Audits, love them or hate them, they form an essential requirement for any successful practice to improve the quality of work while improving profitability continually.
Having evidence of quality improvement and clinical effectiveness is essential for a practice to show the Care Quality Commission (CQC) that they are compliant with the Fundamental Standards and Key Lines of Enquiry.
A practice should be able to demonstrate that the service is:
The CQC expects providers of primary care dental services to conduct clinical and other relevant audits to:
- Demonstrate good governance (Regulation 17)
- Deliver care and treatment safely (Regulation 12), and
- Ensure premises and equipment are clean and suitably maintained (Regulation 15).
The CQC advise the audits below must be completed:
- Infection prevention and control: Establish and operate a quality assurance system that covers the use of effective measures of decontamination and infection control. Complying with HTM01-05 (Decontamination in primary care dental practices) shows there are valid quality assurance systems in place. As a minimum, practices should audit their decontamination processes every six months, with an appropriate review dependent on audit outcomes. The Infection Prevention Society audit tool could be used.
- X-rays: Current regulations for using ionising radiation for medical and dental purposes (both IRR17 and IR(ME)R2017) place a legal responsibility to establish and maintain quality assurance programmes for dental radiology. The consistent quality of radiographs must be assured through audit. There is an example audit under 'selection criteria for dental radiography 9.2.1' on the Faculty of General Dental Practice (FGDP) Standards in Dentistry online.
- Accessibility: All organisations providing services to the public must audit their facilities and ensure they comply with the Equality Act 2010.
The CQC also advise practices to consider the audits to be completed described in:
- Faculty of Dental Surgery Guidelines 2000 click here >
- Intercollegiate faculty guidelines on conscious sedation 2015 click here >
The National Institute for Clinical Excellence defines clinical audit as:
“A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change." (Principles of Best Practice in Clinical Audit 2002).
Planning your Audit
To ensure a successful audit that has the ability to result in change, the audit must be planned carefully.
As you plan your audit, ensure you:
The process simply involves:
- Selecting Criteria (factors that will be measured)
- Setting a standard (a benchmark to compare against)
- Measuring your practice against this
- Establishing an action plan for improvement ensuring this is achievable and sustainable
- Measuring again within an agreed time frame to ensure the standards have been achieved
- Continuing the cycle going forward to maintain the standards set
When starting an audit and collecting data you should set objectives to show what you are going to measure, and how you will obtain this information.
You need to decide whether you are collecting data for:
- Structure – Assesses resources for example; Financial aspect, diary utilisation or failed to return and wasted time.
- Process – Examines procedures for example; The quality of record keeping, radiography & infection control.
- Outcome – Analyses success for example; The success of implants, root treatments & patient surveys.
The data should be accurate, reliable, valid and should not breach patient confidentiality by collecting persons identifiable information.
Ensure data collection is as random as possible to eliminate bias in the data collected.
Reviewing the data collected
Discuss the results of the data collected with your team and agree on an achievable and sustainable action plan to raise standards if required.
Agreeing with the team the changes needed will ensure it “happens” and it stays “live.”
Keep a record of your audit, and the entire process as this is your evidence of quality improvement required by the CQC.
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