Running head: CLINICAL AUDIT 1

Clinical audit and podiatric practices

[Name of Writer]

[Name of Institute]

[Date]
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Table of Contents

Introduction......................................................................................................................................3
Advantages and disadvantages of clinical audit..........................................................................4
Importance of clinical audit in podiatry.......................................................................................5
Clinical audit of podiatry treatments in NHS...............................................................................6
Conclusion.......................................................................................................................................8
References......................................................................................................................................10
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Introduction

Clinical governance can be known as the framework by which organizations of

healthcare are accountable to improve their service quality continuously and to safeguard high

care quality (Tuan, 2012).

Figure 1: Clinical governance cycle

System of quality healthcare is essential for Government and patients. Ultimate purpose

in practices f healthcare is high level quality care of patients. Patients can be taken as authority

for determining that if they are experiencing quality health care or not. Care’s effectiveness

pertains to support and treatment and can be helpful for judging whether staffs are on the right

track for achieving goof clinical outcomes (Stewart et al. 2016). So, service of audit is very

essential for ensuring that practices are adhered in setting best professional criteria and standards.

Clinical audit is a process of quality improvement and it was introduced in 1989 White Paper

‘Working for patients’ to NHS. Previously it was named as medical audit but the name was

changed in 1990s (Bolye & Keep, 2018). Reviewing of healthcare delivery for ensuring that the

best practice is given is involves in clinical audit.

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Improvement and evaluation of care quality given to patients are very essential in

everyday practice in clinic and also in policy of health’s financing and planning. Various tools

have developed which includes assessment of health technology, analysis of incident, and

clinical audit. In clinical audit, there is measuring of clinical process or outcome, against well-

defined set of standards on evidence-based machine’s principle for identification of changes that

are required for improvement of care quality. In specific, patients experiencing podiatric

problems, present many issues that have set as topic for projects of clinical audit (Banwell et al.

2015). Clinical audit’s peculiar characteristic is ‘professionalism’ of initiative, which may be

expressed by typical ingredients like participator’s clinical particular competence, results

confidentiality, object connected to professional ‘quality’ strongly.

Figure 2: Clinical audit cycle

Advantages and disadvantages of clinical audit

There can be some benefits in clinical audit which include:

 Improvement of care of patient

 Helping in demonstration of benefits of practice to others

 Making of good utilization of clinical time

 Many satisfied patients

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 Helpful in advancement of practices

 Identification of area to make efficient practice

 Giving useful evidence of professional activity of development

There may also be some barriers to clinical audit and they can be classified as:

 Less resources

 Lack of advice and expertise in designing and analyzing

 Issues between groups and members of groups

 Lack of planning overall for audit

 Impediments in organization

Importance of clinical audit in podiatry

For many podiatrists, audit is source of concern. Policies of compliance and preparation

may be helpful for practical challenges like thrive and injury. All services of diabetic foot care

can be enabled by clinical audit for measurement of performance against peer units and clinical

guidelines of NICE, and for monitoring adverse outcomes for individuals suffering from diabetes

and develop disease of diabetic foot (Ismail et al. 2015).

In England and Whales, audit for practices of diabetic foot shows that patients who are

assessed expertly in 2 weeks are to be free more likely than the ones who have to longer wait for

assessment. Diabetes patients have great risk of complications of foot that can cause lower

extremity amputations. It has suggested by National standards of UK that early management and

assessment by podiatry cause multidisciplinary high-risk foot clinic (HRFC) can be helpful in

complications reduction (Jeffcoate et al. 2020). Podiatrists have an essential part in such

multidisciplinary teams because they deal with diagnosis, prevention, and treatment of foot.
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Detection (early) of foot problems that is relevant to diabetes complications like PN and PAD,

along with good preventative care which includes appropriate pressure loading and footwear,

decreases the hazard of ulcers of diabetic foot and amputation, thereby to preserve independence

and mobility of an individual and reduction of costs if health care (Leese & Stang, 2016).

