Clinical Audits and Handwashing free essay sample

Clinical Audit is a tool used to examine the practices of health care professionals implemented in a health care environment. Clinical audit can be defined as a clinically led initiative which seeks to improve the quality and outcome of patient care through clinicians examining and modifying their practices according to the standards of what can be achieved, based on the best available evidence’ (Morrell Harvey 1999). Audit has many benefits: increasing the quality of patient care directly, professional development, promoting teamwork, and demonstrating quality to purchasers and consumers (Gannon, 2004). In this assignment, using standard audit criteria the author will undertake a clinical audit in a general nursing area. Clinical Governance was introduced by the British government in 1998 Meal et al, 2004). Taylor and Jones (2006) recognise clinical governance as the framework that ensures that NHS organisations 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 develop. The introduction of Clinical Governance (National Assembly Wales, (2000) cited by Donaldson and Mullally, 2004) has placed increased emphasis on the use of audit to measure the implementation of policies and procedures relating to infection control. Clinical governance is about changing the way people work; demonstrating that leadership, teamwork and communication is as important to high quality care as risk management and clinical effectiveness (Tait, 2004). Tait (2004) also states that clinical governance requires changes at three levels: individual health care professionals need to embrace change, primary care teams need to become multidisciplinary with clear understanding, primary care organisations need to put in place systems and local arrangements to support such teams. Before carrying out an audit, the reasons for and benefits of carrying it out should be identified. Audits are carried out to ensure that practices are safely provided and evidence-based using current research. In order to undertake an audit, staff must be informed of the process of audit. Providing staff with sufficient information about an audit, including details about what it involves and how areas of poor practice will be dealt with, may help to increase practitioners’ willingness to participate in the project (Ashmore, 2005). Staff willing to carry out an audit must be educated on the process of audit, thus they should have an understanding of the stages of clinical audit. The author will proceed to discuss the stages of audit with reference to a clinical audit that was carried out while on clinical placement in the general setting. There are five stages of clinical audit. The first stage is to choose a topic for audit. In order to select a relevant topic the auditor must consider a few questions such as: is there evidence of a serious quality problem, for example patient complaints? Is the topic a priority for the organisation? Is the problem concerned amenable to change? Is it a situation that can be improved with a responsible amount of time and effort? (NICE, 2002). The topic selected for audit must be related to patient well-being. For the purpose of this assignment the topic of effective hand washing was chosen for audit. Prior to undertaking the audit, permission from patients, medical staff, nursing staff, healthcare assistants and house-keeping staff was obtained verbally. In the case of any medical procedure including clinical audit, informed consent must always be acquired (Van Dokkum, 2005). The second stage of the audit process is agreeing or reviewing standards. By working against either local or national standards, audit can prove effective in revealing practice that is either compliant or non-compliant. Before carrying out the audit, the author researched some relevant literature that contributed to the standard that was set for the audit. The World Health Organisation recommends hand-washing at five different points in contact with a patient: before patient contact, before aseptic task, after bodily fluid exposure, after patient contact and after patient surroundings contact (WHO, 2006). A study by Golan et al (2006), illustrates that hand hygiene compliance among nurses is lower than expectations. The standard set by the National Institute of Clinical Excellence (NICE) (2003), is that hands must be decontaminated immediately before each and every episode of direct patient contact or care and after any activity or contact that could potentially result in hands becoming contaminated, and also that hands must be decontaminated, preferably with an alcohol-based hand rub unless hands are visibly soiled, between caring for different patients, or between different care activities for the same patient. According to Girou et al (2002), an alcohol-based solution is significantly more efficient in reducing hand contamination than antiseptic soap. These standards where used by the student to devised an audit eligible to measure them efficiently. In stage three of the audit, the assigned examiner in accordance with the audit tool must collect data from current practice. This data has to be as understandable as possible to achieve the correct results. The most effective way to audit is to develop a questionnaire that can assess a situation effectively. When developing an audit tool, it is important to keep it simple. Complex questions will over-complete the audit procedure and lead to inaccurate findings. The audit tool that the author developed was a questionnaire that contained questions with an answer that was either yes/no or non-applicable. The questions chosen for the audit tool where: 1. Do nursing staff use the correct procedure for decontaminating hands? 2. Do nursing staff thoroughly dry hands after decontamination? 3. Is hand hygiene performed prior to patient contact? 