EXAMPLES: Table 1
Service
Standard Area
Date
Outcomes: Key findings
Recommandations, changes, comment, or improvements
Audit Aim
To demonstrate attainment of expected standards set from 1-8 for clinical documentation. Criteria 1. The clinician should clearly and concisely document the reason for the consultation. Criteria 2. The clinician should clearly and concisely document the history including signs and symptoms. Criteria 3. The clinician should clearly and concisely document the examination findings. Criteria 4. The clinician should clearly and concisely document the diagnosis / differential diagnosis. Criteria 5. The clinician should clearly and concisely document the management plan. Criteria 6. The clinician should clearly and concisely document the use of medication and demonstrate appropriate prescribing. Criteria 7. The clinician should clearly and concisely document the safety netting advice and/or referral processes. Criteria 8. The clinician should clearly and concisely use ‘read codes’ to allow audit trails for the purposes of QOF/ clinical audits for the surgeries. The purpose was to look for continuity and conformity of referral triage across RDS clinicians. It was to look at the quality of referrals and to identify any possible learning outcomes which we could take to our MDT or to communication with referring GP Surgeries
1. Documentation recorded for the patients audited was appropriate and met the criteria with a 100% overall percentage. 2. Essential information was included in all cases reviewed.
GP at the Front Door
Quality Assurance
Reaudit three monthly to ensure maintenance of standards
20.05.2022
Consultation Documentation Quality Re-audit
Patient Safety
All Triages were completed within 72 hours – which is within the RDS SOP. GPs are informed by ERS, email and or/task on SystmOne. Entries are recorded in SystmOne Any Urgent redirections are telephone through for absolute urgency and completeness. All documentation was to a high standard and very transparent for interpretation by the RDS and referrer.
Rapid Diagnostic Service (RDS)
Quality Assurance
We will continue to monitor the situation; we will continue to educate the GP Surgeries at education events and in communication as above.
04.07.2022
Referral Quality Audit
Patient Safety
Corporate – Human Resources
The re-audit will measure compliance against each of the criteria set out recruitment database whereby each recruitment check is recorded prior to issuing a contract of employment and arranging a start date for new employees.
The new processes in place have provided NNPC with assurance that the recruitment standards set out in the Recruitment Policy are being followed thus providing safe staffing for the organisation.
Administrative
01.08.2022 This audit has demonstrated that NNPC has a robust process in place to maintain an accurate database of employment checks with a standardised approach to its management.
Pre-employment checks for compliance with the recruitment policy audit
NNPC Quality Account 2022/23
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