Clinical Audit - Setting The Standard
The Proposed Standard - original (2001) NHS guidance:
Guidance: The standard to be audited against. It should be realistic and measurable
Lack of a suitable standard is the commonest weakness of GDS clinical audits.
Here are some examples of poor standard setting:
That 100% of patients have written evidence of the full medical history having been taken at every check-up visit.
Although laudable, this is not measurable unless every single patient at your practice is included in the audit. A '100%' standard demands a 100% sample size, which is usually not practical.
That 95% of all radiographs will be clinically satisfactory.
If what you mean by 'clinically satisfactory' is not exactly stated in the application, the LAP cannot make a judgement on the chosen standard.
That 90% of our root fillings will meet the standards set in SAMS
For the standard to be considered by the LAP, journal references are not sufficient. The actual standard must be stated in the application.
That at least 20% of bitewings will be excellent, at least 70% satisfactory, at most 9% unsatisfactory, at most 1% poor.
This standard may be unnecessarily complicated. Perhaps it should be changed to: "at least 90% of bitewings will be clinically satisfactory for diagnosis".
I will design a standard based on the source material listed and in consultation with the other dentists in the practice which will then become our ‘gold standard’ for note keeping.
The LAP can not consider applications 'in principle'. The standard must be explicitly stated.
Here are some acceptable examples:
That all staff in clinical contact with patients will have current evidence of immunity to Hepatitis B.
Because the number involved is small, a 100% standard is OK here
That 66% of ID blocks will work first time
Although this may seem low, it is not the job of the LAP to make judgements on the standard you choose to set yourself.
That 85% of patients should report a reduction in anxiety levels at the end of treatment compared with the start.
Next: Setting The Sample Size
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