The following guest blog has been written by Rebecca Jones, Clinical Governance Manager, Langford Vets. CASC are indebted to her for taking the time to write and share this:
I read with interest the blog ‘Doctor, Doctor.....QI is all the rage in 2019!’. Clinical Audit is very much still the buzz word of quality improvement (QI) within the veterinary profession. Although, it is not without its challenges, due largely to the limited availability of evidence-based guidelines to benchmark against. We don’t have the NICE equivalent available to us just yet.....though I know there are some that will say this is not necessarily a bad thing! For us, it can be tricky enough to identify what best practice is, never mind measure it! This is something that the veterinary profession is working incredibly hard to address. There are a growing number of veterinary specific resources available and we have also just seen the launch of a landmark publication, ‘Evidence-based Veterinary Medicine Matters – Our commitment to the Future’ here. This sees 15 major member organisations affirming their commitment to veterinary medicine, based on sound scientific principle. This also showcases the major steps already taken in this field. The mission to advance evidence-based veterinary medicine continues!
For now, veterinary clinical audit can at times be a little murky. The limited evidence-based guidelines can lead to a blurring of lines between audit and research. There is a temptation to introduce an intervention or comparison, rather than simply a measurement of current practice with best. And are we even able to undertake true clinical audit without an identifiable standard? Ironically, the lack of a ‘standard’ to measure against may mean that other methods of QI, such as the PDSA cycle, may indeed be a better fit for us right now. I, for one, will be interested to see how this develops within the veterinary profession. Back to clinical audit, one approach that we have adopted is to conduct a ‘baseline audit’ or ‘service evaluation’ as an initial step. This has at least enabled us to identify how we are performing, providing a benchmark for future assessment and improvement. We have seen some excellent examples of improvements within clinical care using this approach. It is my understanding that this is how it all started within the medical profession before the introduction of NICE guidelines?
On this note, as a profession, we may wish to be further ahead in terms of evidence-based medicine and ‘best practice’ guidelines but, in some respects, I wonder if we need to be careful what we wish for? I hope that we can continue to learn from those that have travelled this road before us and embed the positive elements of this. There is a lot that is positive about taking accountability for ensuring we continuously review and improve our work. I hope though that, through our journey, we can keep the improvement of our clinical care at the heart of our QI work and find the correct balance within the world of ‘targets and compliance’.
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