Audit is now recognised as a key tool for securing a high standard of professional performance.
The RPSGB Clinical Audit Unit was established in 1993 following receipt of a grant from the Department of Health, with a remit to develop audit throughout pharmacy. Audit in pharmacy is now developed by the Society's Practice and Quality Improvement directorate.
In 1998, a Scottish section was added, following the award of a grant from the Clinical Resource and Audit Group (CRAG). The main remit of the part-time Scottish Clinical Audit Fellow was to facilitate, through existing audit networks, pharmacist involvement in multiprofessional clinical audit in primary care in Scotland. Although the project is now completed, a major product of this project has been a Pharmacy Audit Support Pack, which is available throughout Scotland.
The Clinical Audit Unit produced a CD-ROM called Audit to Excellence, which contains tools that will help pharmacists measure the quality of their pharmaceutical service and to make improvements when necessary. It contains most of the resources on this website and extra resources that are not available elsewhere.
Guidance to help pharmacists implement the clinical audit requirements of the new contract for NHS pharmaceutical services in England and Wales was published in The Pharmaceutical Journal in August 2005. For the guidance paper, click here
We have a lot of experience with designing audits for either uniprofessional or multiprofessional clinical audits. If there is an audit topic that we have not currently covered, we will be happy to work with you to design a new audit. In addition, we can adapt our current audits to meet your needs.
The Society has been working with pharmacists and others on clinical audit for a number of years. We have developed considerable expertise in measuring practice and making change happen. We are happy to share that expertise with other pharmacists and those working with pharmacists.
Contact details:
Tel: 020 7572 2208The following audit templates have been written or collected by the Society. Most can be adapted to local circumstances.
You may download copies of any of these audits. If you wish to alter these templates in any way we can send them to you as Word files but we would need to have sight of any alterations that are made before the audit is carried out.
The audits are also available on a CD-ROM, Audit to Excellence, price £10.
Contact details:
Tel: 020 7572 2208
Fax: 020 7572 2501
e-mail: audit@rpsgb.org
Accident prevention - driving Raising patients' awareness that centrally acting medicines can cause impairment of driving (part of the Ready to go series).
Accident prevention - storage of medicines Raising customers' awareness of the dangers of medicines in the home and how to store medicines safely (part of the Ready to go series).
Accuracy and completeness of patient medication records (PMRs) The accuracy of information held on patient medication records within the pharmacy, and the degree of completeness of those records.
Advice on asthma device technique Simple audit that can be used to assess patient's asthma device technique. Patients with a poor technique are identified for further counselling.
Advising diabetic patients in the community Ensuring patients have received comprehensive advice from healthcare professionals. This audit identifies areas where diabetic patients have information gaps.
Antidepressant use This is a collection of three audits. The first audit focuses on whether therapeutic doses of antidepressants are prescribed. The second audit looks at whether patients newly prescribed antidepressants are given counselling to aid compliance. The third audit assesses the monitoring of established patients on antidepressants for side effects and compliance problems.
As directed audit Prescriptions without adequate directions, and thus products labelled "as directed," can lead to potentially dangerous situations. This audit measures what community pharmacists do to minimise these risks.
Aspirin audit - People taking nitrates Audit of the use of aspirin for secondary prevention of cardiovascular disease. It identifies patients in need of aspirin therapy and increases the numbers without contraindications who are taking aspirin at the correct dose (part of the Ready to go series).
Asthma audits This is a collection of audits of asthma care. It covers assessment of inhaler technique, compliance with British Thoracic Society guidelines, etc.
Auditing the treatment of patients with a specific disease state, such as asthma, depression or hypertension Gives guidance on how to audit the treatment of patients with a specific disease state. Includes data collection, sample sizes, data analysis, making the change and when to re-audit.
Availability of leaflets Ensuring that appropriate health information leaflets are available in the pharmacy.
Communication between primary and secondary care How well is discharge information about a patient's medication transferred to the community pharmacist.
Confidentiality Patient confidentiality is at an increasing risk with larger patient care teams and everyone, including pharmacy, is affected. This audit looks at the level of confidentiality that is practised within the pharmacy setting.
