Clinical Auditing and Governance Essay

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Clinical Governance and Auditing

Throughout this paper, an attempt has been made to demonstrate an understanding of the procedure of Clinical Audit (CA). The focus of this CA is the high risk area of patient safety, and with regard to how this is linked to patient safety, hand hygiene has been selected. The findings and the recommendations that follow combined with the CA tool and the selection criteria will be outlined in form of a Clinical Audit. For the purposes of improving clinical practice, CAs forms an integral aspect of clinical governance. It is indeed notable that CAs encapsulates practice which through analysis can result to quality enhancement, particularly for the patients. Various definitions of the term which are invariably the same and which tend towards verbosity exist, but a terse and precise definition is given by Coffey (2009) who puts forth that a CA is a systematic evaluation of clinical processes through careful interpretation and fact finding. A methodological process commonly known as a CA cycle or stages should be adhered to when implementing or considering a CA (Ashmore & Ruthven, 2008)

The five major aspects that should be considered include: selection, preparations, gathering data, analysis, subsequent recommendations and continued changes for improvement. For clinical relevance and decision on the matter under consideration preparation is necessary. This is followed by selecting the standards and criteria through which measurable results are categorized by the criteria. By employing relevant tools, gathering of data is accomplished and interpretation of the data is achieved through analysis by comparing the chosen standard or criteria. And based on these findings, recommendations are developed (Ashmore & Ruthven, 2008).

Instead of a prospective audit, a retroactive audit is preferred because this eliminates the likelihood of the subjects changing their conduct or practice in the process of the audit (Ashmore & Ruthven, 2008). Lack of time is an accepted impediment to auditing despite its accepted advantages. However, it is noteworthy that the importance of CA in enabling best practice cannot be measured. The mainstay or strength of conducting CAs is based on consistent debates of the issues that have been identified and the implementation of strategies that can lead to improvement. It is imperative not to forget that the CA might adduce evidence that standards are complied with and therefore the staff or participants should get commendation.

Background

Presently, nursing and practice based on evidence strongly emphasize agenda for clinical governance geared towards improvement of quality (Iggulden, Macdonald & Staniland, 2009). In order to ensure NHS organizations are not only held responsible for improving clinical practice and adhering to standards but also are charged with implementing safety systems as a safeguard for practice, clinical governance should be deployed as a system. The prevalence of infections associated with health care can be reduced through proper decontamination of hand hygiene or (HCALs) but despite this, HCALs incidences are on the rise and this build barriers for health care workers against reducing such infections. Earlier research indicated that compliance with the standards of hand hygiene by health care workers or (HCWs) is widely sub-standard and any improvement in compliance cannot be easily sustained (Bennett et al., 2012).

Objectives, Aim & Standards

Looking at hygiene practice/hand washing from a behavioral perspective in a report of the study of healthcare workers is what this paper attempts. To achieve this objective an opposite tool of audit was used. The hand hygiene policy was compared to the relevant documentation (Pontivivo et al., 2012), as a procedure need for the practice of clinics. There are no exceptions but for a 100% rate chosen for the criteria. The paper also defines clinical governance and maps its emergence as a means of discussing present best practice and to evaluate what this implies for the executives and boards of director who intend to implement clinical governance for the health services they offer (Braithwaite & Travaglia, 2008).The research also examines whether proper hand hygiene can prevent or stop infections linked with health care. However, existing results indicates that auditing that is advertised is linked to the growth of general hand hygiene rate of adherence including within the subgroups after or before contact with patients and that apparently this is admissible to health care workers (Hui et al., 2014).

Methodology

At a pediatric ward with 30 beds, this retroactive audit examined the completion rate of audit forms in 50 instances. The audit was carried out by Luis at Canterbury hospital in a time span of 90 minutes.

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The tool of audit looked at different aspects such as whether gloves were used, charts needing moment indication and whether this was easy to complete in a straightforward way, and therefore this necessitated no recommendation for any changes.

Results

The compulsory compliance rate or CR of 100% was not achieved for this audit because the criterion was only met by 88%. 87% of moment 1 achieved the CR while just 60% of moment 5 did the same. The overall CR had an average of 89.14%. There were central issues noted in the literature as responsible for proper clinical governance. They included the application of clinical governance to improve safety and quality by focusing on continuous improvement and quality assurance, and making sure that associations are made between corporate and clinical governance and clinical services; the implementation of strategies for ensuring proper data exchange, expertise and skills, the development of structures of clinical governance as a way of improving quality and safety, and sponsorship of service delivery based on patient approach. Specific barriers that included clinical procedures, business and time, lack of knowledge and use of gloves and skin conditions were perceived to affect compliance to hand hygiene. Notably, those who took part thought that health care workers were the influencing reason for compliance in hand hygiene which came as a result of the perception that they should be the same as those who worked in the areas of clinics (Braithwaite & Travaglia, 2008).

Discussion and Recommendations

The health policy has received a lot of help from the development of clinical governance. Some of the major results from one part of an evaluation project which incorporated observation of the health managers and experts are here reviewed. Main lessons concerning clinical governance require clear definition, clinical partnerships and robust management besides a development strategy with various layers which lays emphasis on training investment which is based on organizational structures like presence of clinical boards. For health professionals, the emphasis on clinical governance has largely been positive but at this particular stage it isn't easy or possible to evaluate how far effective this is (Gauld, 2014).

Those who responded mainly outlined the advantages of activities related to hand hygiene carried out in health institutions to increase better understanding and improve awareness of hand hygiene. When they were challenged to point out the barriers and limitations linked to the activities implemented in hand hygiene strategies, the participants pointed out organizational support, resources and time, skin sensitivity, product purchase, hygiene compliance and the attitude of the staff to be the main areas of concern in the regions health facilities and the services provided. Critical to the reduction of infections in health facilities is decontamination of staff hands as has been documented. More analysis of compliance to hand hygiene after and before contact with patients indicates that nursing and allied staff of health had consistently increased compliance to hand hygiene before contact with patients. The results of this study supports the notion that there shouldn't be distinction between implementation and the policy making process. The two are not separable and so should be viewed as parallel entities instead of a sequence or series (Khayatzadeh-Mahani et al., 2013).

There are serious consequences from failure to attend hand hygiene which have negative impacts on the quality and safety of patient's lives besides eroding there confidence in the delivery of health care. Even so, the instances of omission of hand hygiene have been high and the trend still continues. Up to recently, this subject was a remarkable factor in standards, national policies, and campaigning and guidance across the UK leading to efforts to deal with compliance to hand hygiene at all levels of the healthcare system. Various units and wards still announce their hand hygiene compliance outcomes on notice boards, but it is important to make sure that hand hygiene compliance is undertaken at the correct time always. Infections and harm can largely be prevented through improvement of hand hygiene as a means of minimizing the time and cost spent on healthcare which can be especially vital for the present targets of efficiency savings by the NHS. As noted by the WHO, it is a cost effective measure of intervention for saving lives (WHO, 2009); and it is an important aspect of nursing practice. Even so, nurses are also expected to take a lead role in convincing other experts to follow the recommendations of hand hygiene. What is.....

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