GUIDELINES AND AUDIT IMPLEMENTATION NETWORK

1. GUIDELINES AND AUDIT IMPLEMENTATION NETWORK promoting quality through audit & guidelines

3. In 1997 White Paper �The New NHS, Modern, Dependable�, brought together different service improvement processes and formally established them into a coherent Clinical Governance Framework including Clinical Audit. Dr Phil Hammond �MD� in Private Eye stated that �The NHS was founded on the unshakeable belief that doctors are jolly good chaps and the nurses are angels, and so there was no need for quality control.�

4. ESTABLISHMENT OF CREST - 1988

5. Members of CREST

6. CREST Secretariat Angela Lowry Alan Walton Leonora McLaughlin Gary Hannan Christine Smith Joe Feeney

7. Crest Conference on Hospital Acquired Infection

8. Members of NIRAAC

9. NIRAAC Secretariat Margo Roberts Gillian Diffin Andrew Dainty

10. Members of RMAG

11. RMAG Regional Facilitator Eleanor Hayes Paddie Blaney Trevor Fleming Irene Daly Nicola Porter

12. Development of RMAG Development of Multi-professional Audit Establishment of RMAG Publishing of Gleanings Appointment of Regional Facilitator Funding of Regional projects First Annual Conference

13. THE FIRST RMAG  CONFERENCE

14. 2nd RMAG CONFERENCE

16. 1979 DUNDONALD HOUSE

18. Lagan Valley Island Meeting

21. Remit

24. CREST Do you read guidelines produced by CREST? 71% Do you think CREST is useful? 84% Do you follow CREST guidance? 81%

25. What do you like about CREST? �well defined guidelines� �useful information� �guidelines are easy to read and straightforward to follow� �clarity and relevance to local medical need� �useful topics looked at� �comprehensive practical approach�

26. What do you not like about CREST? �not followed UK wide� �no funding with guidelines� �some guidelines are hard to follow� �information not disseminated to all interested parties�

27. LOCAL AUDIT Do you participate in local audit 100% Do you find your local audits useful 86% Do you contribute to local audit 100%

28. What do you like about local audit? �assesses standards of current practice� �relevant� �useful to make improvement� �good feedback on what we do� �compulsory� �imperative to monitor standards� �may change practice� �part of CV�

29. What do you not like about local audit? �not enough presentation of data� �the time it takes� �lack of focus� �recommendations and re-audit� �attendance poor� �conducted to tick a box�

30. NATIONAL/REGIONAL AUDIT Do you participate in regional or national audits 71% Do you think these audits are useful 86%

31. What do you like about regional / national audit? �large sample� �provide useful data to make changes ongoing improvements� �tackles multidisciplinary issues� �renal registry� �useful to monitor progress� �feedback from colleagues around the country�

32. What do you not like about regional / national audit? �time consuming� �not many of them� �often no publicity about them� �need to be based on routinely collected data if possible�

33. Criteria for a good clinical audit

34. Managers should be actively involved in audit, in particular the development of action plans from audit enquiry. Action plans should address local barriers to change and identify those responsible for service improvement. Re-audit should be applied to ascertain whether improvements in care have been implemented as a result of clinical audit. Systems, structures and specific mechanisms should be made available to monitor service improvements once the audit cycle has been completed. Each audit should have a local lead

36. Guideline Work Programme

37. Medical Device Work Programme Endoscopic Washers Nebulisers Need to select champions from each Trust

38. GAIN Work Ethos Room for basic ideas Bottom up Top down Part of Quality Improvement in Northern Ireland RQIA Service Frameworks Patient Safety National Collaboration

39. Mini SWOT Analysis

41. THE FUTURE Science will continue to cross new frontiers Financial pressures will increase and new funding systems will be required Information infrastructure will improve Team work will become even more important Professional roles and boundaries will continue to change Performance management and safety issues will dominate Continuity of care and whole person care will be threatened Service pressures increase and innovation will be valued.

42. FINAL THOUGHTS The work of front line staff will continue to be the foundation of the service despite all the organisational change and new initiatives Audit and focus on quality will continue to be vital in health and social care whether it�s called clinical audit, total quality management, clinical governance or performance management

43. �Medicine used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous. The mystical authority used to be essential to practice. Now we need to be open and work in partnership with our colleagues in health care and with our patients� Cyril Chandler, Dean of Kings College Medical School