Traditionally, clinic governance has been described as a system of accountability through which health organizations can progressively improve the quality of delivery of healthcare services and maintain high standards of care by creating an environment where best practice in clinical care will thrive (Scally & Donaldson, 1998). Clinical governance is an umbrella term that is used to refer to activities aimed at improving and maintaining high standards of care for patients. The concepts are not unfamiliar for nursing staff. However, clinical governance is aimed at merging and relating the concepts to make them more effective (Gauld, Horsburgh & Brown, 2011). Conventionally, clinical governance is described using seven critical pillars (Ellis & Johnson, 2013). The seven pillars that make up clinical governance are risk management, the involvement of the service user, caregiver and public, clinical audit, clinical effectiveness, staffing and management, clinical information and education and training (Greenfield et al., 2011).
Clinical audit is a strategy that doctors, nurses, and other healthcare professionals use to gauge the quality of services in healthcare they offer (Patel, 2010). A clinical audit provides a way for healthcare givers to compare their performance against a set benchmark to see how they fare and establish measures for improvement (Bowie, Bradley & Rushmer, 2012). After evaluating their performance against the set standard, the caregivers can make adjustments where necessary followed by subsequent audits to confirm whether the changes have succeeded. A clinical audit can, therefore, be considered as a continuous cycle of identifying the topics to be audited, measuring the topics against the set standards, acting on the findings that include adjustments and improvements where necessary and finally sustaining the improvements which include a re-audit where necessary.
MUST- Nutritional Audit Tool
The nutritional tool selected for audit is aimed at ensuring compliance of caregivers at the hospital with nutritional guidelines for patients on admission and during their stay. The structure of the MUST nutritional audit tool is based on the hospitals practice. The ward is a dementia-friendly ward for the elderly. The elderly have been identified as being at risk of malnutrition especially those with conditions such as dementia (Kaiser et al., 2010). Subsequently, the elderly have to be regularly screened to detect the risk of malnutrition or its presence and to mitigate the situation if not avert the risks.
The audit tool is designed to collect data on the patients malnutrition information. On admission, patients are screened for malnutrition risk and the data is stored on a form. The data is collected at regular intervals and a chart is created from the data. The nutritional audit tool examines the compliance of the data collection through a review of the admission booklet (Gleason et al., 2010). The patients information is collected on the audit tool as indicated on the admission booklet. The information collected includes the patients BMI, weight, height and a calculated risk score. The collection of this data on the audit tool acts as a double check to verify the situation of the patient by another caregiver at the hospital.
The nutritional audit tool also monitors the actions taken in light of the particular patients condition. In this way, accountability and counterchecking for compliance with health standards is ensured. The audit tool design is, therefore, instrumental in the follow-up of healthcare providers' actions in providing care to the elderly in a dementia-friendly ward. The nutritional audit tool counterchecks the actions of the caregiver against the standards set by the hospital as governed by national medical standards.
Clinical Audit and MUST-Nutritional Audit Tool
In the present day service provision environment, it is the duty of healthcare organizations to be accountable for their services (Pardini-Kiely et al., 2010). In this respect, healthcare organizations have an obligation to the society they serve to improve and uphold quality healthcare. Organizations establish structures, systems, and processes that enable them to provide the services in their mission. In the modern day operating environment, organizations have to show that they uphold standards (Fraser et al., 2011). Clinical governance enables an organization to manage its affairs in a manner that improves and sustains quality standards. Clinical audit as a factor of clinical governance is aimed at identifying the gaps in present practice and potential improvements can be established.
As a clinical audit tool, the MUST-Nutritional audit tool is a part of the overall audit cycle. It has features that contribute to its role in the audit cycle. To begin with, it has a defined patient population. Clinical audit tools should have a defined target population (Borbasi, Jackson & Lockwood, 2010). The target population in this instance is the elderly in a dementia-friendly ward. Secondly, the nutritional audit tool has a definite time framework within which it operates in the measurement of the outcomes of care (Dupont et al., 2011). Patient nutritional information is collected within 6 hours of information and additional information recorded on a weekly basis. The nutritional audit tool monitors these time frames within which the required actions need to be taken.
