Audit Program Research Articles

Variation of stroke-associated pneumonia in stroke units across England and Wales: A registry-based cohort study.

BackgroundPneumonia is common in stroke patients and is associated with worse clinical outcomes. Prevalence of stroke-associated pneumonia varies between studies, and reasons for this variation remain unclear. We aimed to describe the variation of observed stroke-associated pneumonia in England and Wales and explore the influence of patient baseline characteristics on this variation.MethodsPatient data were obtained from the Sentinel Stroke National Audit Programme for all confirmed strokes between 1 April 2013 and 31 December 2018. Stroke-associated pneumonia was defined by new antibiotic initiation for pneumonia within the first seven days of admission. The probability of stroke-associated pneumonia occurrence within stroke units was estimated and compared using a multilevel mixed model with and without adjustment for patient-level characteristics at admission.ResultsOf the 413,133 patients included, median National Institutes of Health Stroke Scale was 4 (IQR: 2–10) and 42.3% were aged over 80 years. Stroke-associated pneumonia was identified in 8.5% of patients. The median within stroke unit stroke-associated pneumonia prevalence was 8.5% (IQR: 6.1–11.5%) with a maximum of 21.4%. The mean and variance of the predicted stroke-associated pneumonia probability across stroke units decreased from 0.08 (0.68) to 0.05 (0.63) when adjusting for patient admission characteristics. This difference in the variance suggests that clinical characteristics account for 5% of the observed variation in stroke-associated pneumonia between units.ConclusionsPatient-level clinical characteristics contributed minimally to the observed variation of stroke-associated pneumonia between stroke units. Additional explanations for the observed variation in stroke-associated pneumonia need to be explored which could reduce variation in antibiotic use for stroke patients.

Qualitative evaluation of a mandatory provincial programme auditing emergency department return visits

ObjectiveThe objective of this qualitative study was to evaluate the perceived impact and value of the Return Visit Quality Programme (RVQP), a mandatory province-wide emergency department audit programme.DesignWe employed an...

Making every birth count: Outcomes of a perinatal mortality audit program.

Stillbirth rates have shown little improvement for two decades in Australia. Perinatal mortality audit is key to prevention, but the literature suggests that implementation is suboptimal. To determine the proportion of perinatal deaths which are associated with contributing factors relating to care in Queensland, Australia. Retrospective audit of perinatal deaths≥34weeks gestation by the Health Department in Queensland was undertaken. Cases and demographic information were obtained from the Queensland Perinatal Data Collection. A multidisciplinary panel used the Perinatal Society of Australia and New Zealand (PSANZ) perinatal mortality audit guidelines to classify the cause of death and to identify contributing factors. Contributing factors were classified as 'insignificant', 'possible', or 'significant'. From 1 January to 31 December 2018, 65 deaths (56 stillbirths and nine neonatal deaths) were eligible and audited. Most deaths were classified as unexplained (51.8% of stillbirths). Contributing factors were identified in 46 (71%) deaths: six insignificant (all stillbirths), 20 possibly related to outcome (17 stillbirths), and 20 significantly (16 stillbirths). Areas for practice improvements mainly related to the care for women with risk factors for stillbirth, especially antenatal care. The PSANZ guidelines were applied and enabled a systematic approach. A high proportion of late gestation perinatal deaths are associated with contributing factors relating to care. Improving antenatal care for women with risk factors for stillbirth is a priority. Perinatal mortality audit is a valuable step in stillbirth prevention and the PSANZ guidelines allow a systematic approach to aid implementation and reporting.

