description of audit, its importance in medical field

1. Auditing
Dr. Amany R. AboSeoud
Prof. of Community Medicine
Zagazig university. EGYPT

2. Auditing ‫المراجعة‬-‫المتابعة‬
Auditing means official examination.
Originally it was related to accounts.
Recently it has been used in relation to
quality management. It is an important
step in the quality assurance cycle.
Audit is an evaluation of a person,
organization, system, process, project or
product. Audits are performed to
ascertain the validity and reliability of
information, and also provide an
assessment of a system's internal
control.

3. In QA we talk about error or defect
prevention.
Primary prevention is reflected by
doing the things right the first time.
This is achieved by conforming to
STANDARDS.
Secondary prevention is by avoiding
repetition of defects to do the things
right every time. This is achieved by
AUDITING.

4. Audit
 Systematic, independent and
documented process for obtaining
evidence and evaluating it
objectively to ensure compliance to
standards.
 Audit client or auditee: organization
or person requesting an audit
 Audit evidence: documents & records
 Auditor: person who conduct an
audit

5. Auditing is done periodically
whether there is a defect or not.
or it is done when something goes
wrong: as malpractice, adverse
event, or sentinel event.
“Audit is a fact finding mission not
a policing operation”

6. Auditing can be considered as a way
for problem solving
This process must involve
everyone who might have
contributed to the problem.
Ask everyone to sit down and
analyze:
 · What went wrong?
 · Why?
 · What actions need to be
taken in order not to repeat the
problem?

7.  Auditing needs measurement
It is based on a scientific approach to
reach a decision based on
information .it depends on people
interview, records, documents,
observation(watch, listen, smell,
touch)
 Auditing involves the whole system
Structure process Outcome
 Auditing can be Internal or External

8.  Internal auditor- are employees of a company
hired to assess and evaluate its system of
internal control. To maintain independence, they
present their reports directly to the Directors or
to Top Management. They provide functional
operation to the concern. Internal Auditors are
employees of the company so that they can
easily find out the frauds and any mishappening.
 External auditor are independent staff
assigned by an auditing firm to assess and
evaluate financial statements of their clients or to
perform other agreed upon evaluations. Most
external auditors are employed by accounting
firms for annual engagements. They are called
upon from the out side of the company.

9.  Clinical audit is the process
formally introduced in 1993 into the
United Kingdom's National Health
Service (NHS), and is defined 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".

10. Stages of audit:
 Stage 1: Identify the problem or issue
 This stage involves the selection of a topic or
issue to be audited
 Stage 2: Define criteria & standards
 Decisions regarding the overall purpose of
the audit, either as what should happen as a
result of the audit, or what question you
want the audit will answer, should be written
as a series of statements or tasks that the
audit will focus on.

11.  Stage 3: Data collection
 To ensure that the data collected are
precise, and that only essential information
is collected, certain details of what is to be
audited must be established from the outset.
 Ethical issues must also be considered; the
data collected must relate only to the
objectives of the audit. Staff and patient
confidentiality must be respected -
identifiable information must not be used

12. Stage 4: Compare performance
with criteria and standards
 This is the analysis stage, whereby
the results of the data collection are
compared with criteria and
standards. The end stage of
analysis is concluding how well the
standards were met and, if
applicable, identifying reasons why
the standards weren't met in all
cases.

13. Types of non conformity
 Major : must be corrected, must
be re-audit to guarantee
correction. Usually in product
quality. Corrective action
 Minor: indirect effect on quality.
It is nice to correct. Preventive
action.
 Remark: as minor, without
evidence.

14.  Stage 5: Implementing change
 Once the results of the audit have
been published and discussed, an
agreement must be reached about the
recommendations for change. Using
an action plan to record these
recommendations is good practice;
this should include who has agreed to
do what and when. Each point needs
to be well defined, with an individual
named as responsible for it, and an
agreed timescale for its completion.

15.  Re-audit: Sustaining
Improvements
 After an agreed period, the audit
should be repeated. The same
strategies for identifying the
sample, methods and data analysis
should be used to ensure
comparability with the original
audit. The re-audit should
demonstrate that the changes have
been implemented and that
improvements have been made

16. Audit procedures
1- Pre-audit management:
(preparation & planning), formation
of audit team, documents, check
lists, standards to compare to,
determine the date of visit.
2- The audit: opening meeting, the
actual audit, report, closing
meeting.
3- Subsequent actions: submit
report, follow up of corrective
actions, maintain records

17.  Collect data and check validity of
evidence
 (by asking for knowledge, by
observation, by evidence)
 Define what went wrong
 Decide on likely causes
 Immediate notification to concerned
persons to take action
 Recording the findings and outcomes
 Report to everyone concerned to
prevent recurrence.

18. Good auditor
 Don’t ask more than 1 question at
a time
 Don’t answer the questions
 Be friendly
 Don’t criticize, be positive
 Speak clearly
 Look at persons they are talking to
you
 Listen carefully
 Verify evidence

19.  Don’t trust memory
 Record what you actually see
 Write clearly
 Be concise
 Use words of standards
 Be there on time
 Don’t forget thanks after auditing

20. Thank you