Clinical Audit Proposal Template: A Guide for NHS Teams

Why this topic matters

Effective clinical audit proposals are crucial for several reasons:

• Clarity and Focus: A well-structured proposal helps to clarify the audit's objectives, scope, and methodology, preventing scope creep and ensuring a focused approach.
• Approval and Resources: It is often a mandatory requirement for gaining approval from audit departments, clinical governance committees, and securing necessary resources (e.g., data access, protected time).
• Stakeholder Engagement: A compelling proposal can engage key stakeholders, including clinical colleagues, managers, and patients, facilitating their support and participation.
• Mitigation of Risks: By systematically planning the audit, potential challenges related to data collection, analysis, and implementation can be identified and addressed proactively.
• Trainee Development: For trainees, developing an audit proposal is a critical learning experience, building skills in project management, data analysis, and quality improvement.

Practical explanation: Components of a strong audit proposal

A robust clinical audit proposal typically includes several key sections, each contributing to the overall clarity and feasibility of the project. While local audit departments may have specific proformas, the core components remain largely consistent.

Title

• What it is: A clear, concise, and informative title that accurately reflects the audit's focus.
• Why it matters: It is the first impression and helps stakeholders quickly grasp the audit's subject.
• Considerations: Include the clinical area, the specific aspect being audited, and sometimes the patient group (e.g., "Audit of Venous Thromboembolism Prophylaxis in Elective Orthopaedic Patients at [Hospital Name]").

Background and Rationale

• What it is: Provides context and justification for the audit. Why is this audit necessary? What problem are you trying to address?
• Why it matters: Establishes the importance and relevance of the audit, linking it to patient safety, clinical effectiveness, or patient experience.
• Considerations: Refer to national guidelines (e.g., NICE, Royal Colleges), local incident reports, previous audits, or identified service gaps. Quantify the problem where possible (e.g., "[X]% of patients..." or "[Y] incidents reported...").

Aim(s)

• What it is: A broad statement of what the audit intends to achieve.
• Why it matters: Provides an overarching goal for the project.
• Considerations: Typically one or two sentences. For example, "To assess compliance with national guidelines for antibiotic prescribing in community-acquired pneumonia."

Objective(s)

• What it is: Specific, measurable, achievable, relevant, and time-bound (SMART) statements that outline the steps to achieve the aim.
• Why it matters: Objectives guide the data collection and analysis, making the project tangible and evaluable.
• Considerations: Usually 2-4 objectives. Use action verbs (e.g., "To determine the proportion of patients who received...", "To identify variations in practice regarding...").

Audit Standards and Criteria

• What it is: The explicit criteria or benchmarks against which current practice will be measured.
• Why it matters: Provides the reference point for comparison, indicating what 'good' or 'expected' practice looks like.
• Considerations: Should be derived from recognised sources such as NICE guidelines, Royal College guidelines, local policies, or established evidence. State the source and the target percentage (e.g., "All patients undergoing hip replacement should receive VTE prophylaxis within 12 hours of surgery [NICE NG89, target 100%]").

Methodology

• What it is: A detailed description of how the audit will be conducted.
• Why it matters: Ensures reproducibility and demonstrates a rigorous approach.
• Considerations:
  • Study Population: Who will be included/excluded? (e.g., all adult patients admitted to Ward X within a specific timeframe).
  • Sample Size: How many patient records will be reviewed? Justify the sample size (e.g., power calculation, practical limitations, previous audits). Discuss how the sample will be selected (e.g., consecutive, random).
  • Data Collection: What data will be collected? From where (e.g., electronic patient records, paper notes, theatre registers)? How will data be collected (e.g., bespoke proforma, electronic data extraction)? Provide a sample data collection form if possible.
  • Data Analysis: How will the data be analysed? (e.g., descriptive statistics, comparison of proportions, identification of themes). Specify software if applicable (e.g., Excel, SPSS). Will anonymised data be used?
  • Ethical/Governance Considerations: State that the project is a clinical audit and does not require REC approval. Mention local audit department registration and Caldicott Guardian principles for data protection.

Resources Required

• What it is: An outline of the personnel, time, and other resources needed.
• Why it matters: Helps in planning and gaining management support.
• Considerations: List team members and their roles, estimated time commitment for data collection/analysis, software, and any other specific requirements.

Timeline

• What it is: A proposed schedule for key stages of the audit.
• Why it matters: Provides a roadmap and helps manage expectations.
• Considerations: Include dates for proposal approval, data collection, analysis, report writing, presentation of findings, and implementation of recommendations.

