Scenario
Your supervisor is concerned that you are producing too many Grade 3 radiographs. He suggests that you consider auditing radiograph quality in the practice. Consider this situation and answer the questions provided.

Take a few minutes to consider your answer to this and then compare to the suggested answers below.

What is an audit and how will you conduct this audit?

Audits are a crucial part of clinical governance and quality improvement. Audits measure current practice against existing standards – this is different from research that aims to create new knowledge.

The steps of an audit are below:

  • Identify the issue/problem – in this situation, it is the quality of the radiographs being taken.
  • Define the standard – you need a standard to compare your results with. For a radiography audit, it is typically the FGDP Selection Criteria for Dental Radiography guidelines.
  • Collect the data – create a data capture form and collect the relevant data over a set time period. This could be collected retrospectively or prospectively – but colleagues cannot know this is being collected as it may skew results. So for this scenario, you would aim to select, for example, the last 50 radiographs taken and audit the quality of them as Grade 1, 2 or 3.
  • Compare current practice with existing standard – compare your recorded results against the FGDP standards (below).
Quality GradeCriteriaTarget
1Excellent – no errors of any kindNot less than 70%
2Diagnostically acceptable – minor errors but those which do not detract from the diagnostic qualityNo greater than 20%
3Unacceptable – errors which do not render the radiograph to be of diagnostic qualityNo greater than 10%
  • Implement a change to improve quality/formulate an action plan – generally results should be presented in a practice meeting and potential reasons for shortcomings should be discussed. Is there a particular reasons results may have been poor? Do practitioners need more CPD? Do the machines need servicing? Following this discussion, implement a change to improve the results.
  • Re-audit and close the loop – this is arguably one of the most important steps of an audit cycle – the cycle isn’t complete unless this is done. Following enough time for the intervention/change to take effect, re-audit the radiographs against the FGDP standards as well as previous radiography audit results to see if there has been an improvement. Then the cycle can continue if needed.

Can you discuss an audit that you have carried out?
  • Discuss an audit that you have closed the loop on.
  • Explain why you chose the topic and what problems you noticed.
  • Describe your audit – follow the steps as in question one.
  • Most importantly, explain the changes you implemented and the result of these change. It is important to demonstrate how the audit has improved the quality of service/care.
What do you understand about clinical governance?

Clinical governance is a quality assurance process to maintain and improve standards of care for patients, with full accountability of the system towards patients. 

There are multiple aspects to it, which include:

  1. Clinical Effectiveness and Research Рthis is ensuring we carry out evidence-based practice and continue to improve our knowledge.
  2. Audit – comparing existing practice against set standards – as described above in the radiography audit.
  3. Risk Management – understanding, monitoring and minimising risks to staff and patients e.g. IRMER.
  4. Education and Training – continual learning as an individual and within the team.
  5. Patient and Public Involvement – patient feedback regarding quality of care – this will help inform any changes.
  6. Information and IT – data protection, GDPR and confidentiality.
  7. Staff Management – correct staff for the correct jobs. Ensuring a safe environment for them and appropriate training and management.

More details on clinical governance can be found here.

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