator at your facility
for guidance as it applies to your area of practice.

Risk management

Risk management is about minimising risks to patients by:

 identifying what can and does go wrong during care

 understanding the factors that influence this
 learning lessons from any adverse events
 ensuring action is taken to prevent recurrence
 putting systems in place to reduce risks

https://www.uhb.nhs.uk/clinical-governance-components.htm
Assessment 1: Clinical Audit Critique Rubric
Criteria High distinction
2.5 to 3 points
Introduction: paper
provides a clear Introduction offers clear
introduction outline of paper and
provides direction for the
discussion
5 to 6 points
Literature: demonstrated
use of relevant literature Literature cited is
relevant and extensive;
consistent evidence of
wide reading
6.25 to 7.5 points
Concepts and theories:
demonstrated Evidence of high level of
understanding of the understanding of
topic and the concepts concepts/theories used,
and theories used demonstrates analysis,
reflective and critical
thinking; paper addresses
all aspects of the question
in an integrated way and
contains no irrelevant
material or repetition of
ideas
6.25 to 7.5 points
Arguments and analysis:
coherent argument Coherent and logical
which is sustained by argument, extensively
logic and evidence sustained by readings and
evidence; argument
reflects student’s critical
thinking and synthesis;
argument demonstrates
imagination, originality
or flair
Distinction
2.25 to 2.49 points
Introduction offers clear
outline of paper and
provides clear direction
for the discussion
4.5 to 5 points
Literature cited is
relevant; some evidence
of wide reading
5.6 to 6.2 points
Evidence of substantial
understanding of
concept/theories used,
demonstrates some
analysis, reflective and/or
critical thinking; paper
addresses all aspects of
the question, includes no
irrelevant material or
repetition but has some
weak connections
between ideas
5.6 to 6.2 points
Well organised and clear
argument sustained by
readings and evidence;
argument reflects
student’s critical thinking
and synthesis of deeper
and less obvious aspects
of the argument;
demonstrates ability to
Credit Pass Fail
1.95 to 2.24 points 1.5 to 1.94 points 0 to 1.4 points
Introduction offers clear Introduction attempts to Limited to no
outline of paper and offer outline of paper or introduction
provides direction for the provide direction for the
discussion discussion
3.9 to 4.5 points 3 to 3.9 points 0 to 2.8 points
Literature cited is Some literature cited; Limited to no literature
appropriate and covers all only some references cited
crucial points; limited relevant to argument
evidence of wide reading Limited to minimal
literature cited
4.9 to 6 points 3.75 to 4.8 points 0 to 3.5 points
Evidence of Evidence of knowledge of Limited to no
understanding of key fundamental concepts; understanding
ideas, awareness of their some understanding of demonstrated; paper does
relevance; partial concepts/theories used; not answer the question
understanding of concepts paper addresses only
and theories used; attempt some aspects of the
at analysis of issues; question and contains
paper addresses only either irrelevant material
some aspects of the or repetition of ideas
question and/or contains
some irrelevant material
and/or repetition of ideas
4.9 to 6 points 3.75 to 4.8 points 0 to 3.5 points
Some evidence of an Mostly description rather Limited to no argument,
argument with some than argument or the only description or
support from readings argument is not well personal opinion, with no
and evidence, but is supported, unclear or supporting logic or
unclear in some important logically flawed with evidence, isolated
areas; shows some use of limited support statements are made but
analytical skills, and are not connected in any
some originality or logical way
insight
 adapt and apply ideas to
new situations
2.5 to 3 points 2.25 to 2.49 points 1.95 to 2.24 points 1.5 to 1.94 points 0 to 1.4 points
Conclusion: paper offers
a purposive conclusion Conclusion presents no Conclusion presents no Conclusion attempts to Conclusion attempts to Limited to no conclusion
new material; offers a new material; offers a summarise the ideas or summarise the ideas or
summation of ideas, summation of ideas, discussion, draw together discussion; may offer the
draws together the draws together the the discussion or offer the student’s ‘position’;
discussion and offers the discussion and/or offers student’s ‘position’ drawn limited linking to
student’s ‘position’ drawn the student’s ‘position’ from the discussion in the discussion
from the discussion in the drawn from the body
body discussion in the body
1.25 to 1.5 points 1.1 to 1.25 points 0.9 to 1 points 0.75 to 0.85 points 0 to 0.7 points
Writing style: paper is
written in formal High level of clarity High level of clarity in Writing style is Writing style is only just Writing style is poor and
Australian English (written in Australian articulating (written in satisfactory and clear satisfactory and clear, unclear, many errors, not
academic style with English) in articulating & Australian English) & (written in Australian many errors, not written written in Australian
clarity and coherence presenting issues and presenting minimal issues English) but not in Australian English English
ideas in a concise, and ideas in a concise, presenting issues in a
coherent manner. coherent manner concise and coherent
manner
1.25 to 1.5 points 1.1 to 1.25 points 0.9 to 1 points 0.75 to 0.85 points 0 to 0.7 points
Presentation: paper Grammar, syntax, Grammar, syntax, Paper contains occasional Paper contains several Paper contains frequent
meets referencing and spelling, sentence and spelling, sentence and grammatical or spelling grammatical or spelling grammatical or spelling
presentation paragraph structure, paragraph structure, errors; inconsistent errors, inappropriate errors, inappropriate
requirements for formal paragraph linking, use of paragraph linking, use of referencing (APA 6th); language, and/or layout language and layout hard
written work section headings are section headings are word count adhered to hard to follow; to follow; limited or no
appropriate; accurate and mostly appropriate; inconsistent and/or referencing ( APA 6th);
systematic referencing ( mostly accurate and incorrect referencing word count not adhered to
APA 6th); word count systematic referencing ( (APA 6th); word count
adhered to APA 6th); word count not adhered to
adhered to
Nuts and Bolts Items to Note for Assessments 1 & 2

