Audit Form Research Articles

Study, Evaluation and Implementation of Improvement in a compressed Air Plant

This paper presents the study of a compressed air generation system in a bus manufacturer, being evaluated the operation of the compressors to identify the electric energy consumption. A maintenance plan is elaborated to correct the air system leaks and also proposes the reuse of thermal energy generated by the compressors. Initially, as for the purpose of this paper, a revision of fundamentals related to thermodynamics transformation, are presented. Afterwards, some important electric energy concepts will lead to the understanding of the energy consumption of the compressors. Then, an overview about compressed air generation systems will be showed with the goal of understanding techniques of energetic efficiency. The tools used in this study for collecting data were the software of a compressor manufacturer with pressure transducers, and an energy analyzer. The basic concepts and their uses will be shown along this paper. The proposal of electric energy consumption reduction was achieved with the installation of compressor operation managers, there was a reduction nearly 60,600 kWh per month, which provided a monthly savings of R$19,400.00, validating the collected data. For heat recovery from the cooling air compressors, externally finned coils were sized to heat water up to 55 ºC and used in a process of heating rubber gaskets. For air leakage reduction, a working methodology to perform the corrective and preventive maintenance has been prepared, and a control system in the form of internal audit. This allowed the reduction of the air leakage was almost 50%. http://dx.doi.org/10.18226/23185279.v1iss1p11

Assessment Practices in the Policy and Politics Cycles: A Contribution to Reflexive Governance for Sustainable Development?

This article examines systematic assessment practices linked to sustainable development policies. We consider five types of assessment — monitoring, policy evaluation, formal audit, peer review, and specialist reporting — and explore their fate in the policy and electoral politics cycles. In contrast to traditional views of the policy cycle, we note that systematic assessments provide complementary feedback around the entire policy cycle. However, despite this omnipresence, their policy relevance is usually severely limited, inter alia because the policy cycle captures only parts of the political reality. A major concern for politicians (but not necessarily for policy or governance scholars) that goes far beyond the formulation and implementation of policies is the broader cycle of electoral politics that determines the state's political personnel as well as government priorities. Here, we highlight that the findings of systematic assessments are often lost in a cacophony of voices to which politicians are more carefully attuned, such as media responses and opinion polls, implying that scientific evidence is simply ‘overwritten’ with other kinds of evidence representing alternative rationalities and priorities. Despite numerous shortcomings, the true value of systematic assessment practices lies in their potential to furnish ammunition to state and non-state actors interested in securing change.

Assessment practices in the policy and politics cycles: a contribution to reflexive governance for sustainable development?

ABSTRACTThis article examines systematic assessment practices linked to sustainable development policies. We consider five types of assessment—monitoring, policy evaluation, formal audit, peer review, and specialist reporting—and explore their fate in the policy and electoral politics cycles. In contrast to traditional views of the policy cycle, we note that systematic assessments provide complementary feedback around the entire policy cycle. However, despite this omnipresence, their policy relevance is usually severely limited, inter alia because the policy cycle captures only parts of the political reality. A major concern for politicians (but not necessarily for policy or governance scholars) that goes far beyond the formulation and implementation of policies is the broader cycle of electoral politics that determines the state's political personnel as well as government priorities. Here, we highlight that the findings of systematic assessments are often lost in a cacophony of voices to which politicians are more carefully attuned, such as media responses and opinion polls, implying that scientific evidence is simply ‘overwritten’ with other kinds of evidence representing alternative rationalities and priorities. Despite numerous shortcomings, the true value of systematic assessment practices lies in their potential to furnish ammunition to state and non-state actors interested in securing change.