4. Is hand hygiene performed following patient contact? With the audit tool completed, the student set about observing practice. The student selected a time when the ward was really busy, so as to catch people off guard. The student observed ten instances of hand washing on the ward, nine of these instances where either preceded or followed with patient contact. All participants observed were nursing staff, and each individual was fully informed that the audit was going to take place. They were not, however, told when the audit was going to take place, in order to prevent simulation. With reference to the first question, 80% of the participants used the correct procedure to decontaminate their hands. With regards the second question, 100% of participants thoroughly dried their hands after decontamination. With regards to the third question, 40% of participants performed hand hygiene prior to patient contact however 100% of participants performed hand hygiene following patient contact. After all data is collected the next stage in the audit cycle can be followed. The fourth stage is where data and findings are compared with the set standards. This is where one can find out whether results meet the set standards or not. The results of this audit did not fully meet the initial standards as only 80% of the participants used the correct procedure to decontaminate their hands successfully. The NICE guidelines (2003) stated that hands must always be contaminated before and after patient activity and in this case 60% failed to follow hand hygiene procedures before patient contact whereas all participants successfully followed hand hygiene procedures after patient contact. Overall only 80% used the correct hand hygiene procedure when decontaminating hands. In the authors’ opinion, the percentage of participants that did not adhere to hand hygiene procedures prior to patient contact is extremely low and shows definite room for improvement. The Nursing and Midwifery Council (2002) state that staff must take care to avoid any act or omission that could reasonably be foreseen as likely to cause injury or harm to themselves or another, therefore, they must follow guidelines designed to reduce the risk of infection to both themselves and their patients. However the author feels that the overall percentage of participants that demonstrated the correct procedure for hand hygiene was satisfactory in this instance. Once results are analyzed and compared with standards the fifth stage of the audit process can be commenced. Stage five is where suggestions for improvement are explored and discussed. These changes are then implemented to bring about change in a certain situation that has been audited. Changes should be implemented with recent relevant evidence-based information. Changing health care practice is commonly attempted by feedback of performance data measured by clinical audit (Reilly et al, 2002). Once these changes are implemented they must be monitored to prove that they are effective, efficient and applied appropriately in practice. For the purposes of this assignment, a few possible changes that could raise compliance with hand hygiene where discussed but not in fact executed. Cooper and Hewison (2002) believe that the use of audit in clinical health settings can bring about improvements in quality of care which is what every health care professional strives to achieve. The author purposes that training sessions for correct hand hygiene procedures are routinely scheduled and carried out by a trained infection control nurse for this ward with attendance records of staff that receive the training. From the records one can see how often the staffs’ knowledge of accurate hand hygiene is updated. An advantage of hand hygiene training routinely available on wards is that all staff will have evidence-based information on hand hygiene which will lead to more effective patient care. The author considers that routine training on the ward will increase staff awareness of hand hygiene and will also educate healthcare professionals to the correct timing and technique of hand hygiene. If this were to be implemented a follow up audit would have to be carried out to evaluate the effectiveness of the training. While the audit process proves effective in measuring practice against procedures there can be drawbacks to clinical audit. If the audit tool is too complicated results can be misconstrued which leads to false outcomes (Rostami et al, 2009). This can then mislead the reader into thinking that practice is either effective or non-effective with the set standards. If results from a particular audit are incorrectly obtained or recorded, preventative measures implemented due to them may be time consuming, expensive and can also cause a reduction in the quality of care patients receive as opposed to increasing the quality of care. When partaking in this audit the author found no huge restrictions during the collection or analysis of data however, the author felt that some of the participants where aware that the author was observing them thus influencing them to perform correct hand hygiene procedures. The author felt that there were no additive measures that could have been implemented to prevent this from occurring in this case. In conclusion, this assignment has discussed what is meant by clinical audit and what the functions of performing an audit are. Audits are carried out to measure the effectiveness of certain clinical procedures and to measure how well healthcare professionals adhere to policies and standards set specifically for any given area. The author also discussed using relevant literature the term of clinical governance. It basically means an approach to maintaining and improving the quality of patient care by observation of current practice within a health care environment that was brought about by the British government. In this assignment the author also discussed a clinical audit take was put into effect while on placement in a general setting. The author also discussed the five stages of audit while also referring to the audit that was carried out. Findings of the audit were reviewed and compared with standards and possible solutions for change were talked about. From the audit, the author can see that more emphasis should be placed on hand hygiene prior to and after patient contact. The author also believes that in order to carry out an audit the individual must be educated in the process of audit and willing to make the necessary changes for improving practice for patient care. The author would advise all health care professionals to update their knowledge of clinical audit by attending workshops and seminars on the topic of audit (Kinn et al, 1994).