Dissemination and Recommendations

• What it is: How will findings be shared, and what form will recommendations take?
• Why it matters: Ensures the audit findings lead to meaningful change.
• Considerations: Plan for presenting results at departmental meetings, governance committees, and potentially regional/national conferences. Recommendations should be SMART, actionable, and address the identified gaps against the standards. Outline the re-audit strategy.

References

• What it is: A list of all documents and guidelines cited.
• Why it matters: Provides credibility and allows others to verify sources.

Common pitfalls

• Vague Objectives: Without clear, measurable objectives, it's difficult to know what to collect and if the audit was successful.
• Unrealistic Scope: Trying to audit too many areas or a prohibitively large number of patients can lead to project stagnation.
• Lack of Justification: Not clearly articulating why the audit is important can lead to a lack of buy-in or rejection from approvals committees.
• Poorly Defined Standards: Using subjective or unreferenced standards makes the audit findings difficult to interpret or act upon.
• Insufficient Resources/Time: Underestimating the time and personnel required is a common cause of audit failure.
• Ignoring Local Governance: Failing to engage with the local audit department from the outset can lead to delays or require significant rework.

A Step-by-step approach to using the template

1. Identify a Clinical Area for Improvement: This could be based on personal observations, incident reports, patient feedback, or national priorities.
2. Conduct a Literature Review: Look for national guidelines, previous audits, or evidence-based practice in your chosen area to inform your standards.
3. Consult Locally: Speak to your clinical supervisor, audit lead, or senior nursing staff to refine your idea and gain initial support.
4. Draft Your Proposal: Use the template below as a guide, filling in each section systematically. Pay particular attention to making your objectives and standards SMART.
5. Seek Feedback: Share your draft with colleagues, supervisors, or the audit department for constructive criticism.
6. Submit for Approval: Follow your trust's specific process for submitting clinical audit proposals.
7. Iterate and Refine: Be prepared to revise your proposal based on feedback from the audit committee.

Clinical Audit Proposal Template

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1. Project Title:

[Clear, concise, and informative title, e.g., "Audit of compliance with NICE guideline NGXX for the management of Adult Patients with [Condition] in [Department/Ward] of [Trust Name]"]

2. Lead Auditor(s):

[Name(s), Role(s), Department(s)]

3. Clinical Supervisor (if applicable):

[Name, Role, Department]

4. Date of Proposal Submission:

[DD/MM/YYYY]

5. Background and Rationale:

[Provide context for the audit. What is the current situation? Why is this area important? What issues or variations in practice have been identified? Reference national guidelines, local data, or previous audits. (Approx. 200-300 words)]

6. Aim(s):

[Broad statement of what the audit intends to achieve. (1-2 sentences)]

7. Objective(s):

[Specific, Measurable, Achievable, Relevant, Time-bound (SMART) statements. What specific questions will the audit answer? (Usually 2-4 objectives)]

• To determine the proportion of...
• To identify any variations in...
• To assess the documentation of...

8. Audit Standards and Criteria:

[List the explicit standards against which practice will be measured. For each, state the source (e.g., NICE guidance, Royal College recommendation, local policy) and the desired target percentage.]

• Standard 1: [Criterion statement, e.g., "All patients receiving intravenous antibiotics should have allergies clearly documented in their medical notes."]
  • Source: [e.g., Local Medicines Policy, BNF]
  • Target: [e.g., 100%]
• Standard 2: [Criterion statement]
  • Source: [Source]
  • Target: [Target]

9. Methodology:

a. Study Population:

[Describe the patient group. Inclusion and Exclusion criteria. (e.g., "All adult patients (≥18 years) admitted to Ward X between [Start Date] and [End Date] who received intravenous fluids. Patients admitted for day-case procedures will be excluded.")]

b. Sample Size:

[How many records will be reviewed? Justify the sample size. How will the sample be selected (e.g., consecutive, random sampling)? (e.g., "A consecutive sample of 50 patient records from the specified period will be reviewed. This sample size is pragmatic given previous audit cycles and expected data yield.")]

c. Data Collection:

[What data will be collected? From where? Who will collect it? How will it be collected (e.g., bespoke proforma, electronic data extraction)? (A sample data collection proforma should ideally be appended).]

d. Data Analysis:

[How will the collected data be analysed? What statistical methods will be used (e.g., descriptive statistics, percentages)? Which software will be used (e.g., Microsoft Excel)? How will data be anonymised and handled securely?]

e. Ethical and Governance Considerations:

[State that this is a clinical audit and as such, does not require NHS Research Ethics Committee approval. Confirm adherence to Trust Information Governance policies, Caldicott Principles, and Data Protection Act 2018. State that the audit will be registered with the local Clinical Audit Department.]

