Microeconomics analysis 1300words

The preparation of a protocol is an important first step in the process for the following reasons:

· It states the audit topic;

· It encourages adequate consideration and planning of project detail before you begin;

· It acts as a record and reminder for the audit team and collaborators of project aims, stated procedures and staff’ duties and responsibilities;

· It enables stakeholders to monitor the progress of the project;

· It provides the basis for funding and/or human research ethics applications (including budgetary information); and

Audit Case study

A 77-year-old man is admitted to the surgical ward of a local hospital from the operating room. Earlier the same day, he had presented to the emergency department with abdominal pain. His medical history included treated hypertension and hypercholesterolemia, previous heavy alcohol intake, and mild cognitive impairment.

In the emergency department, he was drowsy and confused when roused and was peripherally cold with cyanosis. The systemic blood pressure was 126/55 mm Hg, and the heart rate was 95 beats per minute. The abdomen was tense and distended. After the administration of 1 liter of normal saline to restore the blood pressure, a CT scan of the abdomen showed extraluminal faeces consistent with a perforated sigmoid colon. He was treated with intravenous antibiotics and taken to the theatre for laparotomy. During this procedure, gross fecal peritonitis from a perforated sigmoid colon was confirmed; resection of the sigmoid colon with closure of the rectal stump and creation of an end colostomy (Hartmann’s procedure) was performed with extensive peritoneal toilet and washout. On arrival in the ward, the patient was handed over to the afternoon nursing staff from theatre staff. The following issues were apparent with the patient;

1. An ISOBAR hand over was not completed

2. Medication chart is not completed comprehensively from RMO

3. No FRAMPS tool completed

4. No Braden Scale completed

From this information you will audit one of these problems with the National Health Care Standard and/or a hospital policy as your bench mark.

July 2018 Version 1.

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PROJECT TITLE

A well-constructed title is important as it is the first opportunity to attract the attention of the reader. The title should be descriptive, clear and concise, indicating the subject of inquiry. Having a refined aim can assist in constructing a title.

As a NURSE undertaking a clinical audit project, you are obligated to conduct your project in such a way that, at all times, it complies with:

· Your respective professional Code/s of Conduct.

· Any requirements as defined by your Board/s of professional registration e.g. Australian Health Practitioner Regulation Agency;

· Current best practices in the field or discipline of your project, including offering best current clinical practices and treatments in all arms of your project;

· Relevant State and Commonwealth Acts and legislations; and

· Relevant Institutional policies and procedures

SUGGESTED AUDIT PROPOSAL HEADINGS

· TOPIC

· CRITERION - STANDARDS

· Recommendations

The TOPIC is a very brief overview of project (~150 words). The TOPIC should be concise but sufficient to orientate the reader to the main purpose of the AUDIT, how it will be conducted and its expected benefits. It is a structured sketch of the project that will provide an overview before examining the details

The most important aspect of a research proposal is the clarity of the problem. The background section is an opportunity to convince the reader (or reviewer) of why the project needs to be done (and deserves funding or ethical approval). The background should also include the rationale which specifies the reasons for conducting the audit in light of current knowledge. It should include a well-documented statement of the need/problem that is the basis of the project, the cause of this problem and its possible solutions. Discussion should be clear and logical that demonstrates you are fully conversant with the ideas presented and can grasp their methodological implications. The following key points may be used as a guide:

· Conduct a comprehensive literature search using databases such as Cochrane, Medline, CINAHL and Embase. A comprehensive literature review should include aspects such as the magnitude, frequency, affected geographical areas, ethnic and gender considerations of the problem and should be followed by a brief description of the most relevant studies published on the subject.

· Critically appraise the relevant literature and discuss the state of current knowledge on the topic (including deficiencies in knowledge or gaps that make the project worth doing).

· Discuss the importance of the topic (public health and/or clinical importance and impact on individuals/community, incidence, prevalence, mortality and morbidity).

Note: Clinical audits relate specifically to reviewing current standards, systems or processes of care with the aim of improving outcomes for patients or improving service delivery. In addition, clinical audits do not usually involve assessing new interventions, new treatments or new methods of service delivery; this is also usually considered research. A clinical audit may be undertaken to provide baseline data for the development of a research project.

1. AUDIT SIGNIFICANCE

The SIGNIFICANCE/RATIONALE should be the most important relevant outcome (e.g. clinical, psychological, economic, other) of the project. This primary outcome is the measure used to answer your research question, and should relate directly to your primary aim(s) and objective(s).

To review a local standard of care compared to current recognised standards, systems or processes of care, with the aim of improving outcomes for patients or improving service delivery. The project may also be conducted to provide data to inform the development of clinical standards and guidelines, especially if no higher level evidence is available, or to guide further review of clinical practice.

Having decided on the topic it is helpful to clearly define your clinical audit objectives, why you are doing the audit and what you are hoping to achieve as a result. This will facilitate the setting of standards and development of data collection methods at a later stage. Targets should be set at realistic and attainable levels, while not being set too low. SMART Objectives.

