Nursing Law and Ethics

participate in internal and external clinical audit systems. Clinical audit will pro-
vide a comprehensive framework for quality improvement activity and processes
for monitoring clinical care using effective information and clinical record sys-
tems. It provides a formal approach to questioning clinical practice and to devel-
oping new practices and to ensuring they meet continuous quality improvements
and clinical outcomes. It considers the effectiveness, efficiency and humanity of
care and can be used to enhance education and develop clinical excellence in
dealing with the structure, process and outcomes of health care.
An effective clinical audit programme helps to give necessary reassurance to
patients, clinicians and managers that an agreed quality of service is being pro-
vided within available resources. It is performed to improve standards of care, to
raise awareness of costs, to eliminate waste and inefficiency, and as a valuable
educational tool for peers, juniors and other professionals. It is an educational
process for clinicians, identifying inappropriate and inefficient clinical practices
and inadequate support. It can lead to increased consumer awareness and choices
about health care, as information becomes more readily available about clinical
activity, quality of services and health outcomes. Clinical audit has an important
role in risk management in revealing where care is ineffective or below acceptable
standards and in encouraging its replacement with effective care and improved
clinical outcomes.
Clinical audit 9see Fig. 11.3) through the monitoring of standards and best
practice can assist clinicians in having robust processes for the identification of
effectiveness, efficiency and appropriateness of the clinical care provided. The
clinical governance involvement occurs when standards are not met or best
practice is not being applied and it is all about having interventions to fix the
problem through internal scrutiny. This will also be supplemented by open and
external review and participation in national audit programmes including speci-
ality and subspeciality national external audit programmes endorsed by the
Commission for Health Improvement. Clinical governance places a duty of
responsibility on all health care professionals to ensure that care is satisfactory,
consistent and responsive; each individual will be responsible for the quality of
their clinical practice as part of professional self-regulation. It will strengthen the

What should we

be doing?

Have we made

things better?

Are we doing it?

Continuous Process

Doing something

to fix the problems

Why aren't we

doing it?

Clinical Governance

Fig.11.3 Clinical audit: monitoring standards and best practice. J.H. Wilson, 1999.

Clinical Governance 237