The use of analytical procedures at the audit planning stage

The article considers the main stages of an audit. They allow to achieve the main goal of audit planning, that is, the implementation of a reporting test to identify possible errors; reporting testing for probable errors; horizontal and vertical analysis and "reading" of reports; express analysis of reporting. At the stage of planning the audit, after the disclosure of inconsistencies in the forms of financial statements, significant changes in the dynamics and structure, it is possible to determine the coefficients and at the same time the method of express analysis of the statements is used. The article focuses on the main mistakes in financial reporting. The main ratios for the analysis of financial statements are also given: liquidity ratios; financial stability; turnover; profitability. The analytical procedures presented in the article, which are guided by auditors at the stage of planning an audit, can be divided into the following groups. In addition, the division of audit procedures helps to identify problems in the provided information in a timely manner when disclosing it in the financial statements, and is aimed at identifying audit risks at the substantive stage. The use of analytical procedures at the stage of planning an audit allows you to create an audit program with minimal time costs, reduce the risks of problems that are associated with a lack of time and skills of personnel.

Abstract P99: Impact of the Covid-19 Pandemic on Stroke Thrombolysis Rate and Delay to Thrombolysis Treatment in a Regional Stroke Centre in London, UK

Introduction: There are reports of changes in the numbers of stroke admissions and time intervals to receiving emergency treatments during the COVID-19 pandemic. We examined the impact of the COVID-19 pandemic on the stroke thrombolysis rate and delay to thrombolysis treatment in a regional stroke centre in London, UK. Methods: COVID-19 testing began at our hospital on 3 March 2020. Clinical data for all acute stroke admissions were routinely collected as part of a national Sentinel Stroke National Audit Programme (SSNAP) and all thrombolysis data were entered into our local thrombolysis database. We retrospectively extracted the relevant patient data for the period of March to May 2020 (COVID group) and compared to the same period in 2019 (pre-COVID group). Results: Compared with pre-COVID, there was a 17.5% fall in total stroke admissions (from 315 to 260) during COVID; but there were no significant differences in the demographics, stroke severity, proportions with known time of onset, or median onset-to-arrival time. The thrombolysis rates amongst ischemic strokes were not significantly different between the two groups (59/260=23% pre-COVID vs. 41/228=18% COVID, p=.19). For thrombolysis patients, their stroke severity and demographics were similar between the two both groups. Median onset-to-needle time was significantly longer by 22 minutes during COVID [127 (IQR 94-160) vs. 149 (IQR 110-124) minutes, p=.045]; this delay to treatment was almost entirely due to a longer median onset-to-arrival time by 16 minutes during COVID (p=.029). Favorable early neurological outcomes post-thrombolysis (defined as an improvement in NIHSS by ≥4 points at 24 hours) were similar (45% vs. 46%, p=.86). Conclusion: COVID-19 pandemic had a negative impact on prehospital delays which in turn significantly increased onset-to-needle time, but without affecting the chance of a favorable early neurological outcome. Our data highlight the need to maintain public awareness of taking immediate action when stroke symptoms occur during the COVID-19 pandemic.

Impact of sensory interventions on the quality of life of long-term care residents: a scoping review

Introduction and purposeResidents in long-term care exhibit diminishing senses (hearing, sight, taste, smell or touch). The purpose of this study was to examine the available literature on the impact of...

Аудит виробничих запасів промислового підприємства

The article is devoted to the study of the organization and methods of production stocks audit at the enterprise "Metalozakhyst" LP. International and national standards and regulations, as well as the current regulatory framework for inventory audit are considered. The proposed working papers will help an auditor to achieve this goal when checking production stocks at the enterprise. In the course of the research, a general plan and a detailed audit programme of the selected organization were developed, which will help to identify violations in the financial statements in a timely manner. The audit examination was conducted in accordance with international auditing standards (ISA) at the enterprise "Metalozakhyst" LP and an audit report was provided to help the manager improve the organization financial security.

Too soon or too late? Choosing the right screening test intervals.

> Ms Glow asks you why the radiology practice where she had her mammogram last year recommends annual screening, while the provincial recommendations are to screen every 2 years. She asks which is correct. > > The audit program in which you participate measures the proportion of age-eligible

Compatibility and Safety Implications Associated with Interfacing Medical Devices in Neonatal Respiratory Care: A Case Example Using the Inhaled Nitric Oxide Delivery System.

