Full Audit Research Articles

Screening for expired medications in automated dispensing cabinets

Results of a study to quantify rates of identification of expired medications in automated dispensing cabinets (ADCs) are reported. A pre-post analysis was conducted to determine the effect of various types of ADC audits on rates of finding expired medications in ADCs. For the experimental phase of the study, 4 ADCs at the main campus of an academic medical center were randomly assigned to receive one of 4 interventions: (1) monthly audits of all ADC pockets, (2) monthly audits of matrix (open pocket) drawers only, (3) monthly audits of unassigned pockets only, and (4) no additional intervention. At baseline, rates of finding expired medication doses in the 4 ADCs ranged from 0.4% to 0.7%. During the 3-month experimental period, rates of finding expired medication doses ranged from 0.1% to 0.3%. During a final audit 1 month later, the ADC targeted for monthly audits of all pockets was found to contain no expired doses, with an overall improvement in expired-dose rates for all audited ADCs observed over the course of the 4-month study. The average time to perform a full audit for an ADC with about 340 pockets was 1 hour, or 15 seconds per pocket. The average time to perform matrix drawer-only audits averaged around 45 minutes, or 11 seconds per pocket. The average time to perform audits of unassigned matrix drawers averaged 30 minutes, or 10 seconds per pocket. Auditing of all ADC pockets on a monthly basis appears to be an effective method of reducing the rate of identification of expired medications in ADC pockets.

Erratum: “The Economic Consequences of Partisanship in a Polarized Era”

The data and materials required to verify the computational reproducibility of the results, procedures, and analyses in this erratum are available on the American Journal of Political Science Dataverse within the Harvard Dataverse Network, at: https://doi.org/10.7910/DVN/R3GZZW. This erratum corrects errors in the published version of our article “The Economic Consequences of Partisanship in a Polarized Era” (McConnell et al. 2018). One of the authors was reviewing the replication materials as he prepared to file his thesis. After discovering a coding error, we decided to conduct a full audit from the original source files to search for further issues and subsequently identified a few additional errors. Resolving these errors did not substantively change either the statistical results or our substantive conclusions (in Tables 1 and 2, we present a comparison of the original and corrected estimates). No changes were required for Table 3. In some cases, reducing measurement error strengthened the original findings. The overall conclusion of Studies 1 and 2 was that workers and buyers had more positive assessments of copartisan firms and did not have more negative assessments of counter-partisan firms. None of the corrections contradicts those findings. Nonetheless, we deeply regret these errors. More detail on these corrections can be found in McConnell et al. (2020). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Poster 17 - Improving the Quality of Renal Colic Referrals to Urology Services: A Full Cycle Departmental Audit

Poster 17 - Improving the Quality of Renal Colic Referrals to Urology Services: A Full Cycle Departmental Audit

HEROIC: a 5-year observational cohort study aimed at identifying novel factors that drive diabetic kidney disease: rationale and study protocol

IntroductionDiabetic kidney disease (DKD) is the leading cause of end-stage kidney disease worldwide and a major cause of premature mortality in diabetes mellitus (DM). While improvements in care have reduced...

Building trust in food safety certification

Building trust in food safety certification

Risk-adjusted hospital clinical management issue rates using data from the Victorian Audit of Surgical Mortality.

In recent years, there has been a concerted drive for an increase in public reporting of hospital-level outcomes as a means of identifying strategies to improve patient safety. Surgical care, as a high-risk area of medical practice, has come under sharp scrutiny. This study uses data from the Victorian Audit of Surgical Mortality (VASM) in conjunction with data from the Victorian Admitted Episode Dataset to compare hospital rates of clinically identified serious clinical management issues that were definitely or probably preventable and caused or contributed to the death of the patient who would otherwise be expected to survive. Cases where the date of death was between 1 July 2015 and 30 June 2017 that completed the full VASM audit process were extracted from the VASM database and combined with data extracted from the Victorian Admitted Episode Dataset, where a surgical admission occurred in the same time period. A logistic regression model was used as a method of indirect standardization to derive the probability of preventable clinical management issues, which was then used to calculate the standardized incident rate for all Victorian surgical hospitals. Hospitals were compared by plotting the standardized incident rates on three funnel plots. There were five hospitals (8.3%) of the 60 that deviated significantly from the state-wide rate of 0.00012. The risk adjustment model identified several hospitals that may have a systematic issue which warrant further clinical quality assurance investigation.