Continuity of medicines supply to patients with mental health problems To develop multidisciplinary systems to support the identification and appropriate referral of patients with mental health problems who require additional support with their medicines.
Dispensing process audit Reducing the risk of dispensing errors by analysing errors picked up during the dispensing process (part of the Ready to go series).
Drug wastage audit Identifies the main causes of medicines being returned to pharmacies for destruction (eg, poor compliance, prescribing of excessive quantities, inequivalence on prescriptions) and quantifies the amount and value of returned medicines.
Facilities A simple checklist of facilities in the community pharmacy. Identifies where facilities are inadequate and helps to prioritise the action required.
Generic prescribing and rationalisation of tablet strength To effect cost savings through promotion of generic prescribing and rationalisation of tablet strength.
Health promotion - accident prevention Includes audits on medicines and driving falls in the elderly and safety in the pharmacy.
Health promotion - diabetes leaflets Evaluating the appropriateness of health promotion leaflets for diabetes.
Health promotion - leaflets Evaluating the appropriateness of health promotion leaflets.
Health promotion - oral health Covers advice about oral infections and diseases, sales of dental products, and sweets sold in the pharmacy.
Health promotion - preconceptual care and pregnancy Promoting the appropriate use of folic acid.
Health promotion - smoking cessation The pharmacist's role in smoking cessation.
Health promotion - smoking cessation campaign Evaluation of a smoking cessation campaign (part of the Ready to go series).
Health promotion - travel health Sun awareness campaigns and other travel health issues.
Interventions on prescriptions Monitoring interventions made by the pharmacist on any prescriptions. The aim is to identify the different types of interventions, the numbers of interventions, the time spent on interventions and most importantly assess the outcome of making the intervention.
Monitored dosage systems This audit should be carried out by those already providing monitored dosage systems (MDS) or those thinking of providing this service in the future. It is an audit of the systems and processes that need to be established to ensure that the process of assembling and supplying medication in a MDS is as robust and safe as possible.
Medicines use review standards An audit of the systems and processes that need to be established to ensure that the process of providing an MUR service is in line with legal, contractual and ethical obligations and good practice guidance.
Non-prescription medicines: referrals between pharmacist and GP An audit of cross-referrals between pharmacists and GPs.
Owings The level of prescription items owed, and the reasons for out-of-stock situations.
Patient counselling Advice given by pharmacists to patients about how to use their medicines.
Patient compliance in mental health A simple audit for checking that patients discharged to the community from psychiatric care are monitored to ensure that they are regularly collecting their medicines.
Patients' knowledge of emergency contraception How well are patients being informed about emergency contraception.
Patients' knowledge of the correct use of the oral contraceptive pill How well are patients being informed about the correct use of the oral contraceptive pill
Prescription waiting times Minimising the time patients have to wait to receive their prescription.
Repeat prescribing A series of audits of the repeat prescriptions system with topics from timeliness to inequivalence to drugs liable to dependence or abuse.
Requests for non-prescription medicines Measures the safety of Pharmacy Only sales for a certain drug or group of drugs.
Responding to symptoms Suitability of questioning of a customer asking for advice for treating a symptom.
Statins, aspirin and lifestyle modification in the prevention of coronary heart disease (CHD) To evaluate patient knowledge of statin therapy and the extent of concurrent aspirin prescribing and lifestyle advice provision.
Sublingual glyceryl trinitrate and aspirin usage in angina patients To ensure patients can correctly describe when and how to administer sublingual GTN and are appropriately referred for medical advice
Supervised methadone: An audit of multidisciplinary communication To ensure effective communication and teamworking between pharmacists and other health care workers caring for patients receiving supervised methadone.
The sale and supply of sugar-free medicines To encourage the supply of sugar-free liquid medicines and promote good oral health.
Model standards for self audit in community pharmacy in England Many people find standard setting the hardest part of audit. This series of booklets, developed by Keele University and funded by the Department of Health, sets out standards that pharmacists can use to measure the quality of their work. They contain a simple scoring system that community pharmacists can use to identify areas of practice that they could improve.
The series breaks pharmacy practice down into nine areas:
The audits in the Ready to go series contain everything you need to conduct an audit of a major area of practice. They all contain:
A resource pack accompanies the series and takes you through how to complete an audit successfully.
