Foundation Year 2: Leading Audits and Completing the Cycle
This resource provides F2 doctors and core training applicants with a comprehensive, practical guide to leading clinical audits, completing the audit cycle, and demonstrating this essential governance activity effectively for both appraisal and specialty training applications.
F2 Audit Expectations and the Importance of the Full Cycle
Leading a clinical audit to completion is a core requirement of the Foundation Programme Curriculum and a critical skill for all clinicians. It demonstrates engagement with clinical governance, a commitment to quality improvement, and the ability to lead a project. The key differentiator at the F2 level is not just participation, but leadership and the successful completion of the audit cycle.
The Audit Cycle: From Theory to Practice
The clinical audit cycle is a systematic process for improving patient care. A completed cycle involves:
- Selecting a Topic: Choosing a high-impact area relevant to your clinical setting.
- Setting Criteria and Standards: Defining optimal care based on robust evidence, typically from NICE guidance.
- Measuring Performance (First Data Collection): Collecting data against the set standards.
- Analysing and Comparing: Identifying gaps between current practice and the standard.
- Implementing Change: Developing and executing an action plan to address the gaps.
- Sustaining Improvement (Re-audit): Measuring performance a second time to confirm improvement.
F2 Audit Leadership Checklist
- ✓ I identified the audit topic and justified its importance.
- ✓ I led the literature review to establish the evidence-based standard.
- ✓ I designed the data collection tool and methodology.
- ✓ I coordinated the initial data collection (or delegated clearly).
- ✓ I analysed the results and presented the findings to the relevant team/department.
- ✓ I developed the action plan in collaboration with the multidisciplinary team.
- ✓ I led or significantly contributed to the implementation of changes.
- ✓ I organised and executed the re-audit to close the loop.
Utilising NICE Resources for Robust, CQC-Ready Audits
Using outdated or non-evidence-based standards invalidates an audit's purpose. The National Institute for Health and Care Excellence (NICE) provides the definitive source for clinical standards in the NHS. Familiarity with NICE resources is non-negotiable for effective audit leadership.
Navigating NICE Guidance Types
It is crucial to reference the correct type of NICE guidance. Using an outdated "Clinical Guideline" (CG) when a newer "NICE Guideline" (NG) exists will undermine your audit's credibility.
| Guidance Type | Prefix | Purpose | Example for an Audit Standard |
|---|---|---|---|
| NICE Guideline | NG | Broad clinical recommendations on the treatment and care of people with specific diseases and conditions. | NG28: "Patients presenting to the Emergency Department with suspected transient loss of consciousness should have a 12-lead ECG recorded." |
| Quality Standard | QS | Concise, measurable statements derived from NICE Guidelines, designed to drive measurable quality improvements. Ideal for audit standards. | QS15 (Diabetes in Adults): "Adults with type 1 diabetes have HbA1c levels measured every 3 to 6 months." |
| Technology Appraisal | TA | Recommendations on the use of new and existing medicines and treatments within the NHS. | TA275: "Apolipoprotein B measurement is recommended as an alternative to LDL-C for assessing response to lipid-lowering therapy." |
| Medtech Innovation Briefing | MIB | Describes innovative medical technologies; useful for audits of new equipment or devices. | MIB344: Provides evidence on a point-of-care test for heart failure. |
Staying Current: Avoiding Outdated References
Always check the NICE website to ensure your referenced guidance is the current version. Look for the "This guideline updates and replaces NICE guideline CG[X]" or "This guideline is the basis of QS[X]" text on the guideline page. The website's search function is the most reliable method.
CQC Alignment: Effective Monitoring
Using current NICE guidance directly supports the Care Quality Commission's (CQC) Quality Statement "Effective monitoring of outcomes". It demonstrates that the service is using the best available evidence to systematically monitor and improve the quality of care, a key line of enquiry for CQC inspections. Documenting your NICE-based audit provides tangible evidence of this governance activity.
F2-Level Project Examples with Demonstrable Leadership
Choose an audit topic that is manageable within your F2 rotation timeframe but has clear clinical significance. Below are examples across different specialties, highlighting the leadership evidence you should document.
Example 1: Medical Ward - VTE Prophylaxis
- Topic: Assessment and administration of pharmacological VTE prophylaxis in medical inpatients.
- NICE Standard: NG89 (Venous thromboembolism in over 16s). Standard: "Assess all patients on admission for risk of VTE and bleeding."
- Leadership Evidence:
- Identified the topic after noticing variation in practice during clerking.