Performance Audit: Importance and Prospects within the Public Financial Control System

The article discusses the concept and application of performance audit in public administration integral to the modern public financial control system. The aim of the study is to analyze the public financial control system using modern approaches to audit performance and its development prospects in Russia. The authors use general scientific and special research methods (analysis, synthesis, induction, deduction), as well as methods of economic theory: positive analysis and scientific abstraction. The study analyzed basic approaches to defining the concept of “performance audit”, its idea, the most important issues that it solves, and development prospects. The study proposed the concept of a two-level control system: the internal control bodies represented by the Federal Treasury of the Russian Federation should supplement the bodies conducting the performance audit. In the future, this will help build a full performance audit system of the use of public financial resources. As a result , the authors identified the problems of implementing the proposed concept. The key problem is the different statuses of the Federal Treasury of Russia and the Accounts Chamber of the Russian Federation, with different regulation of their activities. The authors named directions for the development of the public financial control system when it is impossible to implement the proposed system. In particular, they proposed to review and precisely regulate the activities of all public financial control bodies. The authors concluded that there is still no regulatory, legal and informational base necessary to switch to the proposed two-level performance audit system. Further studies may provide a deeper look at the possibilities and prospects of the integrated implementation of the performance audit system in the general government sector.

FORMALIZATION AND AUDIT OF THE SYSTEM OF MANAGEMENT OF RIGHTS TO THE RESULTS OF INTELLECTUAL ACTIVITY AT AN ENTERPRISE

The principles of building an effective system of management of rights to the results of intellectual activity (SM RIA) are considered. The results of intellectual activity (RIA) represent the assets of an organization that directly affect the innovative potential of the enterprise, competitiveness, capitalization of the business and its profitability. In this regard, the protection of rights to RIA, the accounting of intellectual property (IP) and the further commercialization policy of RIA appear to be important tasks of a modern enterprise. The formalization of SM RIA at an enterprise is impossible without a full audit of intellectual property. Audit of intellectual property concludes a complex of expert analyses and audit of documentation on the results of intellectual activity available in the organization. The audit will reveal inconsistencies with the legislation regulating the protection of RIA, accounting of IP and reflection in the reporting of IP, the correctness of the assessment of RIA, the procedure of capitalization of RIA, and answer questions about the effectiveness of the existing SM RIA in the implementation of the policy of commercialization of RIA. Further formalization of the SM RIA is represented by the sequence of bringing the reed SM RIA with the legislation of the Russian Federation and business goals.

Management of Respiratory Distress Syndrome in Preterm Infants In Wales: A Full Audit Cycle of a Quality Improvement Project

Respiratory Distress Syndrome (RDS) is the commonest diagnosis after premature birth. We aimed to audit clinical practices before and after introduction of a national guideline in Wales on RDS management. Anonymised, prospective data on all infants born at <34 weeks of gestation and cared for at one of the participating neonatal units in Wales were collected in two six-month time periods in 2015 and 2018. A national guideline was introduced in 2016 by the Wales Neonatal Network. Data collection included areas of antenatal management, delivery room stabilisation, invasive and non-invasive respiratory support, surfactant treatment and elements of supportive care. Univariate and multivariate methods were used to compare data between the two epochs. Comparing care before and after introduction of the national guideline, areas of significant improvement include use of targeted tidal volume ventilation, use of caffeine therapy, oxygen therapy post-surfactant and increasing early use of parenteral nutrition. Areas of poorer management included levels of positive end expiratory pressures and timing of introduction of enteral feeds. Little variation was seen between level two and three units, although gestational age was a significant independent variable for several practices, including delayed cord clamping, stabilisation with intubation, early enteral feeding and caffeine administration. A national guideline for management of RDS in Wales has significantly improved practice in several areas. However, despite a large volume of high-quality evidence and robust guidance, there remains a significant variation in some elements of best practice for RDS management. Further work should focus on education and training, especially for elements requiring cross-departmental work.

Fraud and Abuse in the Saudi Healthcare System: A Triangulation Analysis.