Brachytherapy practice across Canada: A survey of workforce and barriers

To determine the current use of brachytherapy, characteristics of the brachytherapy workforce, and barriers to development and maintenance of brachytherapy programs across Canada. A survey was designed to inquire about the use of brachytherapy and was sent to all Canadian radiation oncologists. Of the 116 respondents, we identified 80 radiation oncologists from 33 of 41 responding centers who currently or in the past have practiced brachytherapy. Responses were received from 30% overall and 80% of provinces. Approximately 58% of the respondents treat in one site with brachytherapy, whereas 12% treat in three or more sites. Gynecologic (GYN) and genitourinary are the most commonly treated sites (49% of respondents). For all sites, there was a large range in the number of patients treated with brachytherapy by each radiation oncologist per year (i.e., cervix: 1-50). Approximately 49% of the respondents have discontinued practicing brachytherapy for a certain site, most commonly head and neck (28%), GYN (25%), and bronchus (24%). The most common reasons include reassignment or lack of a local program. The most common reasons why brachytherapy is not used for sites other than GYN and prostate include lack of infrastructure and insufficient training of radiation oncologists rather than insufficient patient numbers or lack of evidence for a benefit of brachytherapy. Within its limitations, our study suggests a mismatch between demand and availability of brachytherapy programs across Canada. In light of finite resources, a rational approach to investment in brachytherapy is needed and this must be based on a formal audit of brachytherapy demand and use.

Mandatory continuing professional development in South Africa: Rehabilitation therapists' perspective

Aims: In 2007, Health Professions Council of South Africa (HPCSA) introduced mandatory continuing professional development (CPD), which enables therapists to acquire new knowledge and skills to improve patient care. To remain registered, therapists must meet CPD standards by formal HPCSA audits; however, latest figures revealed a compliance rate of 35% due to non-attendance of CPD activities. This study reviewed the experiences of therapists to identify barriers and obtain suggestions to improve attendance. Methodology: This cross-sectional descriptive study used a questionnaire with closed and open questions to explore the aims from a sample of 138 rehabilitation therapists, comprising speech and language therapists (9%), occupational therapists (21%) and physiotherapists (70%), attending an ethics workshop. Results: Eighty five (62%) supported CPD and 97 (71%) supported compulsory ethics. Short 1 to 3 day courses, mini-congresses and journal club activities were the most frequently-attended events. Barriers to CPD were: time, cost of courses, cost of travel due to geographical distance, staff shortages, lack of employee support, and multi-disciplinary or inappropriate courses. Suggestions for improving attendance were: introducing state subsidised and corporate sponsorships, increased in-service journal club activities, tele- and video-conferences, on-line presentations, and profession-specific courses. Conclusion: Therapists support mandatory CPD, but stakeholders must take cognisance of the barriers and suggestions to improve CPD attendance and compliance.

Current Australian Pediatric Practice in the Assessment and Treatment of ADHD

ObjectiveTo study the characteristics of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Australia, and the assessment and management practices of their pediatricians. MethodsA 2-week practice audit was conducted in a large representative sample of Australian general/community pediatricians. Pediatricians completed an audit form for all patients seen. Demographic details, diagnoses, treatments, and referrals made were recorded for each consultation. ResultsA total of 199 pediatricians completed the audit (response rate 66%). There were 1528 consultations with patients with ADHD. Eighty percent of the subjects were male, and mean age at diagnosis was 9.1 years (range 3–19 years). Most patients (60%) had 1 or more comorbidity identified, although the reported rates of anxiety (8%) and oppositional defiant disorder (15%) were lower than expected. Patients with ADHD were more likely than patients with other diagnoses to be seen in private practice settings (76% vs. 65%; P < .001). Children with ADHD were referred to numerous services at diagnosis, most commonly psychology (32%). Stimulant medication or atomoxetine was prescribed for 40% at initial diagnosis and 80% at continuing consultation. Overall, methylphenidate was the most common medication prescribed (63%), with a minority prescribed dexamphetamine, atomoxetine, or clonidine. Eighteen percent were prescribed 2 or more medications. Medication prescription was predicted by age but not by gender or socioeconomic status. ConclusionsADHD is the most frequent diagnosis seen by Australian pediatricians, with some patients being seen into early adult life. Comorbidities appear to be inconsistently identified, with some possibly underdiagnosed. Older children are more likely to be prescribed medication.