Over the past decade, international organizations have instituted strict regulations for the safe use of connected medical devices. The International Organization for Standardization and the Medical Device Single Audit Program instituted certifications to ensure that connected devices are compatible and operate within their proper clinical parameters. These efforts came about, in part, as a consequence of clinicians’ decisions to use nonstandard, modified, or improvised devices for purposes outside the original manufacturers’ approved parameters. Unapproved device modifications can be associated with increased risk of dosing errors, monitoring errors, tubing misconnections and serious or potentially fatal adverse events; furthermore, health care providers who implement unapproved device modifications may assume legal and financial liability should harm come to patients as a consequence of the modification. Using the inhaled nitric oxide delivery system as an example, the objective of this paper is to raise awareness of the potential dangers associated with unapproved modification and interfacing of therapeutic gas delivery systems and ventilators in the neonatal intensive care unit setting. The paper also highlights the rationale and necessity for rigorous validation processes that ensure that interfaced medical devices perform as intended in the clinical setting.

THE INTERNAL AUDITORS OF PHARMACEUTICAL QUALITY SYSTEMS COMPETENCE IMPROVING

The importance of internal audits for the pharmaceutical company, which is indicated in the guidelines for good practices in pharmacy (in particular, GMP, GDP).
 The issue of selection, training, grading, certification and continuous improvement of the auditor’s competence at pharmaceutical companies are relevant and important both for domestic ones, and for foreign enterprises.
 The aim of the study was to determine the competence of the pharmacy quality system internal auditors’ and the areas of its development.
 Materials and methods. The object of the study was the competence of internal auditors of pharmaceutical quality systems. Empirical and theoretical research methods were used, in particular the method of comparative analysis of scientific literature in the field of research, the method of structural and logical modeling. The information basis was the provisions of regulations and materials published in the open professional scientific literature.
 Results. The competence of quality management system auditors in general and pharmaceutical quality system in particular consists of personal qualities, professional knowledge and skills. The ISO 19011 standard highlights the importance of evaluating and continuous development of auditors’ competence. Such an assessment should take into account the needs of the audit program and its objectives. Areas of development of auditors' competence should be determined by the specifics of industry activities. This provision of the standard should be considered relevant for pharmaceutical companies.
 Conclusions. We studied the requirements for the competence of QMS internal auditors of international and industry standards. A review of the regulatory framework showed a lack of information on the chosen area of the research. Defined requirements for the competence of the PQM audits staff assists the selection of specialists to the audit team so that the overall competence of the audit team is sufficient to achieve the objectives of the audit.

Desain dan Implementasi Audit Operasional pada bagian Perpustakaan SMA Laboratorium Kristen Satya Wacana

Community service activities in the field of internal audit are carried out in the Satya Wacana Christian High School to assess the existing 3E (efficient, effective, and economical). The methods in this internal audit activity include identifying risks, audit programs and procedures, interviewing, observing, confirming, distributing questionnaires, and providing recommendations based on audit findings. The results if this activity are in the form of recommendations for prevention, improvement of the library operational activitiesbased of the 3E principle.

Cryptocurrency Exchanges: Predicting Which Markets Will Remain Active

About 99 percent of cryptocurrency trades occur on organised exchanges and many investors subsequently keep their digital assets in accounts with cryptocurrency markets. This generates exposure to the risk of exchange closures. We construct a database containing eight key characteristics on 238 cryptocurrency exchanges and employ machine learning techniques to predict whether a cryptocurrency market will remain active or whether it will go out of business. Both in-sample and out-of-sample measures of forecasting performance are computed and ranked for four popular machine learning algorithms. While all four models produce satisfactory classification accuracy, our best model is a random forest classifier. It reaches accuracy of 90.4 percent on training data and 86.1 percent on test data. From the list of predictors we find that exchange lifetime, transacted volume and cyber security measures such as security audit, cold storage and bug bounty programs rank high in terms of feature importance across multiple algorithms. On the other hand, whether an exchange has previously experienced a security breach does not rank highly according to its contribution to classification accuracy.