10. Resources Required:

[Personnel, time commitment, software, access to clinical systems, etc.]

• Personnel: [e.g., Lead Auditor Name (X hours), Data Collector Name (Y hours)]
• Time: [e.g., 2 weeks for data collection, 1 week for analysis]
• Other: [e.g., Access to Electronic Patient Record, Microsoft Excel]

11. Timeline:

[Proposed schedule for the audit lifecycle]

• Proposal Submission/Approval: [Start Date] - [End Date]
• Data Collection: [Start Date] - [End Date]
• Data Analysis: [Start Date] - [End Date]
• Report Writing: [Start Date] - [End Date]
• Presentation of Findings: [Date]
• Implementation of Recommendations: [Ongoing]
• Re-audit: [Date/Timeframe (e.g., 6-12 months after implementation)]

12. Dissemination and Recommendations:

[How will the findings be shared? What types of recommendations are anticipated? How will implementation be monitored?]

• Dissemination: [e.g., Presentation at departmental meeting, Clinical Governance meeting, Trust Clinical Audit Day]
• Anticipated Recommendations (Examples):
  • Development of a new local guideline.
  • Targeted training for staff.
  • A change to the electronic patient record system.
• Monitoring and Re-audit Strategy: [e.g., A re-audit will be conducted within 6-12 months to assess the impact of implemented changes.]

13. References:

[List all cited guidelines, policies, and literature using a consistent referencing style.]

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This template supports, but does not replace, clinical judgement. Local policy, formulary, and specialist advice should be followed. Always consult your Trust's Clinical Audit Department for specific requirements and support.

Example in clinical practice: Audit of Delirium Screening in Older Adults

Consider a junior doctor on a busy care of the elderly ward. They notice that while staff are excellent at recognising overt delirium, formal screening tools aren't consistently used for all at-risk older patients. Inspired by national guidelines and local incident reports highlighting missed delirium diagnoses leading to poorer outcomes, they decide to conduct an audit.

Using the template, they draft a proposal:

• Title: Audit of Compliance with NICE Guideline NG103 on Delirium Screening in Patients Aged ≥65 Admitted to [Ward Name], [Trust Name].
• Background: Details the impact of delirium, national prevalence data, and how formal screening improves early detection. References NICE NG103.
• Aim: To assess current practice in delirium screening against NICE guidelines.
• Objectives: 1) To determine the proportion of patients aged ≥65 admitted to [Ward Name] over a 4-week period who received a formal delirium screen (e.g., 4AT, CAM) within 24 hours of admission. 2) To identify factors associated with non-compliance.
• Standards: "All patients aged ≥65 admitted to an acute hospital setting should be screened for delirium risk using a validated tool within 24 hours of admission (NICE NG103, target 90%)."
• Methodology: Retrospective review of 50 consecutive patient notes from the specified period. Data points: age, admission date, delirium risk factors, use of screening tool, date/time of screen, result. Data recorded on a bespoke proforma. Descriptive statistics in Excel. Consent from audit department obtained.
• Timeline: Data collection (2 weeks), analysis (1 week), report (1 week), presentation at ward meeting.
• Dissemination/Recommendations: Present to ward staff. Propose mandatory training on 4AT, integrate 4AT into the electronic clerking proforma, re-audit in 6 months.

This structured approach supports the doctor in developing a clear, justified, and feasible audit, increasing its chances of approval and successful completion.

How Lazomis can help

While Lazomis does not produce clinical content or substitute for local audit department advice, our platform can support the execution and management of your clinical audit once the proposal is approved:

• Lazomis QI Project Setup: This tool can help you structure your approved audit project, defining roles, timelines, and action plans, ensuring all team members are aligned with the proposal's objectives.
• Lazomis Data Collection Forms: You can build customisable, digital data collection forms within Lazomis, mirroring your approved data collection proforma. This digitises the process, potentially speeding up data capture and reducing transcription errors.
• Lazomis Dashboards: Once data is collected, Lazomis Dashboards can help visualise your audit findings, making it easier to identify trends, compare against standards, and prepare for dissemination. This supports the 'analysis' and 'dissemination' phases of your audit.
• Lazomis Action Tracking: To ensure your recommendations are implemented effectively, our action tracking feature allows you to assign tasks, set deadlines, and monitor progress, which is crucial for the 'implementation' and 're-audit' phases.

Using Lazomis can streamline the practical aspects of your audit, allowing you to focus more on the clinical impact and less on administrative overhead. Always ensure Lazomis use aligns with your Trust's Information Governance policies and local audit department guidelines.