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Sample Temp L Clinical Audit Proposal Pro Form A

The document is a sample template for a clinical audit proposal proforma created by the Quality and Patient Safety Directorate of the Health Service Executive (HSE). It outlines essential components for conducting a clinical audit, including audit title, standards, audit tool, reasons for the audit, stakeholder identification, and compliance with data protection legislation. The template aims to ensure audits improve patient care and have the necessary support and resources for implementation.

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141 views3 pages

Sample Temp L Clinical Audit Proposal Pro Form A

The document is a sample template for a clinical audit proposal proforma created by the Quality and Patient Safety Directorate of the Health Service Executive (HSE). It outlines essential components for conducting a clinical audit, including audit title, standards, audit tool, reasons for the audit, stakeholder identification, and compliance with data protection legislation. The template aims to ensure audits improve patient care and have the necessary support and resources for implementation.

Uploaded by

jsdakash.i15pro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Sample Template for Clinical Audit Proposal Proforma

Item Type Other

Authors Quality and Patient Safety Directorate

Publisher Health Service Executive (HSE)

Download date 12/11/2024 21:40:58

Link to Item http://hdl.handle.net/10147/628444

Find this and similar works at - http://www.lenus.ie/hse


SAMPLE TEMPLATE FOR CLINICAL AUDIT PROPOSAL PROFORMA

Name Department

Contact
Title
details

Audit title

Is this a re-audit? Yes No If Yes, have previous audit’s actions been


implemented?

Why are you proposing to conduct this audit? Why was this topic chosen?

What standards will you be auditing against? Please attach a copy of the relevant standard(s) to
the submission

Describe the audit tool you intend to use? Please attach a copy of the audit tool to the
submission
Please tick additional reasons (if any) for carrying out this audit:

Patient centeredness Professional development


High volume activity Service improvement
High risk activity Re-audit
High cost activity Risk management
Policy/guideline recommendation Specify if: Local National

Other, please state:

_____________________________________________________________________

Each audit should satisfy all of the following:


 It should aim to improve patient care.
 It should be multidisciplinary where possible.
 It should have support within your department, including a willingness to
implement changes.
 Data Protection legislation.

Have all the potential stakeholders been identified? Yes No

List relevant stakeholders by name Are these stakeholders


aware of this audit?
Yes No
Yes No
Yes No
Yes No

Has a literature search been undertaken? Yes No


Sample size:
Length of time to audit and target completion date: date

I confirm that all data collection/storage will comply Yes


with (insert name of service provider) ICT policies:

The final section of the clinical audit proposal submission will depend on the
resources/supports available within the service i.e. request for assistance with carrying out
the clinical audit, who has the authority to approve performance of the audit etc.

Signed: Signed:
Audit lead Audit sponsor

Date received: Date discussed:

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