Clinical Audit: Non Hemorrhagic Stroke

Group 7 - International
Group Member:
1. Surya Adhi 18136 6. Muhammad Nazhan 19096
2. Muhammad Rafi Nabih 18729 7. Nur Amalia Rusydina F 19111
3. Siti Aisyah Affiati 18737 8. Setya Atsil A 19145
4. Haniifah Anjani P 18882 9. Tiffany
5. Kevin Thenedi 19072 19153
Stages in Clinical Audit
1. Proposed Topics
Topic Risk Volume Cost Problem

Stroke non- High Moderate High High mortality

hemorrhagic risk

PPH High High High High mortality

risk

HIV High High High High rate of

unprotected sex

TB High Moderate High High resistance

risk

Management of Moderate High Moderate High rate of

Traffic Accident reckless drivers

DBD High High High High incidence

Diarrhea in children Moderate High Moderate High grade

medical condition

Diabetes High High High High incidence

2a. Develop Background
Background of Clinical Audit:
➔ Florence Nightingale was appalled at the unsanitary condition and high
mortality rates of the soldiers in the hospital at Scutari. According to this
condition, she and other 38 nurses make a strict sanitary routines and
standards of hygiene to the hospital and equipment. She evaluates the
result of this changes and it showed that the mortality rate is fell down
from 40% to 2%.
From Medical Audit, “the systematic critical analysis of the quality of the
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.”

to Clinical Audit, “is a quality improvement process that seeks to improve

patients care and outcome through systematic care of review against explicit
criteria. Where indicated, changes are implemented, and further monitoring
is used to confirm improvement in healthcare delivery.” (NICE, 2002)
2b. Objectives
Objectives of Clinical Audit:

➔ Clinical audit is used to ensure best practice is being followed and that patients
outcomes are the desired ones.
➔ Clinical audit also aimed to make changes and improvement of the practices.
3. Audit Criteria
No Criteria Standard Exception Data Collection
Guide

1. Neurological Examination 100% - Score:

1 -> has been done
2. Gadjah Mada Scoring 100% - 2 -> has not been
done, but is included
3. IV tPA 100% - in exception criteria
3 -> has not been
4. Mannitol 100% No ICP elevation done and cannot be
included in exception
criteria
5. Barthel Index 100% Patient Died
4. Data Collection
5. Data Analysis

From the analysis, several criteria were found to be not completely fulfilled, i.e.
criteria 1 (RBG, electrolyte, ureum creatinine, lipid profile examination), criteria 4
(80 mg Aspilet administration), and criteria 10 (Mannitol administration). While
there were also criteria that were not met at all, i.e. criteria 8 (Gadjah Mada scoring)
and criteria 9 (IV tPA administration).
 5. Data Analysis

Measurement Human Machines

Improper methods Inadequate training Tooling problems

Incorrect specifications
The management of patients is
not in compliance with the
guidelines.
Ineffective quality
Not to specifications management
Poor process design

Materials Process
 6. Making Plan of Action

Actions Objective Measurable Responsible Timeline Cost

Indicator Person

Make seminar Increase Laboratory Neurologist 3 months According to

about clinical skill of exam and inaCBG
managing doctors in treatment in regulation and
stroke patients managing medical record hospital
stroke patients expenses
After this practical session, how does the group feel about clinical audit?
Give comments

- Clinical audit is very crucial to improve the quality of health services in a

hospital.

- Clinical audit has to be based on the latest evidence-based medicine and proper
guidelines.

- Searching for patient’s data in medical record during clinical audit can be very
challenging and has to be done thoroughly.