FIRE SAFETY AT HIGH-RISE SHOPPING MALLS AT DHANMONDI, DHAKA AND APPLICATION OF SAFETY AUDIT AS A PREVENTIVE MEASURE

In our country safety is a common urge from almost every corner. We breathe in a society where we have to struggle for our basic issues like safety. Fire at different shopping malls is the clear evidence that safety at high-rise shopping malls was poorly measured. But a minimum courtesy from the concerned authority could mitigate this problem at the optimum level. This paper tries to depict the safety condition at high-rise shopping malls at Dhanmondi, Dhaka as well as to emphasize on safety audit to avert fire risk. Lack of formal safety audit department among the high-rise shopping malls at Dhanmondi is one of the major findings of the study. That’s why, efficient use of safety audit on behalf of the market management can be an effective tool to solve this problem

Implementing an Obstetric Triage Nurse Competency Program

<h2>Poster Presentation</h2><h3>Purpose for the Program</h3> The need for a method to validate the competency of the U.C. Davis Medical Center's labor and delivery (L&D) triage nurses was identified during a visit by the United States Department of Health and Human Services (DHHS). Deficiencies in Emergency Medical Treatment and Active Labor Act (EMTALA) compliance were noted in both the emergency room and the L&D triage unit, and there was no documentation of training specific to triage for the L&D nurses. Additionally, the unit lacked a consistent method of assigning acuity as patients presented for care. Our project involved the creation and implementation of both an obstetric (OB)‐specific acuity system, and a program to establish and validate the competency of the nurses from the L&D triage unit. <h3>Proposed Change</h3> A multidisciplinary committee was established and tasked with the development of a comprehensive program for the orientation, training, and ongoing competency validation of the L&D triage nurses. The L&D managers of other area hospitals were queried about their triage nurse competency validation tools and methods, and many quickly responded. We worked with the emergency room staff to develop an OB acuity system compatible with the Emergency Severity Index (ESI), a program already in use by the emergency room. The basic education and training requirements for the L&D triage registered nurses (RN) were delineated and some audit tools were developed: a medical screening exam competency assessment tool and an annual chart audit form. A standardized procedure for the medical screening examination, performed by the L&D triage nurse, in compliance with EMTALA regulations, was written and approved. A spreadsheet was developed to verify the current status of the training of each of the L&D triage nurses. <h3>Implementation, Outcomes, and Evaluation</h3> Core L&D RNs attended the emergency department's ESI training and became the trainers for the L&D staff. A PowerPoint presentation was developed, courses were scheduled, and all L&D triage staff attended a 2‐hour training session on the use of the newly developed "Emergency Severity Index for OB." Using the aforementioned competency validation tool, a trainer then tested each RN in his or her competency of a medical screening examination. An Intermediate Fetal Monitoring course of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) was scheduled. All OB triage nurses who had not previously attended were enrolled. The new, five‐tiered OB ESI acuity system was put into practice. These changes have allowed us to more efficiently triage and care for OB patients and improve documentation of the competency of our OB triage nurses. <h3>Implications for Nursing Practice</h3> The education and ongoing competency evaluation of OB triage nurses should be well documented. A standardized medical screening examination procedure and OB acuity system will enable OB triage nurses to improve patient flow and outcomes.

Achieving a Culture of Quality in Pharmaceutical Biostatistics: One Approach to Achieving Quality Deliverables.