The Ready to go series provides work books to support the audit of evidence based practice topics and outline health promotion campaigns. The resource pack is also designed to provide a reference source to all topics and campaigns covered in the series.
Excel 97 spreadsheets to support analysis are available for the Ready to Go series on the Audit to Excellence CD-ROM.
Aspirin audit - people taking nitrates
Audit
of the use of aspirin for secondary prevention of cardiovascular
disease. It identifies patients in need of aspirin therapy and
increases the numbers without contraindications who are taking
aspirin at the correct dose.
Aspirin audit - OTC sales
Audit of whether customers purchasing low dose aspirin have been advised to do so by a doctor, have informed their doctor they are taking it, have a condition that warrants taking aspirin, have a contraindication to it and realise the long term benefits.
Accident prevention - driving
Raising
patients' awareness that centrally acting medicines can cause impairment
of driving.
Accident prevention - storage of medicines
Raising
customers' awareness of the dangers of medicines in the home and
how to store medicines safely.
Health promotion - smoking cessation campaign
Evaluation
of a smoking cessation campaign.
Dispensing process audit
Reducing the risk
of dispensing errors by analysing errors picked up during the dispensing
process.
The Centre for Pharmacy Postgraduate Education is the major provider of continuing education material for community pharmacists. The CPPE provides both distance learning material and workshops through a network of local tutors. We have long believed that there should be a close link between continuing education and audit. This was cemented when we produced an audit for inclusion in one of the evidence based practice series of workshops. This was highly successful and we plan to include further audits in future workshops.
There are several large pharmacy chains such as Boots, Lloyds, Moss, etc, that own a substantial number of pharmacies. Most of the large chains have incorporated audit into their organisation. They have done so in different ways, eg, Safeway give managers protected time for audit and have formed peer review groups; Moss made audit one of the criteria for managers' annual bonus; others conduct company wide audits.
We conducted a national audit in pharmacy in 1997 and invited all community pharmacies in Great Britain to take part. Over 2,500 community pharmacies took part and submitted their results to the RPSGB. We analysed the results and gave each participant detailed feedback about their performance compared to the national picture.
We have also been partners with other Royal Colleges and professional bodies in two of the National Sentinel Audits funded by the Department of Health. We are looking at further ways of developing national audits.
The Practice and Quality Improvement Directorate is developing new audits all the time. We are working with primary care audit groups and other professional bodies on audit projects. We are currently developing a number of multidisciplinary audit templates.
This is a book written for pharmacists working in primary care. It uses the example of antibiotic prescribing to take you through the principles of change management. Change does not happen by itself, it needs to planned and made to happen. This book will help you make successful and lasting changes to your practice.
Price - only £10 each.
To order the CD-ROM, click here for an order form. Print and complete the form and return it to the Society.
Contact details:
Tel: 020 7572 2208Bandolier Monthly journal on evidence based healthcare produced by the NHS R&D Directorate. Access is free and you can download full text of articles.
Cochrane Centre The Cochrane Library site contains abstracts of Cochrane Reviews. These are organised by review groups. The site also contains links to training materials to support the use of Cochrane reviews.
Effective Health Care Bulletins A bi-monthly bulletin about the effectiveness of a variety of healthcare interventions. It is possible to download full text copies of the bulletins.
Health Technology Assessment The NHS R&D Health Technology Assessment Co-ordinating Centre site. The use of the term "health technology" can be misleading. The assessments cover all interventions and can include the use of devices, equipment, drugs, procedures and care. This is a very full site and contains many reports that can be downloaded.
Medline A free medline site for health professionals. Requires free registration.
NICE Contains details of the activities of the National Institute for Clinical Excellence. It hosts a database of audits conducted throughout England, audit templates and other related publications. The site contains some of the best clinical audit and Department of Health links. Access to the database is through free membership only.
NHS Centre for Reviews and Dissemination The NHS CRD identifies and reviews the results of good quality health research. It also aims to disseminate the findings to key decision makers in the NHS and consumers. The site contains searchable databases (Database of Abstracts of Reviews of Effectiveness (DARE); NHS Economic Evaluation Database; Health Technology Assessment Database).