Impact of Clinical Audit on Education, Clinical Effectiveness, Risk Management, and Staff Management in Medical and Infectious Ward

This essay examines the impact of clinical audit on education and training, clinical effectiveness, risk management, and staff management in the specialty practice area of registered nurses working in medical and infectious wards.

Running head: CLINICAL GOVERNANCE
Clinical governance
Name of the student:
Name of the University:
Author’s note

1CLINICAL GOVERNANCE
Introduction:
Clinical audit is one of the pillars of clinical governance that focuses on improving the
quality of patient care by systematic review of care process based on well-defines standard or
criteria and implementation of changes in structure, processes and outcome of care (Limb et al.,
2017). It is mainly concerned with ensuring that right thing is done to promote quality of care in
clinical setting. It is a major part of continuous quality improvement process in many hospitals.
Clinical audit provides health care professionals an opportunity to improve their practice by
giving feedback about their performance in the form of audit (Esposito & Canton, 2014). This
essay aims to examine the clinical audit process in the specialty practice area of registered nurse
working in medical and infectious ward and consider its impact on education and training,
clinical effectiveness, staffing and staff management and risk management.
Background:
The main purpose of clinical audit is to improve the quality of patient care. It involves a
six step process starting with identification of the problem in clinical setting, defining standards
or criteria, collecting relevant data, analysing the data, implementing the change and conducting
re-audit to assess improvement in patient care (Limb et al., 2017). Selecting a topic or clinical
problem for audit depends on objectives of the audit and it mainly seeks to measure adherence to
processes that produce best outcomes for patient. For example the topic may be needle stick
injuries or high rate of postoperative complications in patient. The next of selecting criteria for
audit review includes using clinical practice guidelines related to the problem to develop relevant
criteria and standards. The criteria mainly define an outcome that can be measured. The focus is

2CLINICAL GOVERNANCE
to choose optimum standards that help to maintain standard of care under normal conditions
(Chamber & Wakley, 2016).
The third phase of collecting data during the audit involves collecting data manually or
by a computerized information system based on outcome to be measured. Clinical records are the
most common tool for data collection (Neuburger et al., 2015). The next step involves analysing
the data collected and comparing it with set criteria and standards. This stage mainly focus on
identifying whether the set criteria in relation to a topic was met or not. If the criteria is not met,
the reasons for the same is identified. This is followed by the vital step of implementing the
change which involves disseminating education or other material to improve practice. The last
stage involves taking steps to sustain improvement by evaluating the effect of the change by
repeating the audit process (Yorston & Wormald, 2010).
Impacts of clinical audits on specialty area:
The specialty area of focus for this essay includes the practice areas of clinical nurse in
medical and infectious ward. In medical and infectious ward, nursing practice related to hand
hygiene and adherence to safety culture influences the incidence of hospital acquired infection.
As staffing issues and heavy workflow increases the risk of hospital acquired infection in
medical ward (Ginawi et al., 2014), the clinical audit process can focus on collecting data related
to hand hygiene adherence and implement appropriate changes to reduce risk of such infection in
medical wards.
Education and training: A clinical audit done in medical and infectious ward can help to identify
the standards of care in relation to hand hygiene and identify areas in which registered nurse may
require education and training to reduce the risk of hospital acquired infection. For registered

3CLINICAL GOVERNANCE
nurse practicing in medical ward, engaging in professional development and continuing
education in relation to practice is critical to engage in evidence based practice. Education and
training is also vital to increase knowledge regarding updated standard of care needed to improve
patient outcome and professional performance. For the speciality areas of nursing practice,
continuing education along with knowledge and skill development is associated with
improvement in nursing activity (Eslamian, Moeini & Soleimani, 2015).
A clinical audit done in the speciality area of clinical nurse in infectious ward would help
to scrutinize performance of all nurse in relation to adherence to hand hygiene protocol and the
results of the clinical audit would help to identify whether nurses are working in accordance with
set standards of practice or not. Hand hygiene is one of the major cause behind health care
associated infection and low compliance to hand hygiene among nurse is one of the cause behind
high risk of infection for patient (Mostafazadeh-Bora, Bahrami & Hosseini, 2018). Hence,
clinical audit in the specialty practice area may help to review performance of nurse in relation to
adherence to current best standards for hand hygiene. For example, WHO’s five moment of hand
hygiene is a crucial framework to define the situations in which a nurse need to sanitize their
hands. Hence, the clinical audit can focus on identifying the performance of nurse team in
complying with the five moments of hand hygiene. The results of the clinical audit can be
reviewed to identify areas where improvement and further education is needed by nurse to fulfil
best practice standards (Coyne et al., 2016). The above discussion gives example regarding
improving skills related to prevention of health care associated infection for clinical nurse.
However, the clinical audit results can focus on other problems like gap in knowledge of clinical
nurse in relation to pain management or delay in care for patient.