УДОСКОНАЛЕННЯ ПРОЦЕДУРИ АНАЛІЗУ ТА АУДИТУ ФІНАНСОВИХ РЕЗУЛЬТАТІВ ПІДПРИЄМСТВ В УМОВАХ ГЛОБАЛЬНИХ ВИКЛИКІВ

Modern global challenges related to social and behavioral constraints, accelerating the process of digitalization of interaction between different actors, cause changes in forms and methods of enterprise management, require new approaches to determining the place and role of accounting, analysis and control in enterprise information system. Given the significant decline in entrepreneurial activity during the COVID-19 pandemic, the problems of analyzing the economic entities financial results and the impact of global challenges are becoming relevant and require research to save costs and strengthen revenue control. The research purpose is justification the theoretical provisions and development practical recommendations for improving the methodology and organization of accounting, analysis and audit of enterprises financial results in today's global challenges. The study used methods of observation, comparison, analysis, generalization and formalization, forecasting. The article identifies the main problems of forestry and key indicators of their solution. The main problems are high level of corruption and illegal activities in forests and the necessity to ensure the balance between environmental, economic and social functions of forestry. The procedure of financial results accounting at a forestry enterprise and the algorithm for generating net financial result is considered. The main stages of the enterprise financial results audit are described. The Plan and the Program of audit of forestry enterprise financial results are offered. The expediency of using the electronic timber accounting system at forestry enterprises, in particular at the State Enterprise "Sveske Forestry", which in the current global challenges related to global environmental degradation and social and behavioral constraints in connection with the pandemic, will in the shortest possible time to install all the information about the wood, as well as quickly and in real time to see the remains of products by species and range, etc. The conclusions and suggestions obtained from the research can be used in the practice of forestry enterprises.

УДОСКОНАЛЕННЯ МЕТОДИКИ АУДИТУ ПРИБУТКУ

In the article the necessity of receiving of high-quality information about the income of a subject who manages different groups of users for the acceptance of administrative decisions is considered. It is set that the audit of reflection of income indexes in accounting will allow information users to get a confidence in her authenticity. The improvement of audit income methodology will contribute in the efficiency rise during the verification with the aim of offering an independent opinion of an accountant. A conceptual model is worked out with the purpose, which represents key moments of audit of income authenticity in the different forms of accounting: the retained earnings in Balance, forming of net income in Report on financial results, rightness’s of his taxation in the Tax return and legality of the use in Report on a property asset. The indicated model serves as basis for development of the detailed program of audit of income. In the program concrete tasks are determined on all stages of verification, for which the list of methods and accountant’s procedures are selected. Moreover, information sources are selected for research of a problem and working documents. Such program must become the detailed organizationally-methodical instruction for every performer with definitions of tasks implementation. Greater part of enterprise’s income is formed from the main activity, as a difference between a net profit from realization and realized unit cost. Therefore, it is possible to set authenticity of forming of result of accountant’s basic activity after confirmation of terms of confession of profits and charges, rightness of their forming, reflection in the system of account and reports. During the test of correctness of income tax calculation, an accountant studies the object and rate of taxation, especially paying attention to enterprise’s activity terms that allow applying favorable tax treatments. The size of income depends on optimization of the tax loading that is the subject of the business entity’s personal interest. During the verification of profit-using operations constituent documents and annual protocols of founders’ gatherings are investigated in detail that allows learning the sanctioned directions of the enterprise’s income using, check exactness of the realizable withholdings and rightness of the done book-keeping records. At the same time, it is important to pay attention not only to quantitative indexes, but also to analyze quality of income, since this information will be useful for decision making of all groups of the interested users.

