CLINICAL AUDIT & COMMENTARY

Clinical Audit & Commentary

Clinical Audit & Commentary

In this assignment the I will address the process of clinical audit and will provide commentary, and will discuss the clinical audit process relating to one aspect of care delivery, along with how clinical governance can influence the quality of healthcare for patients. The audit topic chosen is phosphate enema administration from a patient's perspective. Using Gibbs model of reflection (Gibbs 1988) the author will reflect on her experience of the audit carried out on a practice placement, and will produce results of this audit. This assignment will also consider the relationship between clinical audit and the wider framework for quality improvement in healthcare.

I have changed the names of any clients used in this assignment, to protect their confidentiality, as referred to in the NMC Code of Conduct (Nursing and Midwifery Council 2004).

Clinical governance is the term used to describe a systematic approach to maintaining and improving the quality of patient care. The most widely cited formal definition describes clinical governance as: "A framework through which NHS organizations are accountable for continually 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 and Donaldson, 1998).

There are seven pillars of clinical governance (appendix 1) which includes clinical effectiveness, research and development, openness, risk management, education and training and clinical audit.

Clinical audit (appendix 2) is the process formally introduced into the NHS in 1993. Clinical audit comes under the clinical governance umbrella and forms part of the system for improving the standard of clinical practice. One of first ever clinical audits was undertaken by Florence Nightingale during the Crimean War of 1853-1855. 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 (Baker, 2000).

Additionally, audit topics may be recommended by national bodies, such as the National Institute for Clinical Excellence (NICE) or the Healthcare Commission, which the NHS Trust has agreed to participate in. 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.

The author used a benchmark to set standards for this audit; a benchmark is “a standard by which something is evaluated or measured” (Martin 2004). This is advocated in the Department of Health (DoH) document, The Essence of Care (2003). Which includes the background to Essence of Care, a description of the benchmarking tool, how to use the benchmarks and record forms for developing action and business plans. Nine sets of benchmarks are also included. It is intended that health and social care personnel use this document to address issues of concern within their areas of work and to improve services already provided.

A new benchmark, was added to this document in 2003. Promoting Health, This new benchmark provides a framework ...