4CLINICAL GOVERNANCE
Therefore, based on above explanation, it can be said that clinical audit directly
influences education and training process for nurses in medical ward. Mykkänen, Saranto and
Miettinen (2012) support that after the processing of an audit result, the next step involves
implementation of relevant training for nurses. The training is based on development plan made
to improve a problem and the participation in training improves nurse knowledge in relation to
specific practice process.
Clinical effectiveness:
Clinical effectiveness is one of the indicators of quality that focus on achieving
excellence in safe delivery of care. It is mainly linked to achievement of best outcome for patient
using evidence based practice. The impact of a clinical audit is that it initiates all possible
changes to organizational structure and skills and attitude of health care professional to achieve
clinical effectiveness. A clinical audit highlights practice issue and key gaps in organization
process and professional staff’s skills that lead to problem or poor quality of care for patient
(Tsaloglidou, 2009). Hence, by focussing on taking action to improve the clinical process, the
clinical audit process in a clinical setting plays a role in promoting clinical effectiveness of the
organization.
In my speciality area of clinical nursing practice in medical ward, clinical audit has
helped to promote clinical effectiveness by implementing effective hand hygiene protocol and
resources to ensure that no nurse miss any moments of hand hygiene. Williams (2013) supports
that daily vigilance and implementation of evidence based infection prevention protocol controls
health care associated infection. Clinical audit has played a role in checking actual practice of
nurse against set standard and reporting about concerns related to non-compliance or any

5CLINICAL GOVERNANCE
challenges faced by health care workers. This has been associated with implementation of bundle
of intervention to promote clinical effectiveness in relation to hand hygiene in clinical setting.
Bundle of intervention is often implemented after a clinical audit and it involves providing a
statement of commitment to all clinical team and standard operating procedure for the bundle
(Steinmo et al., 2015).
Hale et al. (2015) gives the evidence that clinical audit is associated with implementation
of many initiative to embed infection prevention and control. This included imposing mandatory
reporting requirement that increase day-to-day functioning of the infection prevention and
control team. Another example of such initiative included implementation of infection control
program that focussed on hand hygiene compliance, staff dress code, cleanliness of environment
and attendance in education training. Similar initiative in my speciality practice increase clinical
effectiveness. Assessment of knowledge and procedure in a clinical setting is a pillar of clinical
audit and they facilitate bringing changes that enhances clinical effectiveness of the overall
clinical team in a medical and infectious ward (Hale et al., 2015).
Risk management:
Clinical audit in the speciality area of nursing in medical ward has played a role
increasing risk management process to promote safety of patient. Risk management is a
systematic process that involves assessment of risk and strategies needed to reduce the
occurrence of any safety issues for patient. The benefit of clinical audit in clinical setting is that
the process focus on different aspects of quality care and by the process of comparing care
outcomes with relevant standards of care, it plays a role in managing risk and safety issues for
patient or other staff in the ward (Hysong et al., 2017).

6CLINICAL GOVERNANCE
One example which shows the impact of clinical audit on risk management process
includes implementation of clinical audit in medical ward to reduce risk of hospital acquired
infection for staffs. To manage risk in this area, clinical audit team plays a role in identifying the
cause of such infection rate and analysing adherence to best standards of practice. Mehta et al.
(2014) shows that for risk management of nosocomial infection, clinical audit plays a role in
identifying patients at risk, observing hand hygiene, following standard precaution to reduce risk
and implementing strategies that reduces risk. Hence, overall the procedure initiated during
clinical audit plays a role in improving the risk management process too. It leads to prioritization
of many activities in clinical setting to reduce safety or risk issues for patient. For example, room
ventilation, protective clothing and decontamination have been implemented to manage risk of
infection in patient following clinical audit (Smiddy et al., 2019). Hence, clinical audit along
with initiation of practice change facilitates risk management in a clinical setting.
Staffing & staff management:
Clinical audit process plays a role in addressing staffing issues and challenges for staffs
in working in certain areas too. This is said because by focusing on identify the cause of
problem, the performance of staffs is also scrutinized. This process helps to manage staff related
issues and challenges that has impact on quality of patient care (Van Zwanenberg & Edwards,
2018). In the chosen practice area, clinical audit has been associated with identification of
several barriers to hand hygiene for nursing staffs. This includes high workload and challenges in
adhering to hand hygiene because of lack of resource in vital point of care (Zingg et al., 2015).
Hence, following the audit process, concerns for staffs were identified and the nursing staffs
were provided with reminder and sanitizers at all points of care to ensure that no safety issues

