Research Methodology Audit Assignment Guidelines
Introduction
Diabetes educators should continuously improve the quality and safety of diabetes care. A clinical audit can be used as a quality improvement project. A clinical audit is ‘a quality improvement process that seeks to improve the patient care and outcomes through systematic review of care against explicit criteria and the implementation of change’. [1] It helps to operationalise the concepts of quality care in diabetes management.
During the audit workshop, you would have learnt the use of PDSA (Plan-Do-Study-Act) cycle as an audit tool. This assignment requires you to prepare an audit report related to the quality or safety of diabetes care provided in your workplace using PDSA cycle audit tool.
Learning outcomes
Upon completion of this assignment, you should be able to:
• discuss the purpose of audit and the reasons for an audit
• discuss the quality management/audit process in maintaining good standards of diabetes care.
Instructions
• Write an audit report related to an identified area for improvement in diabetes management in your workplace.
• Your audit report can be retrospective or prospective in nature.
• Identify an area of your practice that you would like to improve the quality or safety of diabetes care provided. During the workshop, you will be using the PDSA cycle as a clinical audit tool to structure iterative development of change to improve the identified area of your practice. Areas that you may wish to consider for this audit process include (but not limited to):
o patients, referrals, and/or follow-ups
o screening or assessments
o interventions provided
o patient clinical outcomes
o documentation of patient care
• Your report should contain no less than 2000 words (excluding references), use Arial font size 12, 1.5-line spacing, use Vancouver referencing style. References need to be latest of 5 years
• The written audit report should include:
1. Title
• Be concise and explicit to reflect the audit objectives
2. Introduction
• Give a brief background of your workplace.
• Describe the identified challenges in maintaining good standards of diabetes care at your workplace.
3. Methods (Scope paragraph)
This section contains 5 sub-sections – Objective and Plan-Do-Study-Act (PDSA). Objective
• Explain and state the objectives of your audit exercise in addressing the identified challenges in maintaining good standards of diabetes care at your workplace.
PDSA cycle
You can either describe an audit that you have already done (retrospective), or an audit that you are planning to do (prospective). Clearly state if your audit is retrospective or prospective in nature.
• Plan – Describe your plan to improve the quality of diabetes management care in your workplace. Your plan should be specific, measurable, achievable, realistic, and timely.
• Do – Describe the methods taken or planned to execute the audit plan. Write down all action steps you took or planned to achieve your audit exercise. Include details, such as the date of the audit, areas audited, standards used, persons involved, strength and weakness, deviation from a standard and any other observations.
• Study – Present the obtained or forecast results after execution of the audit plan. You can present your results in the form of tables, charts or figures. Write a brief summary of your results and identify the gaps found in your audit.
• Act – State the actions you took or will take to standardise and/or improve the gaps found in your audit.
4. Reflection
• Based on GIBBS model, reflect upon the implication of your action plan set in improving the quality of diabetes management care in your workplace.
Reference:
[1] Copeland G. 2005. A Practical Handbook for Clinical Audit. NHS Clinical Governance Support Team.
Audit assignment rubric assessment
Assessment Criteria 9 – 10 Weightage Marks
Content
Background (Plan) Demonstrate excellent understanding of the purpose of audit activity within the application of diabetes care
management in respective workplace 5%
Rationale (objectives) for conducting audit
(Plan) The audit study is important & there is a good attempt to build on existing audit. 5%
Audit design (Do) It is written clearly & the methods are supportive and coherent to the audit purpose. It contains all
key elements of the methods. 25%
Audit Assessment (Study) • ALL indicators are monitored & measured against policies, objectives, and requirements for the diabetes care service. 25%
• The Assessment reported is valid and accurate in a comprehensive
manner.
Practicality of action plan/areas for improvement (Including reflection) (Act) • ALL action plans are set in practical, feasible manner within the structure of workplace setting.
• Well thought for all aspects in areas of improvement 25%
Organisation
Organisation • The audit document is excellently organised.
• All sections of the audit document are present in an excellent flow of
writing across and within sections. 10%
Grammar, punctuation & spelling No grammar, punctuation or spelling errors that appears the
audit was clearly proofread. 5%
The plan should be like this – changes are allowed but kindly follow the tittle
Title:
Assessment of Insulin Injection practice of nurses employed within six months to two years in a private hospital.
Introduction:
I am a diabetes educator working in private hospital. My job scope is to educate inpatient patients, outpatients and nurses in this hospital related to diabetes. Good practice on insulin injection practice is important for nurses in order to administer insulin dosages correctly and to educate the patient or family. Based on this, I decided to conduct a study on nurses employed within six months to two years in the hospital on their insulin injection practice.
Objectives:
This study aimed to assess the current practice of insulin injection by nurses employed within six months to two years in the private hospital
Plan:
Audit relevant questions/ predictions Desired outcome/ hypothesis
What is the assessment and education? Assessment on insulin injection practice by nurses employed within six months to two years in the private hospital
Educating nurses on right injection practice
Who is the assessor? Diabetes Educator (DE)
Who is being assess? Newly join nurses within 6 months of experience – 2years of experience in private hospital
How is the assessment conducted? Pre intervention:
1. Questionnaire on nurses’ demographic information and insulin injection step practice via checklist.
2. Observe the nurses perform injection practice on patient.
3. Each correct question given score “1” and incorrect practice given score “0”
4. Identify steps that need improvement
Post Intervention:
1. Assess insulin injection practice by nurses employed within six months to two years.
When is the assessment? When diabetes patient requires insulin therapy initiation
Where is the assessment occurring? Inpatient wards 5A, 5B, 4A, 4B, 3A, 3B, 2A, 5C, 5D (Medical and Surgical Ward)
How many nurses will be assessed per day? Approximately 6 nurses per day will be observed
How many total nurses will be selected for this audit? Approximately 30 nurses
Description of plan for audit activities:
– Audit conducted in Inpatient wards 5A, 5B, 4A, 4B, 3A, 3B, 2A, 5C, 5D (Medical and Surgical Ward)
– An emailed will be sent out to respective ward manager for accessibility unit to conduct the audit
– Audit will be started from 1/12/2022 – 30/12/2022
– Schedule and activities as below:
Dates Activities
1/12/2022 – 9/12/2022 Pre – assessment on nurse’s injection practice
12/12/2022 – 16/12/2022 Identify steps that need to improvement and materials for training
19/12/2022- 23/12/2022 Educate the nurses on right injection practice
26/12/2022 – 30/12/2022 Post – assessment on nurse’s injection practice
31/12/2022 – 7/1/2023 Analyse the data
Do:
Assessment method will be used for this audit. The nurses will be audited from a form prepared via Microsoft Forms. During assessment nurse need to fill their demographic information followed by DE will be assessing the nurse on insulin injection step practice via Microsoft Forms. DE will score the nurses according to the Forms. The questionnaire of this audit prepared based on previous literature which is Forum for injection technique -Malaysia (FIT-MY), with modifications. There are two parts of the questionnaire with a total of 27 questions. The description of questions as below:
Part 1- Demographics Descriptions
Age
Department
Current Education level Diploma / Degree / Post Basic
Years of experience in current hospital 6 months – 3 years
Years of experience in previous hospital 6 months – 3 years
How frequent do you give insulin injection to patient
Any exposure in handling diabetes patient Yes / No
Any previous training on insulin injection practice Yes / No
Part 2: Steps of Insulin Injection
A. Prepare Insulin pen device
1. Hand wash / Hand rub
2. Prepared equipment:
• alcohol swab
• insulin pen device
• insulin needle
• Forceps
• Sharp bin
• Laptop with MCC
3. Check insulin for:
• right insulin name
• expiry date
• discolouration or clumps, discard insulin if these occur
4. ***For cloudy insulin, mix the insulin by turning the pen up and down gently 20 times
5. Attached needle to the insulin pen
6. Prime pen :
• dial 2 units,
• remove outer and inner needle shields
• Expel air
7. Dial for the dose as prescribed
B. Administer Insulin
8. Greet patient and explain the procedure
9. Check for the right patient:
i. Ask for patient name
ii. Check name against ID Band
10. Recheck insulin name and dosage
11. Select injection site & clean with alcohol swab.
– Inspect for presence of lipohypertrophy
– Avoid inject areas with lump, bruise or scar
12. Grip a fold of skin at injection site
13. Inject insulin at 90-degree angle
14. Press pen button slowly until indicator show “zero”
15. Count to 10 slowly before withdrawing the needle from the skin
16. Recap needle using single handed / by
Here is a sample audit report on the assessment of insulin injection practice of nurses employed within six months to two years in a private hospital.
Title: Assessment of Insulin Injection Practice of Nurses Employed Within Six Months to Two Years in a Private Hospital
Introduction:
I am a diabetes educator working in a private hospital. My job scope is to educate inpatient patients, outpatients, and nurses in this hospital related to diabetes. Good practice on insulin injection practice is important for nurses in order to administer insulin dosages correctly and to educate the patient or family. Based on this, I decided to conduct a study on nurses employed within six months to two years in the hospital on their insulin injection practice.
Objectives:
This study aimed to assess the current practice of insulin injection by nurses employed within six months to two years in the private hospital.
Methods:
A pre- and post-intervention study design was used. The pre-intervention study was conducted from January 1 to 9, 2023, and the post-intervention study was conducted from December 26 to 30, 2023. A total of 30 nurses were recruited for the study. The nurses were assessed on their insulin injection practice using a checklist. The checklist included 27 items, which were based on the Forum for Injection Technique -Malaysia (FIT-MY) guidelines. The nurses were scored on a scale of 0 to 2, with 0 being incorrect, 1 being partially correct, and 2 being correct.
Results:
The results of the pre-intervention study showed that the mean score of the nurses was 1.4. This indicates that the nurses had a good understanding of the insulin injection procedure, but there were still some areas that needed improvement. The most common areas of improvement were:
Selecting the correct injection site
Administering the insulin at the correct angle
Counting to 10 slowly before withdrawing the needle from the skin
The results of the post-intervention study showed that the mean score of the nurses had increased to 1.8. This indicates that the nurses had improved their insulin injection practice after the intervention. The most significant improvement was in the area of selecting the correct injection site.
Discussion:
The results of this study suggest that the intervention was effective in improving the insulin injection practice of nurses employed within six months to two years in the private hospital. The most significant improvement was in the area of selecting the correct injection site. This is an important area of improvement, as incorrect injection sites can lead to lipohypertrophy, which can make it difficult to administer insulin.
The findings of this study suggest that the following interventions may be effective in improving the insulin injection practice of nurses:
Providing nurses with education on the proper insulin injection procedure
Providing nurses with opportunities to practice the insulin injection procedure under supervision
Providing nurses with feedback on their insulin injection practice
Conclusion:
The findings of this study suggest that the intervention was effective in improving the insulin injection practice of nurses employed within six months to two years in the private hospital. The most significant improvement was in the area of selecting the correct injection site. The findings of this study suggest that the following interventions may be effective in improving the insulin injection practice of nurses:
Providing nurses with education on the proper insulin injection procedure
Providing nurses with opportunities to practice the insulin injection procedure under supervision
Providing nurses with feedback on their insulin injection practice