ВИЗНАННЯ ВИТРАТ ТА ЇХ АУДИТ ПРИ СПРОЩЕНІЙ СИСТЕМІ ОПОДАТКУВАННЯ

The simplified system of taxation, accounting and reporting should be considered an effective tool to stimulate the development of small business and ensure a sufficient level of business activity in the state. The study various aspects of the organization and implementation of accounting, auditing for businesses that have chosen a simplified system of taxation, accounting and reporting is important. The purpose of the article is to deepen the methodological approaches to the recognition of costs and audit of costs in a simplified system of taxation, accounting and reporting. The article reveals the essence of the simplified system of taxation, accounting and reporting, features of its implementation and requirements for individuals -entrepreneurs and legal entities who are allowed to apply the simplified system of taxation, accounting and reporting under current legislation (August 2021). It is established that the payers of the single tax of the first, second and third groups (not the value added tax payer) do not recognize expenses and do not carry out costs accounting. The difference between the recognition of expenses by legal entities and individuals -entrepreneurs in the application of the simplified system of taxation, accounting and reporting is determined. For single tax payers of individuals -entrepreneurs (value added tax payers) the legislation defines the cash method of income recognition upon receipt of funds on the current account (cash desk), withdrawal of cash proceeds from trading machines and, accordingly, recognition of costs upon payment through the current account (cash desk) with mandatory documentary confirmation. Methodological approaches to the recognition of costs by individuals-entrepreneurs (value added tax payers) and legal entities in the application of the simplified system of taxation, accounting and reporting are in-depth. To verify the correctness of the recognition of costs in the application of a simplified system of taxation, accounting and reporting, documentation, accuracy and completeness of reflection in accounting and financial reporting (for legal entities) developed a program of audit of costs.

ПЛАНУВАННЯ ТА ЕТАПИ АУДИТУ НЕМАТЕРІАЛЬНИХ АКТИВІВ ПІДПРИЄМСТВА

The article has examined the essence of the definition of «planning» and «audit planning». The place and importance of planning in the audit process are considered: from the standpoint of ISA and the approaches of domestic scientists, as well as in the context of the audit of intangible assets. The key requirements of ISA 300 «Planning an Audit of Financial Statements» and the possibility of their application in the audit of intangible assets are analyzed. Scientific approaches to determining the stages of audit of intangible assets are studied. As a result of the study, the stages of audit of intangible assets were identified through the projection of the general stages of the audit: preparative, intermediate, physical inspection, audit of financial statement line items, final. It is proposed to consider the audit of intangible assets from two positions: the audit of financial statements and the audit of sustainable development. Emphasis on the importance of the transition to a sustainable development audit, which also includes confirmation of non-financial indicators, is placed. The algorithm of planning the audit of intangible assets in the conditions of sustainable development is determined. The difference between the purpose and objectives of the audit of intangible assets in terms of traditional audit and audit in terms of sustainable development is demonstrated. It is proved that the accents in the development of the audit strategy and detailed plan will depend on the chosen goals and objectives. The main objects of control in the audit of intangible assets are identified. The importance of legal issues (especially protection of intellectual property rights) in the audit of intangible assets and the need for staff with appropriate qualifications is underscored. The audit strategy and plan are considered as elements of documentary evidence of the audit. Factors that slow down the implementation of the audit of sustainable development are identified. The relevance of the concept of «intangible asset audit program» is considered. It is proven that a detailed audit plan for intangible assets should take into account specific procedures, taking into account the nature of intangible assets. At the same time, formalism in drawing up a plan is unacceptable. The consistent list of audit procedures for formation of strategy and plan of audit of intangible assets in the conditions of sustainable development is outlined. It is proved that audit in the conditions of sustainable development expands the list of procedures.

