Foundation Year 1 (F1) - NICE Guidance for First Audits

F1 Audit Requirements and Common Pitfalls

The F1 curriculum mandates completion of at least one full audit cycle. This is a core component of developing skills in quality improvement and clinical governance. The objective is to learn the process of systematically evaluating care against a standard, implementing change, and re-auditing to measure improvement.

The success of an F1 audit hinges on selecting an achievable project and working closely with a supervisor from the outset to ensure the chosen standard and methodology are robust.

Selecting and Citing Appropriate NICE Standards

NICE produces several types of guidance, but not all are suitable for an F1 audit. The most appropriate types are those that provide clear, measurable statements about clinical practice.

Applicable NICE Guidance Types

• NICE Guideline (NG): These contain the most detailed recommendations. Focus on a single, auditable recommendation (e.g., "Offer aspirin 300 mg to people with acute stroke whose bleeding risk is low." - NG128).
• NICE Quality Standard (QS): These are derived from NICE guidelines and consist of specific, concise statements (quality statements) that are ideal for auditing. They often map directly to CQC Quality Statements.
• NICE Technology Appraisal (TA): These can be used if they contain a specific directive about the use of a drug or technology (e.g., "Adefovir dipivoxil is recommended as an option for the treatment of chronic hepatitis B." - TA96). Ensure the drug/technology is used in your department.
• NICE Medical Technologies Guidance (MTG): Less common for F1 audits, but can be used if the technology is available and the guidance includes a clear usage recommendation.

How to Cite NICE Guidance Correctly

Correct citation is essential for portfolio evidence. Use the following format:

F1-Appropriate Project Examples Across Specialities

The key is to choose a project that is simple, has a easily identifiable patient cohort, and where data is readily accessible. Below are examples tailored for F1 rotations.

Medicine Rotation Example

Topic: VTE prophylaxis in medical inpatients.
NICE Standard: NICE Guideline NG89: Venous thromboembolism in over 16s (Recommendation 1.4.1: "Assess all patients on admission for risk of VTE and bleeding.").
Audit Aim: To measure the percentage of patients admitted to a medical ward who have a documented VTE risk assessment within 24 hours of admission.
Method: Retrospective case note review of 30 consecutive admissions. Data points: Date/Time of admission, Date/Time of VTE assessment documented, Assessment completed (Y/N).
Potential Action Plan: If compliance is low, introduce a prompt in the admission proforma or a teaching session for the junior doctor team.

Surgery Rotation Example

Topic: Antibiotic prophylaxis in elective hernia repair.
NICE Standard: NICE Guideline NG125: Surgical site infections (Recommendation 1.3.1: "Do not offer antibiotic prophylaxis for clean surgery that does not involve an implant.").
Audit Aim: To determine the percentage of patients undergoing elective open inguinal hernia repair who receive antibiotic prophylaxis against NICE guidance.
Method: Review theatre records and drug charts for 20 consecutive elective hernia repairs. Data points: Procedure, Antibiotics given (Y/N), If yes, antibiotic type and timing.
Potential Action Plan: If prophylaxis is being incorrectly given, present findings at a departmental meeting and update the local surgical protocol.

Psychiatry Rotation Example

Topic: Physical health monitoring for patients on antipsychotic medication.
NICE Standard: NICE Guideline NG178: Psychosis and schizophrenia in adults (Recommendation 1.5.7: "Monitor weight, plasma glucose and lipid levels at least every 6 months."). This also aligns with NICE Quality Standard QS102.
Audit Aim: To assess the percentage of patients on a community caseload prescribed antipsychotics who have had weight, HbA1c, and lipids recorded in the preceding 6 months.
Method: Review the electronic records of 25 patients on a specific consultant's caseload. Data points: Medication, Date of last weight, HbA1c, lipid profile.
Potential Action Plan: Develop a clinic checklist for physical health monitoring to be used at keyworker appointments.

General Practice Rotation Example

Topic: Annual review for patients with COPD.
NICE Standard: NICE Guideline NG115: Chronic obstructive pulmonary disease (Recommendation 1.5.1: "Offer an annual review to all people with COPD.").
Audit Aim: To measure the proportion of patients on the COPD register who have had a documented annual review in the last 12 months.
Method: Use the practice's clinical system to run a search of the COPD register. Data points: Total patients on register, Number with an annual review code in last 12 months.
Potential Action Plan: If recall rates are low, implement a call/recall system or create dedicated clinic appointments.

Supervisor-Approved Approach to Getting Sign-Off

A proactive and organised approach with your supervisor is critical for a smooth sign-off process. Follow this step-by-step guide.

Step 1: Initial Meeting (Within First 2 Weeks of Rotation)

• Prepare: Come with 2-3 potential audit ideas based on your initial observations and relevant NICE guidance.
• Discuss: Agree on a single, feasible topic. Confirm the NICE standard is correct and current.
• Define Scope: Agree on the patient cohort, sample size, and data collection method.
• Set Timeline: Agree on deadlines for data collection (1), analysis and presentation (2), action plan implementation (3), and re-audit (4).

Step 2: Data Collection and Analysis

• Keep your data collection tool simple.
• If you encounter problems (e.g., missing notes), discuss them with your supervisor promptly.
• Analyse the data to calculate simple percentages (e.g., 70% compliance). Present this clearly in a table or chart.

Step 3: Presenting Findings and Creating an Action Plan

Create a brief report or presentation for your supervisor and/or the relevant team (e.g., at a junior doctor teaching or departmental meeting).

Step 4: Implementing Change and Re-auditing

• The action plan is your responsibility to drive, with support from your supervisor.
• After an appropriate interval (e.g., 4-8 weeks), repeat the data collection using the same method and sample size.
• Compare the pre- and post-intervention results.

Step 5: Final Sign-Off and Portfolio Entry

Once the cycle is complete, meet with your supervisor for final sign-off. Your portfolio entry should evidence the entire cycle. Use the following structure:

• Description: Summarise the audit, including the standard, methods, results, and outcome.
• Reflection: What did you learn about the clinical topic, audit process, and change management?
• Evidence: Attach your audit report or presentation slides.
• Supervisor Verification: Ensure your supervisor adds their comment and confirmation.