Clinical Audit report format by YH95e8


									                                             ‫إدارة التنظيم الصحي‬
                                      Health Regulation Department

    Approved                            Clinical Governance Office              Audit Ref No.

                                            Clinical Audit Report


Project Title:___________________________________________________________________________
Date Started: __________________
Date Completed: _______________
Audit Lead: Name: __________________________________Professional Title: ______________________
Other individuals involved: (please specify names & professional titles):
    1. _____________________________________________________
    2. _____________________________________________________
    3. _____________________________________________________
Name of the Department:______________________________________
Hospital: ___________________________________________________
Contact Address: _____________________________________________
Work Telephone Number: ______________________________________

Background – Rationale for Clinical Audit Project
Provide reasons for choosing the topic? Was it considered to be important?






AS/V.2                                Page 1 of 4                                   HRD/CGO/007
Clinical Audit Report
                                                ‫إدارة التنظيم الصحي‬
                                      Health Regulation Department

Overall Aim includes:
To improve :
□        Patient health outcome                       Patient satisfaction
□        Staff satisfaction                           Delivery of care
        Use of resources                             Others: please specify__________________________

Source of Standards

Professional organizations' guidelines          
Local guidelines/protocols                      
National standards                              
Observation of current practice                 
Others: please specify ___________________

Standard Sets
    1. _______________________________________________Target_______________________%
    2. _______________________________________________Target_______________________%
    3. _______________________________________________Target________________________%
         (any additional standard sets, please continue on same sheet)

Data collection

Source of data: (e.g. Case notes, patients, observation of sessions)


Type of population:


Sample selection:
(e.g. random selection for a period of 3 months)

Data collection process

Data collection tool :
(e.g. interview, questionnaire, record form)
AS/V.2                                   Page 2 of 4                                         HRD/CGO/007
Clinical Audit Report
                                             ‫إدارة التنظيم الصحي‬
                                     Health Regulation Department

Please attach blank copy of data collection tool
Data analysis
How was the data analyzed? Please outline your method

Feedback of findings
To whom were the results communicated and how?

Suggestions for change
What suggestions for changes in practice you would like to make based on the results of the clinical audit?


Meeting with stakeholders
Members :
  □ Medical Director of the hospital
  □ Head of the department (optional)
  □ Head of Clinical Governance Office
  □ Audit team lead
  □ Clinical Auditor(s)
  □ Any others involved for change implementation.

Action plan – Implementation & monitoring change
  Recommendations        Responsible person                        Estimated time to accomplish
Please complete
Audit – Action Follow up form after accomplishing the recommendations as proposed.

AS/V.2                                Page 3 of 4                                                 HRD/CGO/007
Clinical Audit Report
                                              ‫إدارة التنظيم الصحي‬
                                       Health Regulation Department

Date planned for/carried out:
Key findings of re-audit (if conducted):
How regularly do you plan to re-audit this area?

Feedback of the Audit
Problems encountered (if any):

Ways in which the clinical audit design could have been improved:

Strengths of clinical audit design:

Benefits experienced from clinical audit:

Advice to others attempting a similar project:

Name of the Project lead:                                   Signature:                Date:

Head of the Department:                                     Signature:                Date:

Health Regulation -- Clinical Governance Office/ DHA
Senior Clinical Auditor/Health Regulation /DHA:
Received Date :                       Reviewed Date:                     Signature:

Head of Clinical Governance Office:
Approval Date :                                                          Signature:

NB: Clinical Audit Report Writing [CARW] should include the minutes of meeting ,Proforma or Audit tool,
Action plan follow up form duly filled and evidence of results disseminated in the unit with Head of
Department e.g. Power Point Presentation PPP.

AS/V.2                                 Page 4 of 4                                            HRD/CGO/007
Clinical Audit Report

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