Presentation

 Use the headings provided for each part of the task

 Headings and in-text citations are included in the word count (references are not
included)
 NO COVER PAGE OR TABLE OF CONTENTS
 Header or footer with name, student number and page numbers
 1.5 line spacing
 Left align text
 Size 12 font (preferably Arial)
 Normal margins

Word count

 Assessment 1: 2000 words +/- 10%

 Assessment 2: 2000 words +/-10%

References required
 Assessment 1: Minimum of 15
 Assessment 2: Minimum of 15

Referencing

Referencing for all your assessments is as per APA 6th style,

Acceptable and unacceptable resources: all assessments

Acceptable resources

 Original quantitative research

 Original qualitative research
 Systematic reviews and/or meta-analysis of quantitative research
 Systematic reviews and/or meta-synthesis of qualitative research
 Literature reviews
  Scoping reviews
 Integrative reviews
 Journal articles up to 10 years old
 Texts up to 5 years old
 Websites intended for professionals, not consumers

Unacceptable resources

 Evidence summaries
 Information fact sheets
 Blogs
 University and library libguides
 Wikipedia
 Online and text dictionaries
 Resources outside the specified date range above
 Resources with no date or author

Advantage and disadvantages of audits

The following advantages of clinical audits were described by Holmboe and
Hawkins, 2009.
1. Availability: Getting to the records is usually not a major problem but pulling
out specific aspects of care may be a challenge.
2. Feedback: Allow for corrective feedback centred on actual clinical care in a
timely manner
3. Changing clinical behaviour: Once a practice gap is discovered this would
encourage introducing changes in the practice
4. Practicality: Audits allow for a targeted or random selection of patients to be
surveyed
5. Evaluation of clinical reasoning: Depending on the quality of the
documentation, evaluation of skills in analysis, interpretation and management is
possible. Evaluation of particular groups or treatments, conditions is also
possible.
6. Reliability and validity: Since audits use explicit criteria, a high degree of
reliability is possible
7. Learning and evaluating by doing: The audit is done with the active
participation of the practitioners involved or practice; this encourages the
constant improvement of the services
8. Self-assessment and reflection: Comparing the practice to benchmarks allows
practitioners to be their own assessors and to reflect in their own practice. The
practitioner must be prepared to assess his/her own performance.