The nutritional audit tool identifies common nursing problems prevalent among the defined patient population. The elderly have been identified to be at risk of malnutrition especially those with mental conditions such as dementia (Roque, Salva & Vellas, 2013). This is the reason a dementia-friendly ward has been created to cater to the target population of the elderly. In addition, the nutritional audit tool also states the desirable patient outcome criteria. The audit tool has a percentage compliance section that rates the level of compliance of the particular patients case against set standards. From this set standard and level of compliance rating, an acceptable measure of goal achievement has been developed.
In audit cycles, it is important for the particular audit tool to have a defined source of information that will be audited (Gillam & Siriwardena, 2013). The MUST-nutritional audit tool specifies a source of information. The information is gathered from the admissions form of the patient. Further information is collected from the food chart at regular intervals. The design of the tool is also clear and precise to allow for easy interpretation and understanding (Lynch et al., 2011). A complex design would make it difficult to gather information. Lack of specificity would lead to ineffectiveness of the entire process since a lot of disarranged information cannot be effectively used to make inferences or gauge progress.
In the audit cycle, the primary focus is quality assurance. All audit tools are therefore designed with the top priority being quality assurance. The nutritional audit tool has been developed to focus on quality assurance with the use of scores to measure compliance at various levels. The patient is evaluated at the initial screening and subsequent evaluations take place at regular intervals. The nutritional tool scores each level for efficacy and compliance. In addition, the tool is not only recalled when required for audit, it is under the care of a programmer who constantly gauges the effectiveness of the tool itself and takes measures to ensure that the tool stays relevant in serving the needs of the organization.
The entire audit cycle under which the tool is used is under a coordinator who monitors and regulates the quality assurance activities. The quality assurance coordinator is also in charge of the evaluation of the quality assurance efforts. The individuals involved in the quality assurance program have their roles clearly defined. Subsequently, the individual using the MUST-nutritional tool knows their specific roles and this enables them to carry out their duties effectively. Nurses also have to be informed of the process and the results of the program since it affects their practice due to their involvement (Anderson et al., 2015). The data gathered from the quality assurance process has to be reliable for it to be valid. In addition, is also important to have sufficient orientation of data collection. Finally, the data should be analyzed and implemented by nursing staff at all levels.
Optimizing Clinical Effectiveness
In order to improve clinical effectiveness, it is necessary to employ tools that will optimize clinical decisions. In the course of serving individual patients, healthcare providers make decisions that affect outcomes in the patients (Straus, Tetroe & Graham, 2011). Using the audit tool, it is possible to gather information that will lead to the development of new care delivery models that will cater to the different populations of patients with their unique needs. In the past years, there has been a huge volume of information that has been generated. Subsequently, it is important to have data collection tools that can capture adequate information to be used in decision-making towards clinical effectiveness.
The ability to absorb clinical data is also gaining momentum. In many instances, there are gaps that exist in the absorption of clinical data (Krishnankutty et al., 2012). However, tools such as the nutritional audit tool can aid in minimizing unwanted variability in the provision of healthcare in the hospital. In addition, information from the audit tool can be used to improve the safety of care while at the same time seek cost-effective mechanisms to cater to the problems of the patient population.
Optimization of clinical effectiveness faces several challenges as earlier mentioned. The challenges facing optimization of clinical effectiveness can be eliminated by the use of integrated solutions that are capable of working alongside present day technology and achieving the goals they are designed to reach (Proctor et al., 2011). The nutritional audit tool is one such integrated tool. It can be used alongside modern technology since the data can be entered into a computer for storage purposes or for further analysis and evaluation using computer software. Therefore, the organization is saved from the risk of combining different tools that have no synergy and are incompatible with available technology investments.
The nutritional audit tool is a product of the clinical decision making team and supports technology. It can, therefore, be considered an end to end solution that can assist caregivers to improve their delivery of care. In addition, the information that is obtained from the nutritional audit tool can be applied to strategies that benefit stakeholders in the healthcare provision field. In particular, the beneficiaries from this information who are mainly those concerned with the delivery of care can gain knowledge in the best possible way of providing care and value. Content delivered across solutions must also be unified for consistency across the range of care settings and providers. As a result, it will be simple to execute decision support, in-work flow solutions and measure the impact of interventions.
Audit to Improve Patient Experience
Audits can be used to improve the experience of patients in various ways. First, audits can be used to indicate where resources are needed for the improvement of delivery of healthcare (Burgess, 2011). Audits provide evidence that justifies the need for particular resources to raise the quality of standards of performance. Secondly, audits can provide important feedback regarding outreach to the patients. Mentor...
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