Biostatistics units within the pharmaceutical industry are faced with the challenge of increasing productivity, reducing costs, and accelerating timelines while at the same time maintaining high quality. This paper describes how the global biostatistics unit in one company is addressing this challenge by nurturing a "culture of quality" to engage frontline staff responsible for daily deliverables. The approach ties together the measurement, improvement, and maintenance of quality, thus inviting staff to understand their role in achieving quality deliverables. Appointment within the operations unit of a quality lead, who is responsible for quality oversight, further increases visibility and contributes to the culture. Measurement is addressed through the use of a quarterly quality report card in which quality-related metrics are consolidated and tracked over time. Trends and outliers are explored. Through established process improvement practices, a Lean Sigma team tackles select high-value processes. Quality is maintained through continuous feedback loops driven by formal quality assurance audits and logs of lessons learned. This paper first considers how to define quality in this context; then addresses the sometimes disjointed areas of measurement, improvement, and maintenance; and ultimately ties them together to drive a culture of quality.

Can an interprofessional education tool improve healthcare professional confidence, knowledge and quality of inpatient diabetes care: a pilot study?

To conduct a pilot study evaluation of an interprofessional education tool that could improve healthcare professional confidence, knowledge and quality of inpatient diabetes care. Diabetes specialists designed an education tool for use in the hospital environment to educate qualified pharmacists, nurses, healthcare assistants and junior doctors. The interprofessional learning enabled professionals to learn from and about each other. The education tool was piloted at four hospitals. Diabetes specialists delivered the education programme to 31 healthcare professionals over 8 h either as three individual teaching blocks or a whole day. Healthcare professionals completed a multiple choice questionnaire before and after the education intervention to evaluate acquisition of knowledge. The maximum score was 20. Confidence was evaluated using categorical questions. Diabetes specialists used a clinical audit form before and after the education programme, to evaluate the quality of diabetes care. Healthcare professional's confidence improved from 58 to 94% (P < 0.05) and knowledge improved from 12.4 ± 0.6 to 15.0 ± 0.6 (mean ± sem, P < 0.05). There was a reduction in management errors from 74 to 44% (P < 0.05) and improvement in appropriate blood glucose monitoring from 67 to 92% (P < 0.05). The number of patients with documented foot assessment improved from15 to 33% (P < 0.05). Improvement in the number of appropriate diabetes referrals and reduction in prescribing errors did not reach statistical significance. The education tool improved healthcare professional confidence, knowledge and may improve the quality of inpatient diabetes care.

An approach to peer review in forensic pathology

Peer review in forensic pathology has been a long time in evolution but may provide a very useful mechanism to check for, and to correct, errors, in addition to establishing an important educative vehicle for pathologists. A process is reported that has been established at our institution that involves both informal peer review in the mortuary and formal auditing of a set number of cases. Every autopsy case is discussed at a daily meeting of pathologists before a provisional cause of death is released. In addition, one in ten cases including all homicides, deaths in custody, suspicious and paediatric cases, and randomly selected additional cases undergo formal auditing by a second pathologist. Finally, administrative staff check the completed report. This formalized process, in a jurisdiction where autopsies are usually performed by only one pathologist, has been extremely useful in standardizing autopsy reports and in enabling pathologists to discuss cases and associated issues on a regular basis.

Audits and critical incident reporting in paediatric anaesthesia: lessons from 75,331 anaesthetic

This study reports our experience of audit and critical incidents observed by paediatric anaesthetics from 2000 to 2010 at a paediatric teaching hospital in Singapore. Data pertaining to patient demographics, practices and critical incidents during anaesthesia and in the perioperative period were prospectively collected via an audit form and retrospectively analysed thereafter. A total of 2,519 incidents were noted at the 75,331 anaesthetics performed during the study period. There were nine deaths reported. The majority of incidents reported were respiratory critical incidents (n = 1,757, 69.8%), followed by cardiovascular incidents (n = 238, 9.5%). Risk factors for critical incidents included age less than one year, and preterm and former preterm children. Critical incident reporting has value, as it provides insights into the system and helps to identify active and system errors, thus enabling the formulation of effective preventive strategies. By creating and maintaining an environment that encourages reporting, we have maintained a high and consistent reporting rate through the years. The teaching of analysis of critical incidents should be regarded by all clinicians as an important tool for improving patient safety.