Potential disadvantages of clinical audits

The following potential disadvantages need to be taken into consideration in

order to achieve a balance (Holmboe and Hawkins, 2009).
1. Quality of the documentation: The quality of the audit can be only as good as
the quality of the documentation. Was all the pertinent information collected?
2. Process versus outcomes: The utility to using the clinical record audit to
determine causation for patient outcome is limited
3. Implicit review: Reviewing a clinical record without a minimal framework,
structure or especially well defined criteria results in low reliability and reduced
validity.
4. Assessment of clinical judgment: Was the judgement of the clinician properly
recorded? Did the judgement translate into the appropriate management plan?
5. Time: Can be very time consuming, in addition to the normal tasks of running
the practice.
6. Cost: Consider the costs, (audit may not be billable time).

References
Addis, M.E. & Krasnow, A.D. (2000). A national survey of practicing
psychologists' attitudes toward psychotherapy treatment manuals. Journal of
Consulting and Clinical Psychology, 68(2),331-339.
Cabana, M.D., Rand, S., Powe, N.R., Wu, A.W., Wilson, M.H., Abboud, P.A.,
Rubin, H.R. (1999). Why don't physicians follow clinical practice guidelines? A
framework for improvement. Journal of the American Medical Association,
282(15),1458-1465.
Holmboe, E. S. Practice Audit, Medical Record Review, and Chart-Stimulated
Recall. In Holmboe E. S. and Hawkins R. E. (eds): Practical Guide to the
Evaluation of Clinical Competence. Philadelphia, USA: Mosby Elsevier, 2008, pp
60-74.
Kramer, T.L. & Burns, B.J. (2008). Implementing Cognitive Behavioural Therapy
in the real world: A case study of two mental health centers. Implementation
Science, 3:14.

ABSTRACT
The main aim of the project is atomization of the clinical auditing system to atomize all
clinical data from manual errands. It is a front end database for the hospital in the image
based clinical auditing system. This application can be used to analyze the complete
clinical audit process and how this data is used to evaluate the patient information and
their health improvement process. This project also focuses on data reliability by
maintaining the database solutions. All updating from the auditing will be performed
regularly and sporadically analyses the data. This application will provides the frontend
database and used to Analyzing The internal audit for organization in any hospital. It will
provide a user interface for any user and icon based auditing system. In this dissertation
the project will provides the security in each and every level of the database. Only
Administrator can have the right to add the clinical data and the number of user in the
hospital. For the others the level of hierarchy will maintain with the surety access.
Periodically final reports will generates and the reports will export to the excel format as
for the operations required.
CHAPTER 1
INTRODUCTION
1.0 What is Clinical Auditing?
Clinical audit is a process that has been defined as “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”. (NICE, 2002)

The key component of clinical audit is that performance is reviewed (or audited) to
ensure that what should be done is being done, and if not it provides a framework to
enable improvements to be made. It had been formally incorporated in the healthcare
systems of a number of countries, for instance in 1993 into the United
Kingdom’s National Health Service (NHS), and within the NHS there is a clinical audit
guidance group in the UK.

One of first ever clinical audits was undertaken by Florence Nightingale during
the Crimean War of 1853-1855. On arrival at the medical barracks hospital in Scutari in
1854, Florence was appalled by the unsanitary conditions and high mortality
rates among injured or ill soldiers. She and her team of 38 nurses applied strict sanitary
routines and standards of hygiene to the hospital and equipment, and with Florence’s
gift with mathematics and statistics, kept meticulous records of the mortality rates
among the hospital patients. Following this change the mortality rates fell from 40% to
2%, and were instrumental in overcoming the resistance of the British doctors and
officers to Florence’s procedures. Her methodical approach, as well as the emphasis on
uniformity and comparability of the results of health care, is recognised as one of the
earliest programs of outcomes management.

Another famous figure who advocated clinical audit was Ernest Codman .He became
known as the first true medical auditor following his work in 1912 on monitoring
surgical outcomes. Codman’s “end result idea” was to follow every patient’s case history
after surgery to identify individual surgeon’s errors on specific patients. Although his
work is often neglected in the history of health care assessment, Codman’s work
anticipated contemporary approaches to quality monitoring and assurance, establishing
accountability, and allocating and managing resources efficiently.

Whilst Codman’s ‘clinical’ approach is in contrast with Nightingale’s more

‘epidemiological’ audits, these two methods serve to highlight the different
methodologies that can be used in the process of improvement to patient outcome.
The integration into contemporary Healthcare:
Despite the successes of Nightingale in the Crimea and Codman in Massachusetts,
clinical audit was slow to catch on. This situation was to remain for the next 130 or so
years, with only a minority of healthcare staff embracing the process as a means of
evaluating the quality of care delivered to patients.