- Researched and presented NG89 to the ward team to establish the standard.
- Designed a simple data collection proforma for patient notes.
- Collected data for 30 consecutive admissions.
- Analysed results: found 70% compliance with assessment.
- Presented findings at a junior doctor teaching session, proposing an action plan (e.g., reminder sticker in notes, junior doctor teaching).
- Led the creation and implementation of the teaching session.
- Re-audited 30 admissions post-intervention, demonstrating improvement to 95%.
Example 2: Surgical Department - Post-operative VTE Prophylaxis
- Topic: Timely administration of post-operative VTE prophylaxis in elective surgical patients.
- NICE Standard: NG89. Standard: "Offer pharmacological VTE prophylaxis to patients who are having surgery... start at 6–12 hours after surgery."
- Leadership Evidence:
- Collaborated with the ward manager and pharmacists to understand the medication chart process.
- Audited time of first dose from drug charts versus time of surgery from theatre lists.
- Discovered delays due to drug chart rewriting at ward transfer.
- Led a meeting with nurses and pharmacists to develop a new process for ensuring charts travel with the patient.
- Re-audited after process change, showing a significant reduction in delay.
Example 3: Emergency Department - NICE Head Injury Guidance
- Topic: Adherence to CT head imaging criteria for adults with head injuries.
- NICE Standard: NG232 (Head injury: assessment and early management). Standard: "Immediately request a CT head scan for adults with any of the following risk factors... [e.g., GCS <13 on initial assessment]."
- Leadership Evidence:
- Recognised the complexity of NG232 and created a quick-reference checklist for junior doctors.
- Audited CT head requests against the NG232 criteria for appropriateness.
- Identified over-scanning in low-risk cases and under-scanning in one high-risk case.
- Presented findings at the ED governance meeting and gained approval to implement the checklist.
- Led the rollout of the checklist and provided teaching to the junior doctor cohort.
- Re-audited to demonstrate improved adherence and appropriate scanning rates.
Presenting NICE-Based Audits in Specialty Training Applications
Your audit experience is a key differentiator in ST applications. The focus should be on your leadership role and the impact of the completed cycle.
Structuring Your Application Response
When describing your audit, use a structured format like STAR (Situation, Task, Action, Result) to ensure clarity and impact.
Template for ST Application / Portfolio Entry
Audit Title: Completing the Cycle: Improving Adherence to NICE Guideline NG[X] on [Topic] in the [Department].
Situation: During my F2 rotation in [Specialty], I identified a potential variation in practice regarding [specific clinical area]. I recognised this as an opportunity for quality improvement.
Task: My objective was to lead a complete audit cycle to measure compliance with the evidence-based standard set out in [NICE Guideline NG/X or Quality Standard QS/X] and implement sustainable changes to improve patient care.
Action (Focus on Leadership):
- I independently researched and selected the current NICE standard to establish robust audit criteria.
- I designed the data collection methodology and proforma.
- I coordinated the initial data collection over [timeframe], analysing the results which showed a compliance rate of [X]%.
- I presented these findings to [e.g., the departmental governance meeting] and collaboratively developed an action plan, which I then led the implementation of [e.g., by creating an educational tool, changing a proforma, delivering teaching].
- I personally organised and executed the re-audit [X] months later to complete the cycle.
Result: The re-audit demonstrated a significant improvement in compliance to [Y]%, confirming a positive impact on patient care. This completed audit cycle was presented and is now used as part of the department's ongoing governance. I developed skills in project leadership, data analysis, and influencing change within a multidisciplinary team.
Evidencing Leadership and Impact
Ensure you have tangible evidence to support your claims. This can include:
- Presentation Slides: Keep a copy of the presentation you gave to the team or governance meeting.
- Data Collection Tools: Save a blank copy of your audit proforma.
- Summary Report: A one-page summary of the audit cycle, including pre- and post-intervention results in a simple graph or table.
- Email Correspondence: Evidence of you organising meetings or disseminating results.
- Supervisor Feedback: Ask your clinical or audit supervisor to comment on your leadership in your portfolio.
CQC Alignment: Learning, Improving, and Ensuring Safety
A well-documented, completed audit cycle provides direct evidence for multiple CQC Quality Statements, including "Learning culture" and "Safe and effective care". It shows a proactive approach to monitoring outcomes, learning from data, and implementing changes to enhance safety and effectiveness. Highlighting this alignment in your application demonstrates a sophisticated understanding of clinical governance.
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