Care of podiatry is not easy and patients who are being in hospital for foot ulcers can

experience great risk of further complications of foot. DFUs are complicated chronic wounds and

have impacts that can be long-term on mortality, morbidity, and quality of life of patient. Ulcer

foot incidence has been reported of having a one-in-four risk during lifetime of individuals with

prevalence of 5% to 7% (Miller et al. 2017) and at five years, more than 44% mortality in the

one’s who has been undergone on amputation (Kerr, 2020). It has suggested by National audit

report of diabetes that from the time of 2010, some minor amputations have been rise, and

diabetic patients are almost 23 times extra likely of having foot, toe, or limb amputated that non-

diabetic individuals (Kerr, 2020). Issues of foot in such individuals may also having significant

impact financially on NHS, accrue of costing at primary, community, and secondary levels of

care, expanding costs of outpatient, prolonged and bed occupancy stays in hospital.

Clinical audit of podiatry treatments in NHS

Many people experience problems related to foot in the UK and other parts of world

(Armstrong et al. 2017). To survey the food problems, different methods have been utilized by

researchers, including an analysis by professional, postal questionnaires, telephone or face-to-

face interviews. It was found by combined survey by Hindley et al. (2014) that 20 to 78 percent

individuals experience callus, corns and bunions, between 20 to 49 percent have less toe

deformities and 28 to 56 percent can have problems related to toenail. Types and incidence of
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problems related to foot are variable when reported through surveys because of kinds of

population studied and if foot issues are assessed by any professional of healthcare or self-

reported (Hindley et al. 2014). Many surveys in past have concentrated on problems related to

foot in older individuals whether in any hospital ward or in residential care or living in

community. Understandably, when foot problems diagnose and reports by professional, the

incidence is high than comparatively with those that are reported by patient himself (Game,

2016). Foot pathologies high incidence is reflected in many individuals accessing care of

podiatry. According to MacDougall et al. (2014), it has shown by recent available figures that 2

million individuals are getting treatment by NHS, 56 percent are for older individuals and

769,000 of these are latest care episodes.

It is clear that practice of podiatry involves pathologies of foot linked with foot ulcers,

nails and soft tissues; which is regarded as treatment of foot podiatry and is needed for such kind

of conditions. Presently, it has supported by Ismail et al. (2015) the efficacy of treatment of

podiatry though anecdotally podiatrists have believed them to be advantageous. Investigation has

done in some studies (Linton et al. 2021) about properties of pain relieving of scalpel

debridement. 79 individuals were included in a multi-center project based on NHS and found

that pain was reduced after doing treatment when post and pre-operative pain scores utilizing

ASD were used and it was significant statistically, though advantage was not sustained (Linton et

al. 2021). Callus reduction with scalpel was found as well to decrease pain again directly using

pain VAS after treating and after seven days, in conjunction with improvement in functional

capability in some adults (Ismail et al. 2015). Dodds et al. (2014) stated that present priorities of

research identified for practice of podiatry also involve treatment effectiveness, as a big problem

requiring more investigation. In the last decade, particular measures of podiatric outcomes have
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been developed for measuring efficacy of various kinds of treatments and interventions (Dodds

et al. 2014).

In accordance with Joyce & Rajak, (2021), pain scale of VAS was tool which is simple

relatively for utilizing and could be reciprocated easily into records of patients including

electronic systems and paper, though some adult individuals need some help with its completion.

There would be disadvantage for the ones who have visual issues, but verbal description made to

clinician could be substituted if needed (Joyce & Rajak, 2021). If there is difference of sizes of

sample in departments, it is not easy benchmark clinical outcomes adequately across the region.

But the overall size of sample, though not represent all of the population of such people who

receive care of podiatry, is still many patients, comparatively to many previous reports using the

measures of outcomes (Kurar, 2016).

Some valuable information has given been given by this audit regarding the impact of

podiatry treatment and highlighted the requirement of outcome measures to be incorporated into

everyday practice of podiatry for expanding its evidence base. Clinical audit is effective way for

quality improvement continuously. It is necessary to provide much consideration to clinicians

having complexity in auditing and for establishing what proposals can make audit effective.

