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Results for “Management Audit”

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At least 451 records · Page 25Linked to original sources
PubMed1997

Interpractice audit of diagnosis and management of hypertension in primary care: educational intervention and review of medical records.

OBJECTIVE: To determine whether peer review medical audit in a primary care setting changes clinical behaviour in relation to the management of hypertension. DESIGN: Review of medical records in general practices to identify hypertensive patients followed up by assessment of the pre-educational and post-educational management of interventions. SETTING: Six general practices in north west London picked at random within defined criteria of geography and size. SUBJECTS: 740 hypertensive patients managed by 25 different general practitioners. MAIN OUTCOME MEASURES: Improved level of care in terms of better diagnosis by having at least three blood pressure readings before the start of drug treatment, better level of recordings of lifestyle parameters as shown by the level of recordings of body mass index and total lipid values, and better control of blood pressure and harm minimisation as shown by the level of recordings of urea and electrolyte values. RESULTS: Improvement was noted in the level of recordings of body mass index, total lipid concentrations, and urea and electrolyte values but not in better diagnosis or blood pressure control. CONCLUSION: Clinical behaviour of general practitioners can be changed by peer review but more complex behavioural changes which require the cooperation of the patients and cognitive actions by the general practitioners need further investigation.

Blood Pressure Determination↗
PubMedDate not supplied

Iso 19011:2002--a combined auditing standard for quality and environmental management systems.

In a precedent-setting decision in 1998, the International Organization for Standardization (ISO) directed ISO Technical Committee (TC) 176 on Quality Management and ISO TC 207 on Environmental Management to develop jointly a single guideline standard for auditing quality and environmental management systems. When approved, this standard would replace ISO 10011-1, ISO 10011-2, and ISO 10011-3 on quality auditing and ISO 14010, ISO 14011, and ISO 14012 on environmental auditing. A Joint Working Group (JWG) was established comprising experts from both TC 176 and TC 207 to develop the new standard, ISO 19011, Guidelines on Quality and/or Environmental Management Systems Auditing, and to incorporate lessons learned from efforts to improve compatibility between ISO 9001/9004 and ISO 14001/14004, the standards for quality and environmental management systems, respectively. Work is proceeding on the development of ISO 19011 with an expected completion in early 2002.

Environmental Monitoring↗
PubMed2000

Audit of cancer pain management in a cancer centre.

Despite the availability of effective methods of controlling pain, many patients continue to receive inadequate pain relief. An audit was carried out on a single day to identify the prevalence, severity and management of cancer pain in adults in the two teaching hospitals in the Nottingham Cancer Centre. Of 186 patients with cancer, 52 had experienced pain as a result of their cancer during their admission. Of these 52 patients, 47 were assessed. More than half had unrelieved pain that was 'severe' at it s worst and interfered greatly with activities. Compared with patients whose pain had been relieved, patients with uncontrolled pain were likely to have spent less time in hospital, to have not had a formal assessment or reassessment of their pain and not to have a pain-care plan in the nursing notes or to have been seen by the hospital specialist palliative care team. We use our results to highlight areas of good practice, to identify where improvements could be made, and to inform the development of local standards and future audits.

Aged↗
PubMed2006

Protecting the environment: the role of environmental management systems.

Environmental management and auditing systems are increasingly important. They have significant roles to play in relation to environmental protection, workplace safety and public health. Businesses and non-commercial organisations adopt such systems for a variety of reasons. The extent to which they are used varies very considerably between developed countries. The effectiveness of national regulatory systems seems to be a major factor. In the United Kingdom environmental regulators have traditionally sought the voluntary compliance of businesses. This strategy is closely associated with the near absence of administrative penalties. It seems that a wide range of environmental administrative penalties will be introduced in the near future. This may greatly encourage more firms to introduce environmental management and auditing systems.

Certification↗
PubMed1994

Audit of upper limb fracture management in an accident and emergency department.

The objective of this study was to audit the initial management of patients with upper limb fractures, and to determine whether the accident and emergency (A&E) management of fractures is improved by using guidelines for treatment and referral. This was achieved by comparing the standard of treatment, as determined by fracture clinic doctors, before and after the introduction of fracture treatment guidelines in the A&E department of a London teaching hospital. A total of 326 patients seen in the department and referred to the fracture clinic over two 2-month periods were included in the audit. The first audit revealed some error in 69/215 (32.1%) referrals and 51/215 (23.7%) of these were potentially liable to increased morbidity. After introducing the guidelines the total errors fell to 14/111 (12.6%) patients referred, of which only eight patients (7.2%) were at risk of increased morbidity. This represents an overall improvement of 19.5% [95% confidence interval (CI) 12.3 to 29.7%] and a 16.5% (95% CI 9.1 to 23.9%) reduction in the potentially more significant errors. Hence, the use of audit and implementation of simple guidelines for fracture management in an A&E department improves the standard of treatment.

Arm Injuries↗
PubMed1994

An audit of the assessment and management of patients admitted to Christchurch Hospital with chronic obstructive pulmonary disease.