In the insurance industry, the majority of fraud and abuse cases fall into a limited number of patterns, yet false claims normally lead to negative national, local, and organizational effects. Through monitoring the exploitative and abusive behavior commonly found in healthcare services, this paper aims to analyze initiatives implemented by governmental and related healthcare insurance agencies in Saudi Arabia to reduce moral offenses. To accomplish this objective, major governmental health insurance policy documents were analyzed at the macro-level. At the meso-level, semi-structured interviews were conducted with five health insurance professionals on measures undertaken to prevent such incidents. At the micro-level, the critical factors of fraudulent behaviors were analyzed using a retrospective analysis. Data were retrieved from anti-fraud records of ten leading health insurance companies and the focus was mainly on individuals involved in unethical practices between 2014 and 2019. After a full audit was completed, the results concluded that the Saudi healthcare system is composed of twenty-six cooperative health insurance agencies and over 5,202 health services providers. The official documents contain the details of various moral hazard measures. On annual average, more than 196 fraudulent cases were reported with a claim rejection rate of approximately 15%. The majority of fraud cases were reported in dental services with invalid card usage, followed by obstetrics-gynecology services (47 and 113 cases, respectively). Females tended to make up most deceit cases in obstetrics-gynecology with a high level of abuse (95% confidence interval: −83.398 to −24.202; P < .003 and −28 > 638 to −7.362; P < .005, respectively). This study ultimately identifies basic measures employed at the macro-level to reduce moral hazards. However, such measures are not intended to be coherently implemented at the micro-level, especially by health insurance companies and healthcare providers.

Investigating the Effect of Service Messages on Noncompliant Taxpayers’ Reactions to Declining Audit Effectiveness

We examine the very real possibility that audits begin to lose effectiveness as tax authorities continue to receive fewer resources. In an experiment using real US taxpayers, we predict and find a negative relationship between declining audit effectiveness and taxpayer compliance in subsequent periods. Although the most obvious solution would be to invest the resources necessary to achieve full audit effectiveness, this is not feasible in the current budgetary environment. Thus, we propose and test that the inclusion of minimal cost service messages can offset the negative effect of declining audit effectiveness by influencing how the taxpayers perceive the taxing authority. Specifically, our results show taxpayers who view a service message are more likely to view the Internal Revenue Service as focused on customer service (rather than as focused on punishing criminals). Results contribute to the literature on individual tax compliance behavior, particularly related to taxpayers’ awareness of the balance between the service and enforcement efforts of tax authorities.

Blockchain, Wikis, and the Ideal Science Machine: With an Example From Genomics

Until now we have lacked a technology that could well capture the processes of science in a way that preserves every step, and creates a full audit trail. Combining wiki technologies and blockchain provides us with a new opportunity: to create a “science machine” that folds all processes together, from instrument to publication, and enabling science to proceed as never before with greater transparency, accountability, and reproducibility. Here I discuss the theory and method that might be combined to create such a science machine with special reference to the nature of genomic science.

Meeting Proceedings of the “Phase I: Where Science Becomes Medicine” Conference, Manchester, UK

Meeting Proceedings of the “Phase I: Where Science Becomes Medicine” Conference, Manchester, UK

Magnetic resonance imaging for vestibular schwannoma: cost-effective protocol for referrals.

Vestibular schwannoma is the most common neoplasm in the cerebellopontine angle, and fast spin-echo T2-weighted magnetic resonance imaging is the most sensitive test for diagnosing it. This study evaluated the financial and time costs of unnecessary magnetic resonance imaging referrals before and after the application of a magnetic resonance imaging protocol. A full audit cycle was used for the assessment. The first cycle in January 2012 was retrospective and evaluated the financial impact of current selection criteria for magnetic resonance imaging referral against standard guidelines. The second cycle in January 2014 was prospective after implementation of the protocol. There were 46 and 112 patients who had magnetic resonance imaging during first and second cycle, respectively. Of the referrals for magnetic resonance imaging, 65 per cent versus 81 per cent of the referrals were appropriate in the first and second cycles, respectively. The relative risk was reduced from 0.5 to 0.2. The waiting times for magnetic resonance imaging scans improved. Selection criteria for magnetic resonance imaging referral are important in reducing waiting times for scans, patient anxiety and conserving trust resources.

Quality-improvement program for ultrasound-based fetal anatomy screening using large-scale clinical audit.

