Conducting Successful Virtual Care Audits

Introduction

Independent audits are an important tool to promote quality improvement in health and social care organisations. They help to identify if a service or a particular department / area is operating as it should be and to a high standard which is in line with best practice and regulatory requirements. However, the COVID-19 Pandemic has resulted in many challenges and disruptions for the healthcare sector. With travel restrictions and limitations around social contacts, organisations are required to be proactive and rethink ways of conducting audits to ensure consistent and effective oversight of services.

Thankfully, there are many technologies at our disposal that can support healthcare organisation in fulfilling their obligations around auditing. Virtual Care Audits are a great tool to maintain your programme of quality assurance during COVID-19.

In this blog, we detail some of the potential challenges around virtual care audits and provide some tips to help you conduct successful virtual audits.

Potential Challenges to Virtual Care Audits

Virtual audits have the same principles as regular audits, expect that they are conducted using technology. With this format there are likely to be some challenges or adjustments to be made in the way the audit is carried out. Some of the challenges include:

• The inability to access the physical location.
• Acquiring timely access to documentation.
• The lack of face-to-face interactions makes it difficult for ad-hoc questioning.
• Access to key personnel.
• Technical issues such as poor WIFI connection.

Tips to overcome the challenges and effectively manage a Virtual Audit

Preparation for the Audit

It is extremely important to be as prepared as possible for the audit.

• Agree in advance with the audit owner key items such as the scope of the audit, date of the audit, the audit agenda and the key personnel required for interview.
• Identify and request the required documentation well in advance of the audit so that a checklist of queries can be prepared.
• Stay on top of documentation requests as when conducting a virtual audit there may be limited opportunities to review documents remotely on the day of the audit.
• Be familiar with the regulations governing the organisation and factor this into the audit checklist.
• Agree in advance the forms of technology to be used to conduct various parts of the virtual audit. For example, MS Teams or Zoom could be used to conduct the interviews and a mobile phone utilising WhatsApp video call could be used for the virtual tour part of the audit.
• The WIFI connection should be tested in advance to ensure a sufficient connection is available for the day of the audit.
• Ensure key personal are available on the day of the audit for interview. Give them sufficient notice of the date of the audit, times and scope.
• Give considerations to data protection requirements (GDPR) and consent from residents / patients for their data to be used as part of the audit.

Conducting the Audit

The virtual audit should be conducted in as close a format to a regular onsite audit.

• The three key elements of collecting evidence for an audit are interviews, documentation review and observation (walk around). These should be facilitated using the relevant technology.
• At the start of the audit hold an opening meeting with the management team or relevant key personnel to discuss the scope of the audit and set the objectives of the day.

• During the interview the auditor must ensure they actively listen to what is been told to them, stay focused on the subject matter, and observe body language of the interviewee.
• Request a virtual walk around of the facility by the lead auditee. Don’t allow yourself or the camera to be deflected from areas of interest! Be as curious as possible and request the auditee to show you anything of interest to the audit. Feel free to stop people on the walk around to ask them ad-hoc questions.
• Any documents not made available prior to the audit, request them to be shown via video call.
• Record an audit trail so that you can substantiate your audit findings. Remember to be cognisant of patient / resident confidentiality, for example utilise a patient number rather than their name if recording data relevant to a patient record.
• When recording non – compliances you should also associate a risk level which is reflective of the levels associated in the Risk Management Process.
• At the close out meeting of the audit, discuss the situations encountered and the findings made. Highlight and discuss any areas of non-conformances and air any conflict of opinions regarding the findings.
• Provide a timeframe from the final report.

Report and Close Out

• The audit report is created following the close out of the meetings and will detail the findings and proposed corrective or preventative actions. Some root cause analysis may need to be conducted to find out what was the reason for the non-conformances occurring.
• Remember to record facts not faults and provide positive feedback and recommendations too.

Conclusion

Postponing audits is not a viable option in healthcare. Organisations must consider conducting virtual audits to ensure there is effective oversight and quality of care assurance. Although it is clear that performing virtual audits is different, it does not have to be more cumbersome.

HCI is working with our clients to maintain their programmes of independent quality assurance with Virtual Care Audits during the current lock down.

Through remote data analysis, staff interviews, and real time monitoring HCI Specialists continue to provide advice and guidance in line with the everchanging best practice standards.

If you require support in conducting independent audits such as patient safety audits, Infection Prevention and Control Audits or the COVID-19 Assurance Framework Self-Assessment, then contact HCI today. We are here to support you.