AIM: To audit the assessment and management of patients admitted to hospital with chronic obstructive pulmonary disease (COPD) during three months of the winter of 1992. METHODS: Consensus management guidelines were developed as the basis for the audit. Consecutive cases were audited by review of the case notes. Half were admitted initially under a respiratory physician and half under a general physician. Ninety-five cases were audited. RESULTS: The overall standard of medical assessment was adequate but a number of deficiencies were identified. The mean duration of stay in hospital was nine days. In the emergency department the use of pulse oximetry in preference to arterial blood gas analysis led to failure to diagnose significant ventilatory failure in five cases. Initial assessment by junior medical staff failed to include comment about level of consciousness in 50% of cases and chest hyperinflation in 40%. Oxygen therapy was given in 87% of cases, but was not prescribed in one third and was often not adequately monitored. Peak flow monitoring was performed on admission in 74% of cases and arterial blood gas measurement in 81%. Over 90% of patients were given nebulised bronchodilator therapy with both nebulised ipratropium bromide and salbutamol. Antibiotics were given in 77% of cases. Corticosteroids were given in 95% of cases, usually orally. Sedatives were prescribed inappropriately in six cases where there was acute ventilatory failure. Four patients died in hospital, none unexpectedly. Three patients were mechanically ventilated and all survived to leave hospital. There was no discharge summary in the case records in 29% of cases. CONCLUSIONS: Standards of assessment and treatment were adequate. Several areas were identified where improvements are required, particularly in the prescribing and monitoring of oxygen therapy. Hospital-wide guidelines for the management of COPD are to be developed.

Adrenal Cortex Hormones↗
PubMed1996

Rectal perforation after retropubic radical prostatectomy: occurrence and management.

OBJECTIVES: A surgical audit of the management of rectal perforations during retropubic radical prostatectomy. Assessment of incidence, risk factors, management and outcome. METHODS: All 10 cases (3.6%) sustaining a rectal injury of a total series of 270, while undergoing retropubic radical prostatectomy at our 2 institutions were reviewed. In all cases, the injury was immediately recognized and treated by primary suture, anal dilatation and antibiotics. In 1 case, a temporary colostomy was performed. RESULTS: Recovery was uneventful in all cases, and the postoperative hospitalization was only slightly longer than usual in the 9 cases without fecal diversion. No fistulae or wound infections occurred, but closure of 1 colostomy was complicated. CONCLUSION: Provided that the injury is promptly recognized and properly sutured, a rectal perforation at radical prostatectomy is not of great significance and should not deter from an adequate preoperative investigation by multiple transrectal core biopsies or neoadjuvant hormonal treatment. The use of preoperative bowel preparation, routine antibiotic prophylaxis, omental interposition or a proximal colostomy does not appear to be necessary in order to achieve immediate safe repair.

Aged↗
PubMed1997

Environmental auditing in hospitals: approach and implementation in an university hospital.

Medical audit in infection control today is accepted as an important element in the quality assurance of health care. In contrast, environmental auditing, which was approved in 1993 by the Council of the European Communities for industry ("Eco-Management and Audit Scheme-EMAS), has not so far been used as a tool to control and reduce environmental pollution caused by medical care in hospitals. The aim of this study was to investigate, whether environmental auditing in hospitals is useful. This process should also be cost effective. In this paper, methodological and organizational issues are described. Initially an environmental review of activities at the University Hospital, Freiburg and an eco-analysis of the input and output were performed. The first results of the study and a critical discussion will be presented in another paper.

Conservation of Energy Resources↗
PubMedDate not supplied

First episode of psychosis - an audit of service engagement and management at 1-2 year follow-up.

BACKGROUND: The study aimed to develop and implement local audit standards for management and service engagement in the follow-up of patients suffering from a 'first episode of psychosis'. MATERIAL AND METHODS: Audit standards, developed following a literature review and consultation with colleagues, were incorporated into a questionnaire for distribution to the community keyworkers of a 'first episode of psychosis' cohort at 1-2 years of follow-up. RESULTS: Most satisfied standards for engagement (91%) and maintenance medication (91%). Forty-two to sixty-three per cent had received psychological, family and educational interventions but these often lacked theoretical basis and detailed content. Admission, deliberate self-harm and forensic contacts were infrequent. Less than half had any structured daytime activity. Priorities identified for improving services for this group include adequate staff training in psychosocial interventions and more active planning and resourcing of day care and other constructive daytime activities. CONCLUSIONS: Simple locally-developed audit standards such as those described for a 'first episode of psychosis' population can offer a useful way of assessing service delivery and highlighting areas for development.

Cohort Studies↗
PubMed2004

Pragmatic 'real world' study of the effect of audit of asthma on clinical outcome.

AIMS: To test whether participation in clinical audit is associated with improved care of a long-term health condition. METHODS: 'Real world' study comparing 1339 patients of all ages and severity of asthma managed by 77 self-selected highly motivated general practices in Scotland with 9617 patients from 319 practices from a national sample. RESULTS: Patients managed by 'audit' practices had more structured clinical reviews by nurses [817 (61%) versus 4301 (45%) OR 0.52, 95% CI 0.46-0.58] and less acute GP contacts [440 (33%) v 4161 (43%) OR 1.56, CI 1.38-1.56]. Consequently they experienced more checking of inhaler technique, use of peak flow meters and self- management plans. 'Audit' patients had more symptom free days [365 (42%) v 2216 (23%) OR 0.80, CI 0.70-0.91], and fewer asthma attacks [217 (16%) v 1938 (20%) OR 1.30, CI 1.12-1.53]. They made less use of hospital services including A&E [30 (2%) v 326 (3%) OR 1.53, CI 1.03-2.28] and outpatients [42 (3%) v 459 (5%) OR 1.55, CI 1.11-2.16]. CONCLUSIONS: Patients with asthma benefit from being managed by a practice involved in a programme of audit.

Journal Article↗