As concepts of clinical audit have developed, so too have the definitions which sought
to encapsulate and explain the idea. These changes generally reflect the movement
away from the medico-centric views of the mid-Twentieth Century to the more
multidisciplinary approach used in modern healthcare. It also reflects the change in
focus from a professionally-centred view of health provision to the view of the patient-
centred approach. These changes can be seen from comparison of the following
definitions.

In 1989, the White Paper, Working for patients, saw the first move in the UK to
standardise clinical audit as part of professional healthcare. The paper defined medical
audit (as it was called then) as

“the systematic critical analysis of the quality of medical care including the procedures
used for diagnosis and treatment, the use of resources and the resulting outcome and
quality of life for the patient.”

Medical audit later evolved into clinical audit and a revised definition was announced by
the NHS Executive:

“Clinical audit is the systematic analysis of the quality of healthcare, including the
procedures used for diagnosis, treatment and care, the use of resources and the
resulting outcome and quality of life for the patient.”

The National Institute for Health and Clinical Excellence (NICE) published the
paper Principles for Best Practice in Clinical Audit, which defines clinical audit as

“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. Aspects of the structure, processes, and outcomes of care are selected and
systematically evaluated against explicit criteria. Where indicated, changes are
implemented at an individual, team, or service level and further monitoring is used to
confirm improvement in healthcare delivery.”
Types of Audit
Standards-based audit – A cycle which involves defining standards, collecting data to
measure current practice against those standards, and implementing any changes
deemed necessary.

Adverse occurrence screening and critical incident monitoring – This is often used
to peer review cases which have caused concern or from which there was an unexpected
outcome. The multidisciplinary team discusses individual anonymous cases to reflect
upon the way the team functioned and to learn for the future. In the primary care
setting, this is described as a ‘significant event audit’.

Peer review – An assessment of the quality of care provided by a clinical team with a
view to improving clinical care. Individual cases are discussed by peers to determine,
with the benefit of hindsight, whether the best care was given. This is similar to the
method described above, but might include ‘interesting’ or ‘unusual’ cases rather than
problematic ones. Unfortunately, recommendations made from these reviews are often
not pursued as there is no systematic method to follow.

Patient surveys and focus groups – These are methods used to obtain users’ views about
the quality of care they have received. Surveys carried out for their own sake are often
meaningless, but when they are undertaken to collect data they can be extremely
productive.

1.3 Place of clinical audit in modern Healthcare

Clinical audit comes under the Clinical Governance umbrella and forms part of the
system for improving the standard of clinical practice.

Clinical Governance is a system through which NHS organisations are accountable for
continuously improving the quality of services, and ensures that there are clean lines of
accountability within NHS trusts and that there is a comprehensive programme of
quality improvement systems. The six pillars of clinical governance include:

Clinical Effectiveness

Research & Development

Openness

Risk Management

Education & Training

Clinical Audit

Clinical audit was incorporated within Clinical Governance in the 1997 White Paper, “The
New NHS, Modern, Dependable”, which brought together disparate service
improvement processes and formally established them into a coherent Clinical
Governance framework.

1.4 Clinical Audit-The process

Clinical audit can be described as a cycle or a spiral, see figure. Within the cycle there
are stages that follow the systematic process of: establishing best practice; measuring
against criteria; taking action to improve care; and monitoring to sustain improvement.
As the process continues, each cycle aspires to a higher level of quality.

Stage 1: Identify the problem or issue

This stage involves the selection of a topic or issue to be audited, and is likely to involve
measuring adherence to healthcare processes that have been shown to produce best
outcomes for patients. Selection of an audit topic is influenced by factors including:

Where national standards and guidelines exist; where there is conclusive evidence about
effective clinical practice (i.e. evidence).

Areas where problems have been encountered in practice.

What patients & public have recommended that be looked at.

Where there is a clear potential for improving service delivery.

Areas of high volume, high risk or high cost, in which improvements can be made.

