Local guidance should be sought regarding the level of ethical approval required. The aim of your audit will generally dictate whether approval is required; studies undertaken purely for quality improvement will not normally require approval, studies undertaken for research purposes will usually require ethics approval.
Ethical practice and standards should be maintained in all instances.
It is important that the end-of-life care audit and clinician surveys are supported and endorsed by the organisation executive, managers, and clinical leaders.
This leadership will help to ensure that the results are used to drive improvement.
Set up and management
There are a number of decisions to be made in setting up the audit:
– resources, including computing resources and staff time to enable data entry and analysis
– scheduling, which should establish a regular process for audits; this can involve a regular audit (for example, monthly, quarterly or annually), or continuous entry of data which is then analysed regularly
– processes, for accurate data entry (using the data dictionary and patient identifier table) and analysis
– feedback, which should establish the process by which audit results can be fed back into organisation decision making and quality improvement processes.
Communicating with staff, including the executive and staff at all levels, is essential to ensure they understand and support the aims of the audit and the improvement that may need to be made. You may wish to consider the use of flyers, emails, posters and presentations to support staff engagement.
Given the nature of the clinical records being audited, it is important that the staff participating in the data entry process have access to suitable support structures. These structures should allow access to emotional support and also enable auditors to raise any concerns they may have regarding the care provided.