State the methodology and design of the research (prospective or retrospective Audit). Whatever the project design, you need to ensure that you provide the reader with a clear statement and description of your proposed design. The same project can be described in several ways, and as complete a description of the project as possible should be provided. It may also be described as observational; if observational, it may be descriptive.

PROJECT SETTING/LOCATION(S)

The location(s) of where the project will be conducted. You need to mention whether the project is going to be a single-centre project or a multi-centered project (i.e. conducted in more than one location).

AUDIT DURATION

The protocol should specify the time that each phase of the project is likely to take, along with a detailed month by month timeline for each activity to be undertaken. If possible a Gantt chart should be included.

PROJECT POPULATION

Defining your study group population (i.e. the study participants) provides the context for which the audit has relevance. This section also describes how one can be certain that the results from your sample population can be generalised to the target population of interest. This section should describe the target population, including but not limited to:

· Population the participants will be drawn from

· All aspects of participant selection

· The total number and number within any subgroups

· Age range

· Gender

If consent is not being sought, the rationale for not obtaining consent needs to be explained. Generally, a clinical audit can be undertaken without consent of the patients if:

· The project carries only low or negligible risk;

· It is impractical to obtain consent;

Measurement Tools

It is essential to state how the data will be collected to assess the OBJECTIVES of the project. Describe at what point(s) of the project data collection will occur. You should make statements that justify the validity of the project measure/instrument. If not, you will have to verify how you will ensure the validity and quality of data being collected. Also, mention here if you are going to have one or more assessors to collect data, their level of training/experience (or how they will be trained).

Data Collection

Explain in detail your procedure for data collection. Describe the kind of data you will collect (e.g. PATIENT NOTES). Develop a data collection form based on the information you want to collect. Only collect what is absolutely necessary. The data collected should relate to the objectives of the project:

· To ensure that the data collected are precise, and that only essential data are collected, the details of what is to be collected must be established from the outset.

The protocol should provide information on how the data will be managed, including data handling and coding for computer analysis, monitoring and verification. The protocol should explain:

· Who will collect the data?

· Where and how you will obtain the data

· What time period you will you use (i.e. start date and finish date)

· How the data will be collected and stored: non-identifiable, de-identified or re-identifiable

· The actual plan for storing your data. This may involve designing a coding system for your data. The data must be stored in such a way that it is both secure and conforms to legal requirements.

SAMPLE SIZE AND DATA ANALYSIS

· How will you select your sample? (How many participants do you need?) Sample size should be based on your primary AIM.

· You need to be sure that the information you collect from auditing your sample is similar to what you would collect from auditing your whole population. Therefore, you need to ensure that your sample size is large enough and is representative of your audit population.

· There is no ideal number as to exactly how many participants should be included and it will depend on the intervention being audited, the amount of information being collected, how easy it will be to obtain that information and the resources available.

· It is necessary first to define the population to which the project applies; e.g. all patients presenting with an indwelling urinary catheter

· It may be impractical to collect data on every patient in the population, so other sampling methods may be used instead. Methods may include:

· A time frame: e.g. all women referred to the breast clinic within a one-month period.

· A consecutive sample: Choose the first agreed number of participants after an agreed start date, e.g. the first 100 referrals to your clinic.

· Random sampling: Assumes your audit population will remain the same throughout the audit period and that each participant will have a chance of being chosen, e.g. every 8th patient presenting at the clinic.

· Interval Sampling: Assumes your audit population will change over the period of the audit. In these circumstances, the audit sample is often determined by a period of time, e.g. all donors deferred during May and June.

· Convenience Sampling: a non-scientific method of sampling where you take the convenient sample available, e.g. if you were interviewing blood donors, you would just pick donors from those available at the time when you are interviewing.

When analysing your data, you will generally want to try to reach conclusions about:

· The general pattern of actual practice;

· The degree to which actual practice (results of audit) is meeting the standards set;

· Those cases for which it is clinically acceptable for the standards not to be met; and

· The limitations of the project.

Analysing audit data does not usually require complex statistical tests, although these may be necessary in certain situations. The type of data you have collected will determine the type of analysis employed. The following approaches may be used in analysing your data:

· Descriptive Statistics. This is where the data are described numerically. You may wish to calculate:

· The frequency of certain events/values occurring (i.e. rates and percentages);

· Estimates of the central point of your data, such as the mean or the median; and

· Estimates of the variability of your data, such as the standard deviation, interquartile range or range.

· Statistical Tests. These may be used:

· When conducting an outcome audit, for example comparing ‘before’ and ‘after’ results on questionnaires to find out whether there has been a statistically significant improvement in the client symptom scores; or

· When wanting to show whether the results you have obtained can be attributed to chance variation.

Where open-ended questions have been asked as part of the clinical audit project, qualitative data will be obtained. There are a number of ways of analysing qualitative data. It may be possible, for example, to conduct a content analysis of the major recurring themes and a frequency count may then be performed.

Discussing the results of the clinical audit project with key stakeholders is an essential exercise through which areas of practice which need to be changed can be identified and agreed. What actions will be taken for an action plan to be developed after this project results have been finalized?

Include all references used throughout the application.

Data Dissemination – RAG