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Audit
Why Audit?
WhyAudit?
Theaimofclinicalauditin
dentistryaimstoencourage
dentists to selfassess
dentiststoself
assessdifferent
different
aspectsoftheirpractice,
implement changes and monitor
implementchanges,andmonitor
themwithaviewtoimproving
serviceandpatientcare.
d
Clinical Audit
ClinicalAudit
Theaimofclinicalauditistoimprovepatient
treatment by improving professional practice
treatmentbyimprovingprofessionalpractice
andthequalityofservicesdelivered.
Thisisachievedthroughacontinuousprocess
g
p
wherebyhealthcareprofessionalsreviewpatient
careagainstagreedstandardsandmake
changes where necessary to meet those
changes,wherenecessary,tomeetthose
standards.Theauditisthenrepeatedtoseeif
thechangeshavebeenmadeandthequalityof
g
q
y
patientcareimproved.Thisisoftencalledthe
auditcycleorspiral.
Thebasicframeworkuponwhichallaudit
projectsarebased.
j
b d
Theauditcycleemphasizestheneedtocompare
onesownclinicaltreatmentwiththatcurrently
regardedastheGoldStandards
Shortcomingsareidentified,andchangeis
implementedtoimproveclinicaltreatment
p
p
Select a Topic
Implement
Change
PDSA
Observe your
Practice
(i.e. Audit)
Allguidelines,atwhateverlevel;should
g
,
;
thereforebeassessedaccordingtothelevelsof
evidence on which they are based
evidenceonwhichtheyarebased.
(SIGN)ScottishInterCollegiateNetwork
Level
TypeofEvidence
la
Evidenceobtainedfrommetaanalysisor
Evidence
obtained from meta analysis or
randomizedcontroltrials.
lb
Fromatleastonerandomizedcontroltrial
lla
Obtainedfromatleastonewelldesigned
Obtained
from at least one well designed
controlstudyw/orandomization
llb
Obtainedfromatleastoneothertypeofwell
Ob
i df
l
h
f ll
designedquasiexperimentalstudy
lll
Fromwelldesignednonexperimental
descriptivestudies,suchascomparative
studies,correlationandcasecontrolstudies
Fromexpertcommitteereportsoropinions
p
p
p
and/orclinicalexperienceofrespected
authorities
lV
Meta Analysis
MetaAnalysis
MetaAnalysis:Afurtherrefinementof
theprocess;whichusesastatistical
technique to sum up the results of several
techniquetosumuptheresultsofseveral
studiesintoasingleestimate;whilegiving
weight to larger studies
weighttolargerstudies.
Grading
g of recommendations
Grade
Recommendations
A
(Evidencelevelsla,lb)
Requiresatleastonerandomizedcontrolledtrialas
part of the body of the literature of overall good
partofthebodyoftheliteratureofoverallgood
qualityandconsistenceaddressingthespecific
recommendations
B
(
(Levelslla,
l ll llb,lll)
llb lll)
Requiresavailabilityofwellconductedclinical
studiesbutnorandomizedclinicaltrialsonthetopic
ofrecommendation
Requiresevidencefromexpertcommitteereports
oropinionsand/orclinicalexperienceofrespected
authorities.Indicatesabsenceofdirectlyapplicable
th iti I di t
b
f di tl
li bl
studiesofgoodquality
ElementsoftheEBD
5 Elements
5Elements
1.
2.
3.
4.
5
5.
Question Developingaclearquestionbasedonthepatients
clinicalproblem.
Find Findingthe latestevidencethroughefficientsearchingfor
information.
Appraise
pp
Criticallyappraisingtheevidencetoassessitsvalue.
y pp
g
Act Actingontheevidenceyoufind,ifappropriateandrelevant
totheclinicalsituation toprovidetreatmentforthepatients.
Evaluation Eachaspectofyourperformanceinthisprocesscan,
Each aspect of your performance in this process can
andshouldbeevaluatedandthisisincreasinglyrelevantwiththe
developmentofcontinuingprofessionaldevelopment
Discard
Poor Evidence
Make sense of Evidence
Update
Evidence
Store
Good Evidence
Review
cycle
WhatisGoodEvidence
BEST
Asystematicreviewof2ormoregoodrandomized
controlled trials
controlledtrials
Arandomizedcontrolledtrial
Acohortstudyy
Acasecontrolstudy
Adramaticuncontrolledexperiment
Respectedauthoritiesexpertcommittees
Someonetoldme..
WORST
RandomizedControlledTrials
Randomized
Controlled Trials
RCT
RCTsinvolvetherandomallocationofdifferent
interventions (or treatments) to subjects. This
interventions(ortreatments)tosubjects.This
ensuresthatknownandunknownconfounding
factors(externalvariables)areevenly
distributedbetweentreatmentgroups.
Trialsareusedtoestablishaverageefficacyofa
treatmentaswellaslearnaboutitsmost
frequentlyoccurringsideeffects
Aflowchartdescribingpatientprogressthroughthetrial
Truerandomizationofpatientsintotestandcontrol
True randomization of patients into test and control
groups
Shouldbeclearlyfocusedonaspecifiedintervention
y
p
Thepatient,doctorsandobserversshouldbeblindedin
regardstothetreatment
Atleast80%ofthepatientsshouldcompletethetrialto
theend