British Journal of Occupational Therapy

This article explores two common pitfalls for occupational therapists in carrying out clinical audit: failing to complete the audit cycle to bring about actual improvements in practice and confusing audit with research. Given the demanding circumstances under which most clinicians work, these problems are neither surprising nor unique to occupational therapy.

This article defines clinical audit and summarises good practice in audit. The difficulties with completing the audit cycle are explored and some solutions are suggested. The difference between clinical audit and research is discussed, with strategies for avoiding confusion.

Falls in elderly people are a major problem for health and social services because of the incidence of injury and the fear of falling as a disabling consequence (McKee 1998). It seemed that many admissions to a South Buckinghamshire day hospital for elderly people were as a result of falls.

A retrospective and concurrent caseload audit was carried out of medical and occupational therapy notes. The aim of the audit was to establish the incidence of falls among the day hospital population, with a view to improving the quality of the service. The data collected included age, diagnosis, functional ability and consequential actions. These items were included by consensus agreement following a literature review.

Fifty-six of 196 elderly people admitted over the 12-month period had fallen at least once. Of these, 73% had no apparent predisposing factor for their fall and 39% were not carrying out any obvious activity at the time; 59% had an increase in social support due to decreased confidence and mobility after the fall. A multidisciplinary team approach was reinforced and the management of patients' problems on an individual basis was to be continued. The adoption of the audit data collection form as a checklist to facilitate future assessment was recommended.

This article describes how a review was planned, executed and progressed in an occupational therapy children's service. It indicates how the terms of reference were drawn up, the methods used to gain the information required and how the review was written up in order to present it to management and other relevant personnel. It documents what the review achieved in terms of changes to the service and staff development and suggests future directions for the service.

This article documents an audit of the ward occupational therapy service in the Hartington Wing, an Acute Mental Health Unit in Chesterfield and North Derbyshire Royal Hospital NHS Trust. A revised service based on ‘open-door’ groups aims to make occupational therapy more accessible at the point of admission and more responsive to changing needs, and it drew praise at the unit's last visit from the Mental Health Act Commission.

The findings of the audit demonstrate increased uptake of occupational therapy, with patient contacts almost doubling and the time taken from referral to first patient contact being significantly reduced. The ward nursing staff were positive about the changes but their perception of the occupational therapist's role in ward group programmes remains unclear.

To reflect on clinical effectiveness and revise practice to ensure quality of patient care, the Community Occupational Therapy Service in Leicester developed an individualised outcome measure and audit system. Audits were undertaken in 1997 and 1998 and the results showed a positive outcome in 88% and 90% of individual goals respectively. Improvements to practice achieved through auditing the outcomes of occupational therapy were increased patient involvement in goal setting, improved documentation and treatment planning and positive marketing of the service to general practitioners.

This document outlines the College of Occupational Therapists' position on clinical governance. It is recommended that it be read in conjunction with relevant College of Occupational Therapists' documents and papers which outline the Government's intentions in relation to quality in health and social services. These are given as further reading at the end of this document.

Clinical governance is a framework for combining a full range of quality activities, building first upon what is already being carried out. It is being implemented in the National Health Service from April 1999. What is it? What will it mean for occupational therapists working not only in health but also in all other sectors?

This paper has been written to explain this new Government initiative and to coincide with the publication of the College of Occupational Therapists' Position Statement on Clinical Governance (COT 1999a). Government policy on quality is explained in brief, along with the responsibilities of occupational therapy practitioners and managers. A table is provided to help therapists clarify what is already in place and what areas need to be addressed.

People with rheumatic diseases often require an assistive device at some stage to enable them to carry out their normal activities of daily living without placing undue strain on their affected joints. Up till 1995, most assistive devices in Fife were provided through statutory provision via the Fife Social Work Service. However, the Fife Rheumatic Diseases Unit (FRDU) occupational therapists felt that the speed of the supply did not match patient need.

An 18-month audit was set up to establish the current situation and to seek an appropriate intervention which would minimise the delays in patients obtaining these devices. The first audit showed that patients waited an average of 39 days for an assistive device. The FRDU then took on the direct supply of consumables and the second audit showed that waiting times were reduced to an average of 21 days, an improvement of 18 days.

Pain in the elbow impinges on many activities of daily living, both at work and at home, and can severely limit the ability to cope. This article demonstrates the use of a small, practical orthosis, made to measure to relieve lateral and medial epicondylitis, better known as tennis or golfer's elbow. An audit showed that for 84% of the 52 patients who responded, the use of the clasp was considered a success in both the short-term and the long-term results.

Occupational therapists working in care of the elderly assessment units and geriatric orthopaedic rehabilitation units throughout Lothian Health devised an audit project to develop a timescale for organising home assessment visits. The aim was to formulate an achievable and realistic standard which could be adopted for use throughout the area. A steering group organised a 4-week survey of practice to determine how long it takes to organise a home assessment visit. The results showed that 86% of home assessment visits were organised within 5 working days. A standard was subsequently drafted based on these results. A 3-month audit of the standard was then carried out to determine if any exceptions were required.

Following a home assessment visit, a written report is completed and filed in the patient's medical notes. A period of 2 days between the date of the visit and filing the report is the commonly held standard throughout Lothian Health. This standard was examined concurrently with the above. The results showed that 88% of visits were organised within 5 working days and 61% of reports were filed within 2 working days. Both the standards are currently being reaudited but full results are not yet available.

This article examines the use of a quality correction cycle and clinical audit to investigate the issues surrounding the provision of information with the supply of equipment to clients in their homes to promote independence and safety. An analysis was undertaken, adopting a model of quality with a grounded demonstration of clinical audit which informed the process of potential for change.

The findings demonstrated that a low level of information given at the time of issue of equipment resulted in poorly fitting equipment, with some safety issues around the continued use of the equipment. As a result of this audit, the benefit of a working party to examine and implement standards for the provision of information with equipment issue has been raised with management, with an intention to reaudit. It is acknowledged that clinical audit must be viewed as a positive tool in promoting clinical effectiveness, which must be driven multiprofessionally and from the client's perspective.

Historically, Perth and Kinross Social Services supplied every total hip replacement patient with a ‘hip pack’ containing a raised toilet seat, a helping hand, a long-handled shoe horn and a sock/tights aid. This pack was issued by the hospital occupational therapist prior to discharge. In January 1996 the funding for this equipment was withdrawn. This move obstructed the hospital-based occupational therapists from achieving the standard practice that ‘all patients will be provided with a hip pack prior to discharge’. The hip pack should be used for 6–12 weeks postoperatively to reduce the risk of dislocation. These standards are in agreement with guidelines in James (1992). The occupational therapy department was concerned that patients would be at greater risk of dislocation if this equipment was not provided. A variety of options were considered to overcome this, including patients purchasing their own equipment or the hospital trust funding a loan service.

In order to support these proposals an audit was carried out with three main aims: (i) to assess whether the hospital occupational therapists were meeting the standards by providing every total hip replacement patient with equipment from a hip pack; (ii) to assess whether the standard statement that the hip pack equipment should be used for 6–12 weeks was an appropriate time scale for patients; and (iii) to obtain the patient's perspective on the proposals being explored to continue to meet the standards.

There was an 85% (63/74) response rate and the results of the audit highlighted how important the equipment was to the patient. The time each item was used for varied, but many were still in use 6 months postoperatively. Due to budget constraints, patients were also asked if they would purchase some of the equipment; 51 (93%) of the 55 respondents stated that they would have purchased at least one item in the hip pack. The standards were nearly but not fully met. This was due to the lack of flexibility in the standards not acknowledging that some patients would not need equipment.