A Study of E-Commerce System Audit

The changes of the environment of auditing bring about the changes of audit content and forms. With the development of e-commerce, the audit of electronic commerce system is particularly important, and the audit target, content also has its characteristics. Previous literatures on the audit of electronic commerce system focus on data-based audit, mainly on the authenticity, legitimacy and validity of economic business, and those literatures are lack of the research of the audit of electronic commerce system itself. This paper based on information system audit carry out an comprehensive analysis of the electronic commerce system and its economic business, which will perfect our audit work under the electronic commerce environment. Referring to the relative research, on the basis of the goal of the electronic commerce system audit, this paper synthetically analyses the characteristics and content of E-Commerce System audit.

A reply

I thank Brammar and Sharma for their comments on our recent editorial [1] about maximising interscalene catheter safety. We are in complete agreement with the interscalene catheter placement technique the authors propose. Interestingly, the described technique is very similar to one I developed in 2005 with outcome data from a formal prospective audit of over 300 patients published a short time later [2]. I would also add the following. The sonogram supplied is of good quality. Often, all that can be seen is one nerve root (occasionally, roots cannot be seen at all). For this reason, and because accurate catheter (and therefore needle) placement is critical to the technique's success, we recommend concomitant neurostimulation to confirm the target hypo-echoic structure is, in fact, a nerve root. One motor response (preferably deltoid, biceps or triceps) is all that is required to confirm the appropriate root. Single-injection techniques do not require the same needle tip precision. Because the needle is aligned in the direction of the plexus, if using a large calibre blunt needle (e.g. 18-G Tuohy), nerve root penetration is almost certainly impossible, so we try to place the needle as close as possible to the target roots, but still within the middle scalene muscle as the authors propose [3]. We agree with threading the catheter several centimetres past the needle tip, but then withdrawing to 3–4 cm beyond the original needle tip position (after needle removal) [4]. Less than 3 cm increases the risk of subcutaneous placement resulting from movement of the patient's head. More than 5 cm increases the risk of the catheter's deviating away from an optimal position. The catheter's position can indeed be verified by observing local anaesthetic spread, but we do not do this for the following reasons: firstly, observing local anaesthetic spread via the catheter is technically challenging when using the out-of-plane technique. Secondly, as the catheter is blindly left 3–4 cm beyond a needle tip aligned parallel to the plexus, it simply cannot deviate significantly away from the plexus [4]. Finally, it is uncertain what the operator should do if they can't see local anaesthetic spread; removing such catheters will result in the removal of many appropriately placed catheters. The optimal local anesthetic dose for the initial catheter bolus to maximise postoperative analgesia and minimise motor block is 20 ml ropivacaine 0.375%. Local anaesthetic-induced myotoxicity has yet to be confirmed as a clinically relevant issue. Finally, we urge caution when comparing success rates between studies, as there can be multiple confounding variables [5]. A detailed description of the above technique with video is available at http://ultrasoundblock.com.

Evaluation of prescribing patterns of teaching and non teaching hospitals by undergraduate medical students in Pune, India

Background : This study was carried out in various hospitals to analyze the use of rational fixed dose combinations (FDCs) in Pune. Methods : 279 prescriptions were evaluated in this study. Information about age, sex, names of the all the drugs prescribed by doctor/ physician, diagnosis for the use of prescriptions and adverse effects were noted in the audit form from the prescriptions of the patients. Rationality of fixed dose combination is evaluated according to WHO Model List of Essential Drugs, 17th updated version, 2011. Results : 56.98 % doctor’s prescriptions in this study were containing of fixed dose combinations and out of this 10.69 % prescriptions were including two or more FDCs in their prescriptions. Only 13.20% FDCs were in accordance with WHO Model List of Essential Drugs. FDCs from antiinflammatory and antirheumatic products, vitamins, minerals, antianaemic preparations, drugs for acid related disorders, antibacterials for systemic use and cough and cold preparations were used more by private non teaching hospitals as compared to SKNMC &amp; GH teaching hospital. 64.61 % prescriptions of private hospitals and 34.08 % prescriptions of teaching hospital were containing more than one drug. Conclusions : This study has shown that about every alternate prescription contains FDC. More than 80 % of prescribed FDCs are not in accordance with Essential Drugs List. Vitamins, minerals, antianaemic preparation FDCs should be prescribed judiciously as they are not free from ADRs. More number of drugs (poly-pharmacy) and FDCs were prescribed by non teaching private hospitals.