7CLINICAL GOVERNANCE
arise for patient. The process of analysis of data helped to identify the impact of staffing on
quality of care and appropriate resolution was initiated as per the expectation of nursing staffs.
The research evidence by Dioso et al. (2014) is reliable as it explains how clinical audit
affects staff management process. The clinical audit process in this study focussed on evaluating
hand washing compliance among allied health staffs and identifies staffs who had issues with
hand washing. The cause of non-compliance revealed miscommunication as a barrier to hand
washing. This led to initiation of change management plan for staffs lead to increased support
and reduction of challenges for health care staffs in complying with standard of care.
Benefits and limitation of clinical audit on speciality area of practice:
In my speciality practice, clinical audit has resulted in many benefits for nursing staffs as
well as health outcome for patient. For example, this has resulted in increasing reporting about
adverse issues for patient and scrutinizing the main cause behind. Clinical audit process has
resulted in structural changes in the medical ward such as implementation of hand hygiene
protocol, safety culture and regular education and training related to update of nursing staffs skill
in recognizing safety issues and promoting safety of patient. The standards of care has improved
and the burden of care has reduced because of reduction in duration of hospital stay for patient
following implementation of education and best practice standards. However, some limitation of
clinical audit is that it resulted in extra pressure and responsibility for nursing staffs as they need
to be vigilant and ensure that care activities are aligned to all relevant protocols.
Conclusion:
To conclude, the review of the impact of clinical audit on education and training, clinical
effectiveness, risk management and staff management in speciality area suggest that clinical

8CLINICAL GOVERNANCE
audit is an effective process to achieve the goal of continuous quality improvement. The essay
shows that clinical audit is a critical process initiated in health care organizations that works to
implement changes in process, structure and skills of staffs to reduce risk to patient and promote
positive health outcomes for them.

9CLINICAL GOVERNANCE
References:
Chambers, R., & Wakley, G. (2016). Clinical audit in primary care: demonstrating quality and
outcomes. CRC Press. Retrieved from: https://doi.org/10.4324/9781315378145
Coyne, I., Comiskey, C. M., Lalor, J. G., Higgins, A., Elliott, N., & Begley, C. (2016). An
exploration of clinical practice in sites with and without clinical nurse or midwife
specialists or advanced nurse practitioners, in Ireland. BMC health services
research, 16(1), 151. https://doi.org/10.1186/s12913-016-1412-8
Dioso, R. I., Eden, V. R., Samporna, L., Shah, M. A., Dioso, R. I., Eden, V. R., ... & Shah, M. A.
(2014). A clinical audit on the compliance on hand washing laboratory in a private
university in peninsular Malaysia. International Journal, 1, 63-71. Retrieved from:
http://www.ijirst.org/articles/IJIRSTV1I7009.pdf
Eslamian, J., Moeini, M., & Soleimani, M. (2015). Challenges in nursing continuing education:
A qualitative study. Iranian journal of nursing and midwifery research, 20(3), 378.
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462065/
Esposito, P., & Canton, A.(2014). Clinical audit, a valuable tool to improve quality of care:
general methodology and applications in nephrology. World Journal of Nephrology, 3(4),
249-255. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220358/
Ginawi, I., Saleem, M., Sigh, M., Vaish, A. K., Ahmad, I., Srivastava, V. K., & Abdullah, A. F.
M. (2014). Hospital acquired infections among patients admitted in the medical and
surgical wards of a non-teaching secondary care hospital in northern India. Journal of
Clinical and Diagnostic Research: JCDR, 8(2), 81. DOI: 10.7860/JCDR/2014/6673.4014

