Audit is now generally subsumed under the heading 'Clinical Governance' - a term which is becoming increasingly familiar to optometrists, and less of an imposition on their time as it once seemed to be. Clinical Governance will probably turn out to have the single most important influence on how clinicians work inside and outside the NHS in the years to come. It is unlikely that any other aspect of government intervention will have a greater impact on the lives and working habits of those in healthcare.
Clinical Governance has to do with the delivery of high quality clinical services and audit procedures are an integral part of this process. It makes clinical quality an integral part of the NHS governance framework. Clinical Governance has had a higher profile following the problems associated with heart surgery in Bristol, and apparent failures in cervical screening programmes. Public safety is a key aim.
Health professionals will continue to have the right of exercising individual clinical judgement and the Royal Colleges and the statutory bodies will continue in their role for professional self-regulation. Participation in Clinical Governance will become a requirement of practice in the NHS, and should be equally applicable to private work.
The main purpose of clinical governance is to support clinical staff in improving quality of care, it will also ensure that wherever possible poor clinical performance is detected and acted upon.
Clinical governance does not replace an optometrist’s clinical decision making; independent clinical judgement is retained and considered vital. The aim of clinical governance is to put systems in place within which this judgement is exercised so as to reduce the possibility of poor performance and to ensure that wherever possible problems are remedied before they get out of hand. Much of this will relate to the organisation and management of clinical services rather than to individual clinical decisions.
In optometry the following are all aspects of clinical governance:
Please see some examples of audit in the pdf documents or links to abstracts on the right of the page, along with the audit framework document which was produced by the College of Optometrists to guide practitioners through the audit process. Some of the documents may take time to open, but they are there, really !
We are grateful to the journals who originally published some of this information, for the opportunity of reproducing it here on our website.
The audits of the South Wales diabetic screening scheme was published by Optician, February 28, 2003, No 5890, Vol 225, as was the PEARS scheme on February 15, 2002, No 5838, Vol 223. These can also be accessed through their archive website www.optometryonline.net We are grateful to OPTICIAN for allowing us to reproduce this information.
The audit of the effectiveness of optometric involvement in diabetic retinopathy screening using slit-lamp bio was originally published in Eye, 2001, October.
The audit of the optometric screening programme in St Helen's was published in Diabetic Medicine, 19, 741-745, 2002, by the Diabetes Centre, Whiston Hospital and the Prescot & Rennie Eye Clinic, St Helen's Hospital.
The audit of GP ophthalmology referrals was produced by Crewe & District & Central Cheshire PCGs in September 2001.
The audit of acute eye conditions in North Staffordshire was produced by the North Staffordshire Medical Audit Advisory Group.
The audit of the Manchester-based glaucoma referral refinement scheme was published by Eye (2003), 17, 21-26.
The survey of patient/GP satisfaction in the North Staffordshire diabetes shared care scheme was published by OT, October 17, 2003.
The audit of the pilot scheme of direct cataract referrals in Leeds was produced by the South & West Leeds Community Eye Centre, as was the patient focus group report, in 2002.
The photographic study of diabetics, comparing SL-BIO and camera based screening, was published by OT, Oct 19, 2001.
The patient survey of post-operative cataract care in Stockport, was published by OT, May 19, 2000.
The audit of the diabetic retinopathy screening scheme in Newham, London was produced by John Bryan, East London & City LOC, in February 2003.
The audit of the cataract direct referrals scheme was produced by Cambridgeshire LOC in 2003.
The audit by the former North Charnwood PCG of a GP ophthalmic referrals to optometrists' scheme, which was published in December 2003.
The evaluation of the Glasgow Integrated Eyecare Service was produced in 2003, as were the results of the patient questionnaire and the GP questionnaire.
The audit of patients who have had diabetic retiopathy screening at Epsom General Hospital (East Elmbridge & Mid-Surrey PCTs), 2002.
Abstract of the evaluation of a local optometric diabetic retinopathy screening service [in Stockport], published in Diabetic Medicine Vol 21 Issue 6 Page 632 June 2004.
