the National Clinical Audit Patient Outcomes Programme (NCAPOP), as well as locally identified priorities or ‘internal must do’ audits. Status Total A - Abandoned 1 0 – Information requested 4 1- Audit not yet due to start 17 2 -Significant delay 1 3- Some delay - expected to be completed as planned 7 4- On track - Audit proceeding as planned 47 5- Data collection complete 3 6- Finding presented and action plan being developed 1 7- Action plan developed 2 Grand Total 83 The monitoring report shows that as at 04/09/12 the National Health Promotion Audit has been marked as ‘Abandoned’ due to the inability of the supplier to secure funding from Trusts to conduct the audit. The Consent for Chemotherapy local audit has been marked as ‘Significant delay’ due the possibility of a Network audit of the same subject being undertaken. 2 audits have been completed with action plans developed that have been reported to the relevant Directorate Governance Group. Summary details are provided in the table below. FP Title of audit Summary ref 2.10 Audit of Antenatal Steroid Compliance The National Neonatal Programme Audit Report 2010 (published July 11) had indicated that according to data extracted from the Badger database, the percentage of eligible mothers receiving any dose of sterioids was below the national average. As a result one of the acting arising was to undertake an audit of casenotes to confirm the level of compliance. The audit examined antenatal steroid use for babies less than 34 weeks gestation. The audit found that compliance with antenatal steroid administration in this group was 81.8% across the trust (City 82.1%, Sandwell 66.7%). National standard 85%. According to the neonatal Badger system, compliance was only 69% at City and 55% at Sandwell. The audit confirmed that the inputs into the Badger system needed to be improved. As a result, the audit recommended a number of actions to improve the accuracy of the data submitted. In addition a recommendation was made to review local guidelines as to what gestation receive steroids and which steroids should be used.
the National Clinical Audit Patient Outcomes Programme (NCAPOP), as well as locally identified priorities or ‘internal must do’ audits. Status Total A - Abandoned 1 0 – Information requested 4 1- Audit not yet due to start 17 2 -Significant delay 1 3- Some delay - expected to be completed as planned 7 4- On track - Audit proceeding as planned 47 5- Data collection complete 3 6- Finding presented and action plan being developed 1 7- Action plan developed 2 Grand Total 83 The monitoring report shows that as at 04/09/12 the National Health Promotion Audit has been marked as ‘Abandoned’ due to the inability of the supplier to secure funding from Trusts to conduct the audit. The Consent for Chemotherapy local audit has been marked as ‘Significant delay’ due the possibility of a Network audit of the same subject being undertaken. 2 audits have been completed with action plans developed that have been reported to the relevant Directorate Governance Group. Summary details are provided in the table below. FP ref Title of audit Summary 2.10 Audit of Antenatal Steroid Compliance The National Neonatal Programme Audit Report 2010 (published July 11) had indicated that according to data extracted from the Badger database, the percentage of eligible mothers receiving any dose of sterioids was below the national average. As a result one of the acting arising was to undertake an audit of casenotes to confirm the level of compliance. The audit examined antenatal steroid use for babies less than 34 weeks gestation. The audit found that compliance with antenatal steroid administration in this group was 81.8% across the trust (City 82.1%, Sandwell 66.7%). National standard 85%. According to the neonatal Badger system, compliance was only 69% at City and 55% at Sandwell. The audit confirmed that the inputs into the Badger system needed to be improved. As a result, the audit recommended a number of actions to improve the accuracy of the data submitted. In addition a recommendation was made to review local guidelines as to what gestation receive steroids and which steroids should be used.
Tabled-Paper-Quality-Report-September-2012-Final.docx