Doing Audits.

In a previous blog, we identified how audits play a vital role in quality improvement and assurance in health and social care settings. We identified that the purpose of audits is not just ticking boxes, but that they play a role in informing providers about areas in which they can improve what they do and how they do it.

We also saw that audits are a key method of demonstrating to the Care Quality Commission (CQC) that a provider is checking their practice and seeking to improve it and that they know what is going on in their business.

In this blog we will look at the practice of audit and how they should be planned, undertaken and what should be done with the results.

How audits work

Audits are, as we mentioned previously a process. This process involves systematically reviewing and evaluating current practices against established standards or criteria – or establishing the criteria if they do not already exist. The audit process begins by selecting an area of focus, such as infection prevention and control or medication management, and then collecting evidence through observations and documentation reviews.

In other cases, interviews might be used, for example if collecting audit data about Service Users experiences of care.

By comparing what they find to the expected standards, the auditor can identify where practice is not meeting the required standard. This in turn provides the focus for areas for improvement.

Planning audit

Audits should be planned. This means identifying what elements of practice need to be audited. While there are some core audits like medication management, care plans and infection prevention and control are obvious, other aspects of practice like auditing accidents and incident are less so but are useful in improving practice.

The registered manager does need to plan what to audit and with what regularity. Many audits need to be done regularly to stay on top of the work of the home care agency, these include:

• Infection prevention and control (including PPE usage and handwashing).
• Medication management.
• Care plans (for accuracy, looking for issues such as appropriate risk assessments, that care needs are all identified and accounted for and cross referencing of risk assessments with care plans).
• Time and attendance – to check arrival times and the amount of time spent providing care versus the contracted time.
• Service user satisfaction.

Other things that are less obvious include auditing things like the staff training uptake, incidents and accidents and staff files.

Collecting information

How information is collected for an audit will depend on what it is being audited. While a paper checklist, such as might be used to check a medication administration record, is useful for auditing medication management and administration, it may not be as useful for collecting Service User satisfaction.

Less objective measures like Service User satisfaction are best audited using a variety of approaches which may include a questionnaire but, verbal feedback is also useful. In this instance, using a variety of questions delivered either face to face or over the phone can be useful, as can talking to people and asking open questions which allow them to express what they think and feel without being pigeonholed by a questionnaire.

Of note, most digital systems either enable or supply audit data for the home care manager without them having to physically do anything. For example, Nurse Buddy provides reports, which act as audits of metrics such as planned versus delivered hours and missed medications. These all provide audit data.

The collection of audit data needs to meet two quality criteria, it needs to be valid, that is it needs to collect data on what it sets out to do, and it needs to be reliable, that is consistent. Validity requires that the audit tool collects information in such a way that is seen to be measuring the issue of interest. For example, a valid medication administration tools will collect data on each of the “rights” of medication administration. So, an audit tool which does not check if medications are administered to the right person at the right time is unlikely to be a valid one.

Similarly, an audit tool needs to consistently collect the same answer when applied to the same scenario. This means an audit question tool applied by different people should collect the same answers if applied to the same place at the same time. This relies on not only the questions being the right ones, but also that the auditor:

• Is trained and knows what is expected of them.
• Understands the tool and the questions in it.
• Knows how to interpret what they see.
• Is honest in their appraisal.

Analysing data

When information is collected it then needs to be analysed to see what it has uncovered. Analysis relies on what data is collected. Quantitative data, that which can be counted, is easy to analyse as the auditor can count yes/no answers to questions. The frequency of these is compared with previous audits and any standard and an outcome derived.

For example, if you have a target of 90%, for mandatory training completion at any one time, this is easy to count and compare to a standard and any previous audits to show progression, or indeed regression.

Qualitative audit data, for example what people said about their satisfaction with care is harder to analyse. The best approach is to gather responses into groups according to the themes or categories of response and reporting these. It is also useful to add verbatim comments to any such report.

Summary

This blog has highlighted some issues which need to be considered in the practice of auditing. We have seen that audits need to be planned with managers needing both a plan for what needs to be audited and a schedule for audit so that they are done with appropriate regularity.

We have identified how audit data need to be collected carefully so that it is both valid and reliable and that data can be both in written or spoken form depending on what is needed from the audit. In a letter blog we will look at how audit, and other data, might be used to generated action plans to underpin continuous quality improvements.

Bettal Quality Consultancy has a comprehensive and regularly updated suite of policies, procedures and risk assessments tailored to all forms of social care provision, to support busy registered managers and their teams in the provision of CQC compliant care. We also have audit tools deigned to meet the demands of the single assessment framework and enable providers to prepare for their CQC inspection.

If you are still not sure whether your service would benefit from adopting our quality management systems and would like to know more, browse our website or contact our friendly team.

Email: info@bettal.co.uk
Telephone: 01697741411

Peter Ellis MA MSc BSc(Hons) RN
Consultant
Bettal Quality Consultancy