Effective audit can improve service quality and build the evidence base

Audit is vital for patient care and safety and for the development and improvement of pharmacy practice. In addition, the Government is keen to promote and expand clinical audit activity, particularly since it resonates with the current QIPP (quality, innovation, productivity and prevention) programme for services to become more efficient and effective and to deliver better care outcomes, prevent waste, save money and offer a high quality of care. With the increasing emphasis on service evaluation as commissioning changes, there is a need to be able to demonstrate a positive impact on health outcomes and value for money for the NHS.^[1]

Audit is an ideal tool to demonstrate the value of the services pharmacists provide to the NHS, look at ways to make improvements, and make evidence-based arguments for the commissioning of new services and the continuation of existing ones.

In Short reports, two methods of audit are compared in order to illustrate the detailed information that can be obtained through effective audit. Traditional audit is compared with the IMPACT audit, developed by Josie Solomon at De Montfort University School of Pharmacy, Leicester, as a tool to incorporate patients’ and other stakeholders’ views in the audit process.

Traditional audit uses standards against which performance can be measured, and subsequently implements changes as a result of the audit.^[2]
In this new model an additional step (the IMPACT section) is added which identifies the perspectives of stakeholders before continuing with the traditional audit cycle. In order to compare these methods of audit, the two articles by Solomon and Harrison describe audits conducted in the same pharmacy, on “prescription owings”, using both methods (traditional and IMPACT).

The traditional audit focused on the number of owings as a percentage of total items dispensed and the reasons for stock problems. The IMPACT audit also used these criteria but additionally identified the costs of owings to the pharmacy (£19 per week for extra deliveries) and highlighted that uncollected items raised concerns around adherence, with the potential consequences of adverse clinical outcomes and wastage of NHS resources.

The traditional method of audit used the clinical governance essential service section of the community pharmacy contract as the motivation behind conducting the audit. This recognises that owed medicines are not only a service issue, but also a clinical governance issue. It falls short; however, from defining why it is a clinical governance issue and what the ramifications of owed medicines are. Furthermore, while it categorises owing items, it does not sufficiently take into account the complexities of the current pharmacy market, not only in terms of supply issues, but also in terms of commercial decisions that contractors need to make in order to run a viable business service.

Incorporating the IMPACT process into the audit highlighted the issues of patient adherence, wastage of NHS resources through unused medicines, and the business costs of owed medicines, which were not addressed using traditional audit. So it appears that IMPACT is a useful tool in audit that facilitates incorporation of the patient perspective into service improvement and makes audit results more meaningful.