10CLINICAL GOVERNANCE
Hale, R., Powell, T., Drey, N. S., & Gould, D. J. (2015). Working practices and success of
infection prevention and control teams: a scoping study. Journal of Hospital
Infection, 89(2), 77-81.
Hysong, S. J., Kell, H. J., Petersen, L. A., Campbell, B. A., & Trautner, B. W. (2017). Theory-
based and evidence-based design of audit and feedback programmes: examples from two
clinical intervention studies. BMJ Qual Saf, 26(4), 323-334.
http://dx.doi.org/10.1136/bmjqs-2015-004796
Limb, C., Fowler, A., Gundogan, B., Koshy, K., & Agha, R. (2017). How to conduct a clinical
audit and quality improvement project. International journal of surgery. Oncology, 2(6),
e24. DOI: 10.1097/IJ9.0000000000000024
Mehta, Y., Gupta, A., Todi, S., Myatra, S. N., Samaddar, D. P., Patil, V., ... & Ramasubban, S.
(2014). Guidelines for prevention of hospital acquired infections. Indian journal of
critical care medicine: peer-reviewed, official publication of Indian Society of Critical
Care Medicine, 18(3), 149. doi: 10.4103/0972-5229.128705
Mostafazadeh-Bora, M., Bahrami, M., & Hosseini, A. (2018). A survey of nurses' compliance
with hand hygiene guidelines in caring for patients with cancer in a selected center of
Isfahan, Iran, in 2016. Iranian journal of nursing and midwifery research, 23(2), 119.
doi: 10.4103/ijnmr.IJNMR_228_16
Mykkänen, M., Saranto, K., & Miettinen, M. (2012). Nursing audit as a method for developing
nursing care and ensuring patient safety. In NI 2012: 11th International Congress on
Nursing Informatics, June 23-27, 2012, Montreal, Canada.(Vol. 2012). American

11CLINICAL GOVERNANCE
Medical Informatics Association. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799087/pdf/amia_2012_ni_301.pdf
Neuburger, J., Currie, C., Wakeman, R., Tsang, C., Plant, F., De Stavola, B., ... & van der
Meulen, J. (2015). The impact of a national clinician-led audit initiative on care and
mortality after hip fracture in England: an external evaluation using time trends in non-
audit data. Medical care, 53(8), 686. doi: 10.1097/MLR.0000000000000383
Smiddy, M. P., Murphy, O. M., Savage, E., & Browne, J. P. (2019). The influence of
observational hand hygiene auditing on consultant doctors’ hand hygiene behaviors: A
qualitative study. American journal of infection control.
https://doi.org/10.1016/j.ajic.2018.12.024
Steinmo, S., Fuller, C., Stone, S. P., & Michie, S. (2015). Characterising an implementation
intervention in terms of behaviour change techniques and theory: the ‘Sepsis Six’clinical
care bundle. Implementation Science, 10(1), 111. https://doi.org/10.1186/s13012-015-
0300-7
Tsaloglidou, A.(2009). Does audit improve the quality of care? International Journal of Caring
Sciences, 2(2), 65-72. Retrieved from
http://internationaljournalofcaringsciences.org/docs/Vol2_Issue2_02_Tsaloglidou.pdf
Van Zwanenberg, T., & Edwards, C. (2018). Clinical governance in primary care. In Clinical
Governance in Primary Care (pp. 17-30). CRC Press. Retrieved from:
https://www.taylorfrancis.com/books/e/9781498793575/chapters/10.1201/978131537568
7-2

12CLINICAL GOVERNANCE
Williams, S.(2013). Research, service evaluation and clinical audit strategy 2013-16: evidence
informed community healthcare improving patient outcomes. Retrieved from
https://www.solent.nhs.uk/_store/documents/research_service_evaluation_and_clinical_a
udit_strategy_2013-16_v_8_1.pdf
Yorston, D., & Wormald, R.(2010). Clinical auditing to improve patient outcomes. Community
Eye Health, 23(74), 48-49. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033614/
Zingg, W., Holmes, A., Dettenkofer, M., Goetting, T., Secci, F., Clack, L., ... & Pittet, D. (2015).
Hospital organisation, management, and structure for prevention of health-care-
associated infection: a systematic review and expert consensus. The Lancet Infectious
Diseases, 15(2), 212-224. https://doi.org/10.1016/S1473-3099(14)70854-0