Additionally, audit topics may be recommended by national bodies, such as NICE or

the Healthcare Commission, in which NHS trusts may agree to participate. The Trent
Accreditation Scheme recommends a culture of audit to participating hospitals inside
and outside of the UK, and can provide advice on audit topics.

Stage 2: Define criteria & standards

Decisions regarding the overall purpose of the audit, either as what should happen as a
result of the audit, or what question you want the audit to answer, should be written as
a series of statements or tasks that the audit will focus on. Collectively, these form the
audit criteria. These criteria are explicit statements that define what is being measured
and represent elements of care that can be measured objectively. The standards define
the aspect of care to be measured, and should always be based on the best available
evidence.

A criterion is a measurable outcome of care, aspect of practice or capacity. For example,

‘parents / carers are involved in negotiating or planning their child’s care’.

A standard is the threshold of the expected compliance for each criterion (these are
usually expressed as a percentage). For the above example an appropriate standard
would be: ‘There is evidence of parent / carer in care planning in 90% of cases’.

Stage 3: Data collection

To ensure that the data collected are precise, and that only essential information is
collected, certain details of what is to be audited must be established from the outset.
These include:

The user group to be included, with any exceptions noted.

The healthcare professionals involved in the users’ care.

The period over which the criteria apply.

Sample sizes for data collection are often a compromise between the statistical validity
of the results and pragmatically issues around data collection. Data to be collected may
be available in a computerised information system, or in other cases it may be
appropriate to collect data manually or electronically using data capture solutions such
as Formic, depending on the outcome being measured. In either case, considerations
need to be given to what data will be collected, where the data will be found, and who
will do the data collection.

Ethical issues must also be considered; the data collected must relate only to the
objectives of the audit, and staff and patient confidentiality must be respected –
identifiable information must not be used. Any potentially sensitive topics should be
discussed with the local Research Ethics Committee.

Stage 4: Compare performance with criteria and standards

This is the analysis stage, whereby the results of the data collection are compared with
criteria and standards. The end stage of analysis is concluding how well the standards
were met and, if applicable, identifying reasons why the standards weren’t met in all
cases. These reasons might be agreed to be acceptable, i.e. could be added to the
exception criteria for the standard in future, or will suggest a focus for improvement
measures.

In theory, any case where the standard (criteria or exceptions) was not met in 100% of
cases suggests a potential for improvement in care. In practice, where standard results
were close to 100%, it might be agreed that any further improvement will be difficult to
obtain and that other standards, with results further away from 100%, are the priority
targets for action. This decision will depend on the topic area – in some ‘life or death’
type cases, it will be important to achieve 100%, in other areas a much lower result
might still be considered acceptable.

Stage 5: Implementing change

Once the results of the audit have been published and discussed, an agreement must be
reached about the recommendations for change. Using an action plan to record these
recommendations is good practice; this should include who has agreed to do what and
by when. Each point needs to be well defined, with an individual named as responsible
for it, and an agreed timescale for its completion.

Action plan development may involve refinement of the audit tool particularly if
measures used are found to be inappropriate or incorrectly assessed. In other instances
new process or outcome measures may be needed or involve linkages to other
departments or individuals. Too often audit results in criticism of other organisations,
departments or individuals without their knowledge or involvement. Joint audit is far
more profitable in this situation and should be encouraged by the Clinical Audit lead
and manager.

Re-audit: Sustaining Improvements

After an agreed period, the audit should be repeated. The same strategies for
identifying the sample, methods and data analysis should be used to ensure
comparability with the original audit. The re-audit should demonstrate that the changes
have been implemented and that improvements have been made. Further changes may
then be required, leading to additional re-audits.

This stage is critical to the successful outcome of an audit process – as it verifies whether
the changes implemented have had an effect and to see if further improvements are
required to achieve the standards of healthcare delivery identified in stage 2.

Results of good audit should be disseminated both locally via the Strategic Health
Authorities and nationally where possible. Professional journals, such as the BMJ and
the Nursing Standard publish the findings of good quality audits, especially if the work
or the methodology is generalisable.