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Introduction: Accuracy of data abstracted from medical records is essential in research and quality improvement initiatives. Source data verification is a common, but expensive, approach to ensuring data reliability. Pre-study calibration exercises may be useful to clarify methodology across centers. Hypothesis: We hypothesized that a structured duplicate chart abstraction exercise preceding a multicenter audit would identify points of data discordance, clarify methodology, and have utility from the perspective of abstractors. Methods: In preparation for a multicenter thromboprophylaxis audit in the critically ill, 2 research coordinators in each of 8 centers reviewed the audit forms and manual before performing independent audits of 5 charts. From each chart, 27 baseline demographic variables and 30 daily data variables related to pharmaceutical and mechanical thromboprophylaxis strategies, risk factors and clinical outcomes were abstracted. Data were collected for ICU length of stay (range 2 to 60 days). Abstractors documented discordant variables and reported on the impact of the calibration exercise. Results: 2.01% (n = 190) discordant variables were reported. Discordance was identified in 38/40 (95%) charts with the number of discordant variables per chart ranging from 2 to 31. For each discordant variable, abstractors achieved consensus and data were revised accordingly. The majority of abstractors reported that the exercise confirmed that abstraction was being conducted properly (75%). The exercise prompted abstractors to clarify both the source data (50%) and correct time window for variables (50%) as well as check the implementation manual (50%) or communicate with the Methods Center for clarification (25%). Conclusions: A pre-audit calibration exercise identified minimal, but important, discordance between abstractors. This preparatory work was useful to identify and mitigate data disagreement within centers, and standardize methods across centers. Multicenter preparatory calibration exercises can help to ensure data integrity by increasing the internal validity and operational efficiency of full scale multicenter audits, which are typically conducted with minimal funds and without source data verification.

Implementing combination DMARDs strategy in early RA not as nice as we like?

Sir, there is evidence that therapy with a combination of DMARDs and prednisolone results in better outcomes in patients with early RA than does treatment with a single DMARD [1]. The National Institute for Health and Clinical Excellence (NICE) of UK has also recommended that appropriate patients with newly diagnosed rheumatoid arthritis (RA) should be offered a combination of DMARDs (including methotrexate) plus short-term glucocorticoids as first-line treatment, ideally within 3 months of the onset of persistent symptoms [2]. NICE also recommends monthly measuring of disease activity (using a composite score such as DAS28) until treatment has controlled the disease to a level previously agreed with the RA sufferer. Having introduced an updated local protocol for early RA management on the basis of these guidelines (aimed at early but not immediate introduction of combination therapy), we performed an audit to assess the practicalities of our adherence to the use of combination therapy and monthly DAS28 monitoring. We collected data retrospectively for the first 65 new RA patients considered for our protocol on a standard protocol audit form was assessed (from Nov 2009 to Aug 2011). Of the total number of patients (n = 65), all had DAS28 performed at base line, (mean DAS28-5.20). Out of sixty-five, sixty-four patients were felt suitable for combination therapy. Fifty-seven patients were commenced on methotrexate as per protocol preference (7.5 mg weekly increasing to 15 mg weekly over 6 weeks). Eight patients commenced sulfasalazine as per personal preference. All patients were offered steroids, with an uptake rate on first visit of n = 47 (72 %). Planned 1-month follow-up appointment was only achieved in n = 23 patients (predominantly due to patient (not clinician)-related factors). Although n = 16 patients had DAS-28 [ 3.2 (considered a threshold for DMARD alteration), only one patient proceeded to combination therapy at this visit (predominantly whilst awaiting continuing efficacy or dose increase of MTX). Out of 23 patients seen at second visit, 8/23 (35 %) received steroid therapy. For the third visit (planned at a further 1-month interval), 21/64 (33 %) patients were seen within the time frame of approximately 4 weeks later; 13/21 (62 %) had DAS28 [ 3.2. Only four of these ‘eligible’ patients (31 %) commenced combination therapy. At 3 months, final DMARD allocation in the 65 patients was methotrexate (n = 46), sulfasalazine (n = 7), combination (n = 8), leflunamide (n = 1); two patients were not on any DMARD and one awaiting review. This audit highlights difficulties with the commencement of combination therapy. In the real world setting, a number of factors particularly patient and therapy related factors can interfere with an aspiration to commence and escalate combination therapy in RA patients. Our study emphasis the importance of working towards individual patient agreed outcomes and ensuring flexibility of timing of appointments to achieve most effective use of patient and clinician time.