State Aviation Risk Assessment Level Determination Using Hierarchical Fuzzy Inference System Based on Cognitive Maps

During 2018, ICAO (International Civil Aviation Organization, a specialized UN organization) made available the results of its USOAP (Universal Safety Oversight Audit Program): the ratio of compliance for each ICAO member State to 1047 aviation safety-related protocol questions, divided into eight audit areas. Numbers itself has little meaning, even for aviation personnel. Using Cognitive Mapping (CogMap), a Problem Structuring Method tool, this paper develops a framework to extract and organize information from aviation specialists, allowing define Risk Assessment Level for each State, and for each Aviation Safety Branch defined. Using Fuzzy Inference Systems (FIS), helpful supporting decision making, Big Data available from ICAO is converted to Risk Levels for each State and audit area, what may be used to make informed better Safety decisions on the World Aviation Market. Up to the moment, there’s no evidence on the literature of using CogMap to establish a FIS.

Fraud Risk Factors that Affect the Audit Program Plan: The Case of Kurdistan Region, Iraq

This paper aims to identify the most frequent fraud risk factors that affect the nature, timing, and extent of planned audit procedures. The perceptions of both international and local external auditors in the Kurdistan Region, Iraq, were investigated. In general, it was found that the respondents were more interested in assessing fraud risk factors related to misappropriation of assets (84.61%) compared with those related to fraudulent financial reporting (75.43%). Stepwise regression analysis indicates a positive and significant effect of each fraud risk factor related to fraudulent financial reporting that resulted from incentives or pressures and attitudes or rationalization, and the fraud risk factors related to the misappropriation of assets that resulted from attitudes or rationalization on the nature, timing, and extent of the planned audit procedures. However, other fraud risk factors in the study model did not show a significant effect on the audit program plan. The findings of this paper contribute to the existing literature in the area of fraud risk assessment and its effect on planning audit programs in eastern developing countries such as the Kurdistan Region, Iraq.

83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship

BackgroundFacilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital.MethodsA pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI).ResultsSignificant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p < 0.001), ciprofloxacin (23.22 vs. 9.97; p < 0.001), levofloxacin (11.2 vs. 5.07; p < 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p < 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p < 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p < 0.001), levofloxacin ($2,168 vs. $672; p < 0.001), ciprofloxacin ($6,700 vs. $1,954; p < 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p < 0.001).ConclusionImplementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives.Disclosures All Authors: No reported disclosures

Inclusion of Construction Occupational Health and Safety Management System (OHSMS) Components in Building Construction Project

Building construction projects are required to have the Occupational Health and Safety Management System (Sistem Manajemen Kesehatan dan Keselamatan Kerja, OHSMS) due to its high-risk nature. For this purpose, the Ministry of Public Works and People’s Housing of the Republic of Indonesia has issued the Circular Letter Number 66/SE/M/2015 on Costs for Implementing Construction Occupational Health and Safety Management System (OHSMS) in the Field of Public Works. The purpose of this study is to present a detailed description of OHSMS implementation in several building construction projects by using the Ministry’s Circular as the reference. This study is a descriptive study on 30 building construction projects implemented in Indonesia from 2017 to 2019 as the unit of analysis. Data were collected using a questionnaire which was developed based on the content of the Circular of the Minister of Public Works and People’s Housing Number 66/SE/M/2015. This questionnaire was then distributed to respondents using the purposive sampling technic.The OHSMS implementation subcomponents that are most frequently included in the work agreement of building construction projects are work procedure manual development, OHS induction, safety net, protective helmet, worker insurance (BPJS ketenagakerjaan dan kesehatan kerja), OHS expert and/or OHS officer, first aids kit, prohibition sign, and portable fire extinguishers. The least frequently included subcomponents are the provision of worker identity cards (KIP), poster, fall restraint, life jacket, Certificate of OHS Steering Committee (Panitia Pembina Keselamatan dan Kesehatan Kerja, P2K3), medical officer, fogging solution, traffic strip light, OHS flag, and internal audit and inspection programs. A total of 30 building construction projects have implemented OHSMS by including the details of the construction OHSMS implementation, as stated in the Minister of Public Works and People’s Housing Circular Number 66/SE/M/2015 in their work contract.