Clinical audit non-conformances

[RR1]

When transfusion related clinical audits (e.g wristband audits) are performed in your hospital, are the outcomes just benchmarked against other hospitals, or are non-compliances fed into the blood bank QI system for corrective actions?

[jayjay]

I would think non compliances in clinical audit should be fed into the Trusts risk register. Think it may be confusing to feed into lab QI unless there is something specific to labs

Joan

[RR1]

Hi Joan,

Surely these should be fed into the lab system first and then escalated upto Trust level and the risk register- just so they can be tracked properly?- Otherwise these have a tendency (from what I have seen) to be overlooked andnot handled correctly.

I have been told that the lab team and clinical team need to integrate the deviation system- and it makes sense, as what occurs in one area affects the performance of the other.

[bmsjbatt]

Rashmi, the Clinical audit findings need to be published by your clinical audit team. this may be done internally, the findings should be discussed by a clinical audit and effectiveness team (probably divisional). It is decided at this level if it needs to go onto trust risk register, or just be handled locally, and don't forget with clinical audit that every time another change is made it needs re-auditing, sorry if I'm teaching egg sucking but I am finding a lot of confusion in many trusts about the difference between Quality Audit and Clinical Audit. They are two very different beasts and need to be managed differently.

Your trust should have a clinical audit department and you should follow their advice.

[RR1]

Hi Jo, our clinical audit team do publish findings, and these get discussed at various meetings upto Trust level and risk register if required.. ...but then this is all that happens. How many years have we all been discussing/ auditing if patients are wearing wristbands, and have the figures actually improved significantly?.....not in my place. All that happens is the practice is re-audited a year later with no solid corrective actions taken....just a pointless, benchmarking task.

It just seems that people want to perform clinical/ quality audits just fo get a 'tick' in the box. I agree that the clinical audit team should handle these, but the deviation system needs to track the actions - just to ensure these haven't been forgotton, or lost in a black hole somewhere.

Surely the findings of any audit that shows significant problems, can be escalated to Trust level and considered to be placed on the risk register?

[bmsjbatt]

The discussion by the clinical audit teams should include the implementation plans for the corrective actions identified,

However Clinical audits should NOT be used to identify corrective actions, they should be examining an existing change and checking the effectiveness of that change, and that it is being implemented against agreed criteria.

Obviously if that change isn't being properly adopted then that is a change control issue, and then should make it's way to the risk register.

here is the NICE definition of clinical audit which shows that the onus can be put on small individual teams to improve as well as a trust wide responsibility.

[

"a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery."

/QUOTE]

[RR1]

Hi Jo, I do sort of understand what you are saying, but I have seen this process you described being ineffective in achieving the desired outcomes.

I just feel that an audit is an audit, regardless of being lab or clinical based. The whole purpose of any audit is to ensure compliance with requirements and meet acceptable standards . If the audit shows poor compliance, then an improvement plan needs to be instigated (if in clinical areas- then yes, higher 'tiers' in the hospital need to be involved).

The NICE definition of audit also mentions teams, which could refer to the HTT, working together in an integrated way rather than the dis-integrated way things have always previously been done. Clinical side and lab should work together to improve patient care. Each affects the other.

I am trying to place these audit problems into my QI system (they can still be dealt with by the audit dept, etc), so I can monitor them with my TP colleague, and try to achieve better collaboration and understanding.

Does this make sense?

[Eoin]

Hi Rashmi,

Clinical Audits are fed through Best Practice Department, but the forum is the Hospital Transfusion Committee, and it is up to the director (Consultant Haematologist) to follow-up any matters which need attention directly with his medical colleagues.

[RR1]

Hi Eoin,

Maybe I should just stop interfering !!!!.....but when I see little progress using the correct channels for these sorts of things, I just become very frustrated (especially if poor practices are impacting on my lab), and want to resort to Plan B- except nobody usually has a Plan B !.

It amazes me that a lot of audits are purely used as benchmarking figures, and not to improve current local practices to the next level.

[Tonyd]

Hi Eoin,

Maybe I should just stop interfering !!!!.....but when I see little progress using the correct channels for these sorts of things, I just become very frustrated (especially if poor practices are impacting on my lab), and want to resort to Plan B- except nobody usually has a Plan B !.

It amazes me that a lot of audits are purely used as benchmarking figures, and not to improve current local practices to the next level.

Hi Rashmi

That's why your TP especially has to be fully engaged with the Trust Clinical Governance Committee and Risk Management.

No reason why your department can't have an effective input into the process, but for the laboratory to take ownership of clinical issues can be counterproductive.

Best wishes

Tony

[RR1]

Thanks Tony, our weak point might be the Risk Management aspects. I also think quite a few people don't know how to write up Risk Assessments properly, I am still learning to do this too.

I don't really want any ownership of the clinical issues...just want to know that actions have been taken appropriately to address these. I find if I don't interfere then these just get buried and forgotton in the ever increasing HTT workload.

[Tonyd]

I find if I don't interfere then these just get buried and forgotton in the ever increasing HTT workload.

I know exactly what you mean

One Trust I go to has all their outstanding items in a tabular format, referenced with responsibilities, dates etc, which is widely circulated and brought up at every meeting - seems to concentrate minds on clearing them off - works well for them