Why clinical audit doesn't work

BMJ 1998;316:1905 ( 20 June )

Letters

Why clinical audit doesn't work

Clinical audit in nursing homes has proved ineffective

Monitoring undermines confidence in medical services

Success depends on type of audit

Profession must rise to challenge of innovation

Clinical audit in nursing homes has proved ineffective

Education and debate p 1893

The first 150 words of the full text of this article appear below.

EDITOR $---$ We share Berger's frustration with clinical audit in its current form.¹ Between 1995 and 1997 we tried to introduce clinical audit into nursing homes in Wakefield. There are 24 registered homes with nearly 1000 beds $---$ equivalent to an entire hospital $---$ and their quality of care has obvious and lasting relevance to thequality of life for residents.

The project coordinator (JC) introduced the concept of clinical audit to local homes, provided training, and helped each homeconduct an audit of its own choosing. One home refused to participate.The other 23 were receptive, but in five no progress was madebecause of staff changes. Eleven topics were audited by 15 homes;the other three conducted pseudo-audits that were actually managementactivities, such as stock control.

The 11 topics were: reporting of accidents; procedures of staff changeover; continence care, activities and stimulation ofresidents (3 homes); individual keyworker system, where each residenthas a named worker on . . . [Full text of this article]