The Value of Audit Tools in Children's Services: Reflections upon a Common Assessment Framework Audit

This paper considers the value of audit tools in children's services. The article draws upon reflections from an audit of the Common Assessment Framework (CAF) in an English local authority. The wider context of the CAF is outlined, highlighting the prominence of performance management within children's services and critical commentary around the same. Thereafter, the local context of CAF audit and the Quality Review Form (‘audit form’) used in the exercise is described. Observations from the audit are noted and the author reflects upon the validity of the audit form in light of the relevant literature. The article concludes that the CAF audit form does have many shortfalls, similar to those evident in other audit tools, including reliance upon quantitative data and a lack of both practitioners and children's perspectives. However, there is significant potential for it to be shaped into a useful tool to facilitate organisational learning, particularly through the incorporation of qualitative approaches to outcomes measurement.

Monitoring of Biomedical License Agreements: A Practical Guide.

Because technology licensed from research organizations can play a significant role in drug innovation and the generation of novel biomedical products, licensee performance under such agreements must be effectively monitored. This is necessary so that resultant benefits, including public health improvement, may be returned to the innovator(s) as well as society at large. The tasks that comprise monitoring are varied, but all come under the general heading of 'enforcement of license provisions'.Since 1996, the license monitoring and enforcement program established by the US National Institutes of Health (NIH) Group has collected about $US17 million in unpaid and underpaid license royalties through formal financial audits and other investigative activities. During the same period, the Office of Technology Transfer (OTT) settled more than 60 cases of suspected patent infringement, generating around 60 new licenses and collected both back and ongoing royalties. As these numbers show, an active and effective monitoring program is an essential part of any technology transfer or biomedical licensing program.

English

&nbsp; Performance auditing as an audit discipline has developed seriously since the late 1970s. Owing to its developing nature, however, it has been noted that it lacks formal audit methodologies. One of such audit methodology is in the specific design of an audit programme; this is important as the audit programme forms the basis of the audit. This paper presents a methodology for creating an audit programme specifically for performance auditing and further presents this in a model format. To develop this methodology, grounded theory was applied. The audit methodology and model were evaluated against the International Organization of Supreme Audit Institutions (INTOSAI) performance audit standards and were also tested in two private-sector companies.&nbsp;The proposed audit methodology is based on the relationship between process, risk, control and the audit programme; it uses risk-based auditing, and the specific performance audit objectives are inverted to form the primary performance risk; in addition, benchmarks and criteria are included; the model caters for both high-level and detailed information. This methodology and model benefits both performance auditors and business managers. &nbsp; Key words:&nbsp;Performance audit, audit programme, risk, control, risk-based auditing, efficiency, effectiveness, economy, International Organization of Supreme Audit Institutions (INTOSAI), grounded theory.