Fig: The Life cycle of clinical audit process

CHAPTER 2
2.0 Literature review:
Clinical audit process was actually introduced in 1993 by United Kingdom’s National
Health Services (NHS). The main purpose of clinical audit is to diagnose the patient and
giving treatment in regarding the quality of health care. In simple words Clinical audit
can be defined as the quality measures taken to improve the patient care and reviewing
the changes better outcome. It is a systematically practice to examine the patient in all
aspects. The main important aspect in clinical audit system is to ensure that everything
is done as per the predefined procedure and if not introducing measures to happen this.

Both the quantitative and qualitative approaches are considered for the research
process. Basic attributes that contribute the clinical audit system are analyzed by the
quantitative approach and even the hidden truths of the hospital maintenance can be
derived by these quantitative approaches. Behaviour the clinical auditing system and its
impact on the typical operations of hospital can be analyzed by the qualitative methods.
A separate database is maintained to record all the clinical audit issues and the same
data is used to populate at the front end. Research is the process of getting better
knowledge on new aspects and clinical audit is all about finding the best practices and
providing an interface to implement them and thus we can conclude that all the data
required for better implementation of clinical audit is based on the inputs provided at
the research level. All the statistical data that was collected can be best evaluated with
the help of database design and this design can is best decided by the quantitative
methods. Database capacity and its relevant can be decided with the help of these
methods. All the research is focused on the patient information and this information is
collected from the clinics directly to evaluate the best research methods.

2.1 Issues in the present System:

Problems:

All the data in the clinical auditing process is manual

The data collected from the medical professional is done manually.

The evaluation process of data related to the clinical auditing need the lot of effort and
time taking process. Sometimes it may take one month or more to evaluate a single file.
The quality of health care is provided by setting and estimating of best practice

Results are not movable to others, it shows specific and local to one individual patient
group

It is practice-based and continue process Allocating patients never involve randomly to

diverse treatment groups

It never accepts an entire new treatment

2.2 Proposed System:

This application will provides the frontend database and used to Analyzing The internal
audit for organization in any hospital. It will provide a user interface for any user and
icon based auditing system. In this dissertation the project will provides the security in
each and every level of the database. Only Administrator can have the right to add the
clinical data and the number of user in the hospital. For the others the level of hierarchy
will maintain with the surety access. Periodically final reports will generates and the
reports will export to the excel format as for the operations required.

The main steps are taken by clinical audit are as follows:

Normal clinical management will proceed whether patient contact is involved or not but
it doesn’t take any difference

Few audits can have efficiency to entail patient input and carry risks like psychological
harm and distress

Individuals may accept different treatment or services through general clinical

assessment, they are not randomized

Various settings of results were not transferable

Statistical analysis and interviews are best examples for research methodologies

Principles of good practice are source of theoretical constructs and measurement not
hypothesis

The quality of practice is improved by Clinical audit and Clinical research results to
enhanced knowledge
The Nurse role in clinical audit is to address the clinical governance which is focused on
the frame work. The information will be useful for the data collection correctly. While
nurses involve the ward staff, they indirectly correspond to the patient care. Since the
nurse managers have to avail a several tools to simplify the process systematically and
giving effective strategy. The nurse manger takes necessary steps for the audit to
encourage and empower the staff for the best resources as this is the first change agent.
(Morrell 1999; Harvey 1999).

As they believed in “change agents” and the second change agent was needed to
change the staff mode with the result of memo mostly, they are verified by opinion
leader who was a second change agent who was convinced with the conversation
(Lomas, 1991).

Facilitator, it is a professional ward which is external in the third change agent. It is a

part of trusts in clinical governance; this department is to expertise in audit. Co-
coordinator, who will guide the standard setting and services comparing with practices.
(Stark, 2002)

Innovator is fourth agent, here the ward staff enjoys on sudden change, and they are
passion to promote peers. These are offered and utilized by four change agents, nurse
led clinical audit are believed. (Morrell 1999; Harvey 1999).

Problems are identified in based clinical audit, to rectify the problem audit needs an
allocated time. It is an extra work for the team with the audit cycle working on a few
skilled members. To introduce clinical audit and pay to nurses need extra funds to
achieve the process but this resource is lacking in ward level (Chambers and Jolly, 2002;
Nice, 2002).

It is difficult to validate the ward staff to get audit result by not funding them. Absence
of good managers, the particular nurses role in audit will provide an effective training, if
audit is incomplete it is difficult to implement and it cannot be worth. (Smith, 2004; Kinn,
1995).