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Audit steps

The ten steps to a successful audit:

Step 1: Select what to audit

Define the overall purpose of the audit

What should happen as a result of the audit or what question do you want the audit to answer?

Select a topic or issue to be audited

This stage involves the selection of a topic or issue to be audited, which might have resulted from a significant event or some other activity within your practice that you feel could be improved.  Significant Event Analysis (SEA) can be a useful initiator for identification of worthy audits.  Find out more about SEA by clicking on the "SEA Steps" of this site.

You could also select an audit topic where:

  • Clear national standards and guidelines exist e.g. SDCEP guidance problems have been encountered in practice;
  • There is a clear potential for improving patient care;
  • There are areas of high volume, high risk or high cost, where improvements can be made for the benefit of the practice.

To see examples of common topics for audit, click here.

If you wish, you can use the audit planning tool and follow the steps contained within it to guide you.

Step 2: Define the criteria and standard

Criteria are factors which can be measured. For example, "the radiographic distance from the end of the root filling to the apex is less than 0.5mm."

Standards are the threshold of the expected compliance for each criterion or the number of times the criteria are achieved (usually expressed as a percentage).  For example, an appropriate standard for the above criterion might be "85% of root fillings should end within 0.5 mm of the apex."

http://www.scottishdental.org is an excellent site with links to a large number of standards documents e.g. SDCEP and SIGN guidance.

Step 3: Define data to be collected

Do not be tempted to collect too much data.  Be sure that the data collected is fit for your purpose.

Define inclusion and exclusion criteria, i.e. exactly what information you do and do not want to collect.

Decide whether you will collect the data retrospectively (that is from data already held, e.g. existing patients records) or prospectively (from data still to be collected), or a mixture of the two.

Decide how much data will be collected i.e. the sample size.

Define the start and finish dates.

Design the data collection tool - this may take the form of a questionnaire, data collection sheet or checklist.

Ethical issues must be considered. Data collected must relate only to the objectives of the audit, and staff and patient confidentiality must be respected. Person identifiable information must not be collected.

Minimise or eliminate bias which may arise from the sampling method.  For example, if you only issue questionnaires to patients who attend before 3pm, you might not include any school children in your sample.  Similarly, if you include only staff who work in the practice on Mondays, your sample might not be truly representative of the whole practice team.

Step 4: Submit your audit for approval

Dentists wishing to submit an audit for approval should first ensure they have registered with the NES Portal as it is only through Portal that projects can be submitted. If you have not already registered with Portal, go to www.portal.scot.nhs.uk to access the home page and follow the instructions for creating a new account.

Once registered, the audit section can be located with the iBooklet section and from here you can use the New Application tool, to complete the equivalent of the old GP216A (rev 4/11) in order to apply for approval of your project.
 
The following points should be noted in relation to project submission:.

  1. All audit projects must be approved before commencement.
  2. Approval can be gained in 2 ways:
    a) An application is submitted via Portal and is sent electronically to a NES audit administrator, who will in turn allocate it to a NES audit reviewer for consideration;
    b) If the audit you are undertaking is a pre-approved national project, once you ‘join' such a project AND you submit it, you will receive an automatic reply, advising that you have approval to proceed with the project and advising you of the date by which it must be completed.
  3. If more than one dentist is taking part in the audit, and if this is permitted, then you can add additional participants to the project, after your initial completion of the GP216A equivalent, by using the Project Participants tab. Only dentists with Portal accounts can be added.  Once you have searched and added them, you can amend the hours requested for each participant to reflect their involvement in the project.  You should do this before you submit the project for review and approval.
  4. Guidance regarding sample size, claimable hours etc should be followed.  Click here for guidance on sample size and audit hours.  Final reports should also take this guidance into account.  The hours approved initially are an estimate based on an anticipated standard of report and these may be altered if the submitted report varies from this expectation.

Note – After the initial automatic acknowledgement of receipt, projects will be reviewed and we aim to approve or seek amendments within 4 weeks of submission, though it will often be much sooner than this.

Step 5: Establish the baseline (collect initial data)

When you have received approval for your audit, using an appropriate data collection tool, collect baseline data about what is happening or has been happening in the area of focus of your audit.

Step 6: Compare performance with criteria and standards

Compare this baseline performance with the standard you have set and decide how you will implement changes.

Step 7: Implement change

This step is likely to involve other team members.  With the team, discuss changes which you feel are necessary to improve performance to the standard defined in your project submission.  Ensure everyone is clear about their role, the timelines involved and the next stage of data collection.

Change should be achievable and sustainable and might initially require some additional resource, e.g. time / money or both.

Step 8: Carry out a second round of data collection

After an appropriate period of time following the introduction of the changes identified and implemented, carry out a second round of data collection.  Use this data to assess whether the standards defined in your project submission have been achieved.

It is hard to specify the minimum the time between rounds 1 and 2 as projects will vary, but this would normally be 3 to 4 months.  Please note that all projects must be completed within 6 months of when they are approved and that it is not possible for NES to extend this for any reason.

Step 9: Analyse the data

Compare the criteria and standards before and after the change(s) of practice (the intervention(s)).  Determine how well standards were met, if the intervention improved standards and, if applicable, identify any reasons why the standards were not met in all cases.

Step 10: Produce and submit your final audit report

This report should contain the information required to demonstrate to the reviewers that all steps of the audit process have been undertaken.  It must be received within six months of when the project was approved.  Any reports received after this cannot be processed and the approval will lapse and the project status will be updated to 'incomplete'. 

The report should follow the same principles as reports for other health or scientific purposes.  That is, it should contain sufficient information, data and reasoning to demonstrate that the writer has understood the principles of the audit process and has followed them to reach a valid conclusion.

The information and data should be presented in a clear, unambiguous manner with graphs, charts etc, used to illustrate key points.

The report need not be lengthy but it should present the facts in a logical sequence.

It is recommended that your report follows the headings suggested in the document below as this will help you present the information succinctly and in the correct order.  It should be clearly written and include the results, conclusion and discussion.  It may also include consideration of further areas for audit.

If the audit planning tool was used, then the information entered at that stage will be the basis for the subsections of the audit report.

Click here for a suggested list of headings and content of your report.

All reports and associated paperwork must be uploaded against the project in Portal using the Final Reports tab.  This only becomes available after the project is submitted and approved.  There is no need to upload any documents after round one of the data collection has been completed.  Please store all documents locally until they have been completed and are ready to be uploaded and submitted.

Once your final report is reviewed and your project is certified, you will receive an email advising you of this and giving you the link to download a GP217 (rev 04/11) to which you should attach your certification, which states the number of hours of audit activity undertaken and therefore the number of hours of CAA which GDPs can claim.  At present, this must be sent in hard copy to PSD, but we hope that electronic claiming will be possible in the future.

Follow up

After an agreed period, it may be useful to repeat the audit.  The same approach for identifying the sample, standards, methods and data analysis should be used to ensure comparability with the original audit.  This stage is critical to the successful outcome of an audit process, as it verifies whether the changes implemented have had an effect, whether the standards are being maintained and will highlight if further improvements can be made.