Chapter 14
Tools to help you plan and
support self care

Tool 9

Undertake an audit of how well established support for self care is in your practice

Why you should use this

Clinical audit helps you to review the way your practice organisation works as a whole - and make improvements. It will help you to improve the quality of self care support you provide.

You might audit:

the range of self care support provided

– by the doctor/nurse/practice pharmacist/health care assistant/reception staff/ practice systems

– whether it concerns prevention and treatment for common minor conditions and long term conditions e.g. information provision (verbal/printed/web based/noticeboards)

– signposting (to specific patient groups, training, social services etc) - see Chapters 4, 5 and 6 for more ideas about practice systems that support self care as well as how individual practitioners do it
the appropriateness of self care support provided - the extent to which self care services are geared to meeting patient needs. Involve patients or the practice patient forum in feeding back on this
accessibility of self care support services - where located, opening times
information about self care - type, options for non-English speakers
publicity - the extent to which the public are aware of the type and availability of self care support provided
skill mix - staffing levels
training of staff - working within their competencies, sufficient opportunities for continuing professional development
good communication with staff at all levels about promoting and supporting self care.

Once the audit has been undertaken and actions taken to address your findings, review your audit cycle to conclude whether:

any underlying reasons for any failure to meet standards in relation to supporting self care were identified
everyone participated in the actual audit measuring their performance
everyone supported and adhered to any changes made as a result of audit
proposed changes were implemented
training needs that were identified were addressed
any further audits were indicated, and if so whether they were undertaken
the quality of patient care improved
acceptable outcomes were used to measure any interventions or changes to patient care.

What to do

Design your audit of an aspect of how you and others in the practice are promoting and supporting self care around the steps of the audit cycle represented in Figure T9.1.

Prioritise and select the topic of your audit, working with others in your team or practice.
Set objectives: relating to the reason(s) why the audit is being carried out.
Review the literature for that topic and agree the criteria and standards that you think are reasonable - look back at Chapter 2 for information as to how others have promoted and supported self care.
Design the way in which you will do the audit.
Collect the data and look at it.
Feed back the findings; meet with colleagues or your team to discuss the findings and determine the reasons for the results.
Make a timetabled action plan to implement any changes that are needed.
Review your standards – should you keep the standards you previously set, are they unrealistic or not challenging enough?
Re-audit – creating successive audit cycles.

Steps in the audit cycle

How it works (insight)

The audit will be worthwhile if the objectives of your audit are about:

assessing whether or not standards are being met – in relation to promoting and supporting self care
determining if standards are improving
monitoring levels of compliance or concordance with treatment or self care advice and support
changing inadequate current practice.

Whom to engage

Include those members of the PCT/practice team who are directly involved in the task being audited and those who will be collecting the data. Engage with patients to give you their perspective. Decide who is writing the audit protocol and who will search for evidence to enable you to set standards and criteria. Include in the team those who need to agree solutions or find resources if the audit shows that change is necessary. Appoint a lead if there is no-one in this role already. Link to others relevant to the audit who work in different settings: the local hospital, PCT, community clinic, social services, etc.

How much time you should allow

This will depend on the complexity of the audit, how much data gathering is involved etc.

What a facilitator should do

Ensure that the purpose and plan for the audit is clear, and that it concerns an important problem or issue.

What to do next

Follow the stages of the audit cycle, including re-audit after changes have been made.

What makes it work better

Being clear about the reason(s) for doing the audit, and that the objectives are linked to that. The objectives should be relevant and understandable to everyone taking part. The end results should be making improvements to patient care. The quality and nature of the end points of your audit should relate to the objective(s) you set for the audit. You need to have some idea of your end point(s) when you set the objective(s).

What can go wrong

The audit can be too complicated or resource intensive so that it founders halfway through. There may be no change possible once the initial stages of the audit have been completed and the problem is well described - which is demoralising for everyone concerned.

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Chapter 14 Tools to help you plan and support self care