Flashcards in Law And Ethics Audit, Public Health And Behavior change Deck (70)
What is audit all about?
It's about evaluating to ensure quality improvement
It's the quality improvement process that seeks to improve patient care and outcomes through systematic review of care against certain criteria, and then the implementation of change
Why should we audit?
It improves quality of care
It maximises resources
It's an educational tool
It encourages team work (to pass an audit)
Provides evidence to justify change
What is the audit cycle?
1)Identify a problem or issue
2) agree a criteria and set standard of what it SHOULD be
3) collect data
4) analyse data- compare it against your standards
5) implement changes that need to be made to meet the standards
6) then identify next problem
How do we select a topic for audit?
Usually a topic of interest or area of concern that's based on recommendations from a national body such as the NPSA or NICE
How many audits should a community pharmacy be doing each year?
A minimum of 2 a year
1 should be practice based
1 should be determined (the topic) by the Primary Care Trust
How many audits should hospital pharmacies do a year?
Should be doing multiple
Some of these may be mult-disciplinary (involve doctors, nurses too)
What is the definition of criteria?
Systematically developed statements that can be used to assess how appropriate specific healthcare decisions, services and outcomes are.
Criteria can be classified in three ways. What are these?
1) structure; I.e what you need so maybe number of staff, or amount of equipment, or physical space in your pharmacy
2) process; what you do; for example level of communication, dispensing audit, documentation audit
3) outcome: this is a physical and behavioural response to interventions made, people's health status as an outcome of an audit, staffs levels of knowledge after audit etc
For audit criteria to be valid, what must it be?
-Based on evidence
-Related to aspects of care
For example, an audit may be on local policies, eg evaluating your antibiotic policy in a hospital pharmacy
What are audit standards then?
The proportion of times that criteria set out should be filled.
Standards are usually expressed as a percentage, "60% of the Time blah blah should be blah blah"
Eg criteria may be:
Hospital in-patients with known allergies should wear a red wristband indicating the nature of their allergy.
Standard: 100% of hospital in patients should wear red wristbands indicating their allergy
So this criteria should be being met 100% of the time; do an audit to find out if it is!!
Criteria: The IV to oral switch should happen within 3 days
Standard: 95% of the time the IV to oral switch should be happening in 3 days
When do you have to select a study sample?
Unless you can Investigate ALL cases, you need to select a sample.
May not be able to look at all cases due to money, resources etc
What is sample size determined by?
1) the degree of confidence you want in your findings
2) resource constraints such as time, access to data, costs etc. eg. You may not have time to asses every bed in the hospital!
What is a random sample?
Pure chance determines the subjects/ cases which are chosen from a population
What is a stratified sample?
Subjects/ cases are chosen RANDOMLY but sampled from a population that has been divided up into categories.
What is an interval sample?
When data is collected over a refined period of time
Eg interval sample: 1 week duration
Eg when you can't specify a number to sample. Could reviewing of owing slips over a 1 week period (you don't know how many there will be!)
What is a purposive sample?
Selecting cases with specific characteristics relevant to the study
What is a retrospective approach to data collection?
When your event of interest has already occurred and you want to find associated factors with it, you have to trace these back in time-- a retrospective approach -retro= going back
What is a prospective approach to data collection?
If you have some baseline information available from records and you want to study the occurrence of a new event in future, you have to follow these patients in future for the occurrence of an event of your interest-- A prospective approach. Pro= looking into the future
What is a pilot study?
a small-scale experiment or set of observations undertaken to decide how and whether to launch a full-scale project.
It should be conducted BEFORE data collection begins
Aim is to identify and rectify any problems with the data collection form and methodology. Like a mini study to test it out.
How do we a analyse data?
Calculate a basic percentage to determine whether practice meets expected standards.
Eg before we said the standard stated 100% of inpatients should wear red wristbands for allergies.
Data analysis may come up with the result that 89% of patients wear red wristbands after observation.
The audit data is then analysed to identify any particular problems or trends, eg. 15 of these patients with no writsbands had a allergy to penicillin that caused sickness
After change has been implemented, what can then be done to determine whether these changes made have lead to an improvement?
Audit data is recollected using the same procedure and then analysed again.
How do we analyse re-audit data?
Comparing re-audit data against the original data collected first time round before the changes
What is public health?
Public health relates to the health of the population rather than the individual
It involves tracking illness frequency in a population to prevent illness and promote good health
Can you think of any factors that influence health?
Personal behaviors and lifestyle I.e psycho-social influences
Genetic factors/ biological influences (your build and make-up)
Environmental factors: eg housing, pollution, work conditions
These all radiate into you to determine how healthy you are!!
Extent of health services: inverse care law
What is the inverse care law?
The availability of good medical care tends to vary inversely with the need for it in the population served. I.e healthcare is least available to the people who need it most (rich people who don't tend to have many ailments can pay for private care, poor people have to wait for NHS services)
What was health promotion like on the 1920s to 1980s?
Mass media campaigns focused on scare tactics eg aids "don't die of ignorance" leaflets
Poor health was linked with poverty
Health promotion usually only involves medical practitioners
What's health promotion more like nowadays?
Moving away from methods that only seemed to put responsibility for bad health on the individual: i.e. due to their unhealthy lifestyle
Health promotions doesn't just involve medical practitioners (doctors): It now involves pharmacists, special clinics, etc
What does the new broader conception " New public health" focus on?
Focuses on the well being of populations not just disease prevention
Ie their lifestyle in general, providing good healthcare to people