However, we observed a discrepancy between the analysis of factors accounting for therapeutic failure and the interventions planned. In fact, while the low compliance was recognized as the main cause of therapeutic failure, most of the interventions were focused on pharmacological therapy. Consequently, six months after the audit we found that, against a significant increase in the amount of drugs prescribed, the control of MBD parameters did not improve. Therefore, the results of the audit suggested that low compliance with treatments is a main but still neglected cause of failure in the achievement of MBD control in HD patients, while increase of drug administration, regardless the awareness to the compliance to the therapy, is insufficient to obtain an overall satisfactory rate of therapeutic success.
This finding is particularly important, since indicates that future therapeutic strategies, beyond the development of new drugs, should include the implementation of feasible educational programmes addressed to both health personnel and patients.
This kind of study shows the potentiality of a clinical audit that allows to effectively compare theoretical standards with daily clinical practice, providing suggestions to improve quality of care.
Audit methodology could be potentially extended to several other issues in the setting of clinical nephrology. For example, it could be useful to evaluate the causes of treatment failure in patients undergoing peritoneal dialysis, such as to implement protocols to reduce the rate of central venous catheter-related infections.
Moreover, clinical audit could be a feasible tool to solve organizational problems, such as the delays on the waiting list for kidney transplantation. Finally, a clinical audit could be used to face more general topics, which may involve also renal patients, such as management of dyslipidaemia for example, evaluating the appropriateness of statin prescription and implementation of lifestyle change.
Quality control, and consequently the right allocation of resources, is becoming a central issue in the management of Health Care Systems. Several tools are deployed to provide a monitoring of the levels of care and improve its quality. Among them, clinical audit is one of the most popular and widespread. In the specific field of clinical nephrology, this method has proven its effectiveness in facing different problems, such as hypertension and mineral metabolism control.
However, it still seems necessary to spread the understanding of clinical audit and promote its systematic application both nationally and locally, so that it can be part of the expertise of each health care provider, together with other quality improvement techniques. National Center for Biotechnology Information , U. Journal List World J Nephrol v. World J Nephrol. Published online Nov 6.
Pasquale Esposito and Antonio Dal Canton. Author information Article notes Copyright and License information Disclaimer. Author contributions: Esposito P and Dal Canton A contributed to this paper in: 1 conception and design, acquisition, analysis and interpretation of data; and 2 drafting the article and revising it critically for important intellectual content; all authors approved this version to be published. All rights reserved. This article has been cited by other articles in PMC.
Abstract Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and financing. Open in a separate window. Figure 1. Table 1 Factors to consider in the decision on a topic for a clinical audit. Step 2: Selection of indicators, criteria and standards and definition of intervention strategies Once the preliminary issues of the audit have been defined, the next step is to set the standards, which the current clinical practice will be compared to.
Step 3: Data collection In clinical audit data can be collected prospectively or retrospectively[ 15 ]. Step 4: Comparison of collected data with the standards and development of corrective actions This is the central phase of clinical audit. Table 2 Facilitating factors and barriers for effective clinical audit.
Facilitating factors Obstacles Clarity of design and data collection Not clear objectives and planning Good planning Lack of resources-heavy workload Organisation support Lack of clarity on the method Dedicated staff Lack of organizational support Collective analysis of the results Unwillingness to change. Step 5: Check and maintenance of improvements The audit cycle ends with the stage of verification and monitoring of implemented strategies[ 2 , 4 ].
Table 3 Checklist for the planning and validation of a clinical audit. The objectives are clearly specified. Design and planning The audit has been organized in different stages and times, assigning specific responsibilities. Necessary resources have been allocated. Tools for data collection have been designed, preliminarily defining data management methods.
The whole material has been proposed in advance to the participants. Data collection Those who participated in the preventive phase have been involved.
The established phases have been met. Data have been correctly collected. Data analysis Interventions The results have been discussed with the participants to the audit and other interested parties. A structured strategy to implement changes has been defined. Written reports of the results have been made and sent to all the participants. Checking the audit effectiveness A check of the effectiveness of the changes introduced has been planned. The verification has been formally documented.
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Am J Kidney Dis. Shah A, Davenport A. Alternatively, you can purchase access to this article for the next seven days. Buy now. The information in the article is based on a successful series of workshops on clinical audit she and her colleagues ran for nurses in the Greater Glasgow area Nursing Standard. Want to read more? Already subscribed?
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