Conclusion

Improvement and evaluation of quality of care given to people is necessary in everyday

practice in clinic and also in policy of health’s planning and financing. One of the main purposes

in practices of healthcare is high level quality care of patients. For many podiatrists, audit is

source of concern. Care of podiatry is difficult and patients who are being in hospital for foot

ulcers can experience great risk of further complications of foot. It is necessary for measures of
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simple outcomes to be incorporated into clinical care which is day-to-day for make sure that

ongoing treatments are evaluated and there is availability of evidence for such interventions.

Some valuable details has given been given by this audit regarding the effect of podiatry

treatment and highlighted the necessity of outcome measures to be incorporated into practice of

podiatry for expanding its evidence base.

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References

Armstrong, D. G., Boulton, A. J., & Bus, S. A. (2017). Diabetic foot ulcers and their recurrence.

New England Journal of Medicine, 376(24), 2367-2375.

Banwell, H. A., Thewlis, D., & Mackintosh, S. (2015). Adults with flexible pes planus and the

approach to the prescription of customised foot orthoses in clinical practice: A clinical

records audit. The Foot, 25(2), 101-109.

Boyle, A., & Keep, J. (2018). Clinical audit does not work, is quality improvement any better?.

British Journal of Hospital Medicine, 79(9), 508-510.

Dodds, M. K., Daly, A., Ryan, K., & D'Souza, L. (2014). Effectiveness of ‘in-cast’pneumatic

intermittent pedal compression for the pre-operative management of closed ankle

fractures: a clinical audit. Foot and Ankle Surgery, 20(1), 40-43.

Game, F. (2016). Classification of diabetic foot ulcers. Diabetes/metabolism research and

reviews, 32, 186-194.

Hindley, J. (2014). Clinical audit of leg ulceration prevalence in a community area: a case study

of good practice. British Journal of Community Nursing, 19(Sup9), S33-S39.

Ismail, I., Dhanapathy, A., Gandhi, A., & Kannan, S. (2015). Diabetic foot complications in a

secondary foot hospital: A clinical audit. The Australasian Medical Journal, 8(4), 106.
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Jeffcoate, W., Rayman, G., & Young, B. (2020). National Audit of Diabetic Foot Care:

Continuing Audit Is Essential for the Delivery of Optimal Care of Diabetic Foot Ulcers.

The Fo Boyle, A., & Keep, J. (2018).

Joyce, C., & Rajak, R. (2021). A clinical audit into the adherence of foot health management

standards of rheumatoid arthritis compared with the foot health management standards of

diabetes mellitus in North-East London. Rheumatology advances in practice, 5(1),

rkab006.

Kerr, M. (2020). Cost of diabetic foot disease in England. The Foot in Diabetes, 17-29.

Kurar, L. (2016). Clinical audit of ankle fracture management in the elderly. Annals of Medicine

and Surgery, 6, 96-101.

Leese, G. P., & Stang, D. (2016). When and how to audit a diabetic foot service.

Diabetes/Metabolism Research and Reviews, 32, 311-317.

Linton, C., Searle, A., Hawke, F., Tehan, P. E., & Chuter, V. (2021). Nature and extent of

outpatient podiatry service utilisation in people with diabetes undergoing minor foot

amputations: a retrospective clinical audit. Journal of Foot and Ankle Research, 14(1), 1-

6.

MacDougall, M., Robinson, L., & Welsh, L. (2014). Standardisation through clinical audit: an

example of good practice in leg ulcer management. Wounds UK, 10(3).

Miller, L., McFadyen, A., Lord, A. C., Hunter, R., Paul, L., Rafferty, D., ... & Mattison, P.

(2017). Functional electrical stimulation for foot drop in multiple sclerosis: a systematic

review and meta-analysis of the effect on gait speed. Archives of Physical Medicine and

Rehabilitation, 98(7), 1435-1452.

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Stewart, K., Bray, B., & Buckingham, R. (2016). Improving quality of care through national

clinical audit. Future hospital journal, 3(3), 203.

Tuan, L. T. (2012). Clinical governance: a lever for change in Nhan Dan Gia Dinh Hospital in

Vietnam. Clinical Governance: An International Journal.