ABSTRACTObjectiveA large‐scale audit and peer review of ultrasound images may improve sonographer performance, but is rarely performed consistently as it is time‐consuming and expensive. The aim of this study was to perform a large‐scale audit of routine fetal anatomy scans to assess if a full clinical audit cycle can improve clinical image‐acquisition standards.MethodsA large‐scale, clinical, retrospective audit was conducted of ultrasound images obtained during all routine anomaly scans performed from 18 + 0 to 22 + 6 weeks' gestation at a UK hospital during 2013 (Cycle 1), to build a baseline understanding of the performance of sonographers. Targeted actions were undertaken in response to the findings with the aim of improving departmental performance. A second full‐year audit was then performed of fetal anatomy ultrasound images obtained during the following year (Cycle 2). An independent pool of experienced sonographers used an online tool to assess all scans in terms of two parameters: scan completeness (i.e. were all images archived?) and image quality using objective scoring (i.e. were images of high quality?). Both were assessed in each audit at the departmental level and at the individual sonographer level. A random sample of 10% of scans was used to assess interobserver reproducibility.ResultsIn Cycle 1 of the audit, 103 501 ultrasound images from 6257 anomaly examinations performed by 22 sonographers were assessed; in Cycle 2, 153 557 images from 6406 scans performed by 25 sonographers were evaluated. The analysis was performed including the images obtained by the 20 sonographers who participated in both cycles. Departmental median scan completeness improved from 72% in the first year to 78% at the second assessment (P < 0.001); median image‐quality score for all fetal views improved from 0.83 to 0.86 (P < 0.001). The improvement was greatest for those sonographers who performed poorest in the first audit; with regards to scan completeness, the poorest performing 15% of sonographers in Cycle 1 improved by more than 30 percentage points, and with regards to image quality, the poorest performing 11% in Cycle 1 showed a more than 10% improvement. Interobserver repeatability of scan completeness and image‐quality scores across different fetal views were similar to those in the published literature.ConclusionsA clinical audit and a set of targeted actions helped improve sonographer scan‐acquisition completeness and scan quality. Such adherence to recommended clinical acquisition standards may increase the likelihood of correct measurement and thereby fetal growth assessment, and should allow better detection of abnormalities. As such a large‐scale audit is time consuming, further advantages would be achieved if this process could be automated. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

SciPipe: A workflow library for agile development of complex and dynamic bioinformatics pipelines.

BackgroundThe complex nature of biological data has driven the development of specialized software tools. Scientific workflow management systems simplify the assembly of such tools into pipelines, assist with job automation, and aid reproducibility of analyses. Many contemporary workflow tools are specialized or not designed for highly complex workflows, such as with nested loops, dynamic scheduling, and parametrization, which is common in, e.g., machine learning.FindingsSciPipe is a workflow programming library implemented in the programming language Go, for managing complex and dynamic pipelines in bioinformatics, cheminformatics, and other fields. SciPipe helps in particular with workflow constructs common in machine learning, such as extensive branching, parameter sweeps, and dynamic scheduling and parametrization of downstream tasks. SciPipe builds on flow-based programming principles to support agile development of workflows based on a library of self-contained, reusable components. It supports running subsets of workflows for improved iterative development and provides a data-centric audit logging feature that saves a full audit trace for every output file of a workflow, which can be converted to other formats such as HTML, TeX, and PDF on demand. The utility of SciPipe is demonstrated with a machine learning pipeline, a genomics, and a transcriptomics pipeline.ConclusionsSciPipe provides a solution for agile development of complex and dynamic pipelines, especially in machine learning, through a flexible application programming interface suitable for scientists used to programming or scripting.

Alcohol Screening and Brief Advice in NHS General Dental Practices: A Cluster Randomized Controlled Feasibility Trial.

To assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice to eligible patients attending NHS dental practices in London. A two-arm cluster randomized controlled feasibility trial was conducted. Twelve dental practices were recruited and randomized to intervention and control arms. Participants attending for a dental check were recruited into the study and were eligible if they consumed alcohol above recommended levels assessed by the AUDIT-C screening tool. All eligible participants were asked to complete a baseline socio-demographic questionnaire. Six months after the completion of baseline measures, participants were contacted via telephone by a researcher masked to their allocation status. The full AUDIT tool was then administered. Alcohol consumption in the last 90 days was also assessed using the Form 90. A process evaluation assessed the acceptability of the intervention. Over a 7-month period, 229 participants were recruited (95.4% recruitment rate) and at the 6 months follow-up, 176 participants were assessed (76.9% retention rate). At the follow-up, participants in the intervention arm were significantly more likely to report a longer abstinence period (3.2 vs. 2.3 weeks respectively, P = 0.04) and non-significant differences in AUDIT (44.9% vs. 59.8% AUDIT positive respectively, P = 0.053) and AUDIT C difference between baseline and follow-up (-0.67 units vs. -0.29 units respectively, P = 0.058). Results from the process evaluation indicated that the intervention and study procedures were acceptable to dentists and patients. This study has demonstrated the feasibility and acceptability of dentists screening for alcohol misuse and providing brief advice.

Quality Process Improvement: The Impact of Recipient Selection & Evaluation

High dose chemotherapy followed by allogeneic hematopoietic cell transplantation (HCT) can achieve long-term remission and potentially cure patients with hematologic malignancies. Accurate quantification of risk for patients undergoing HCT is critical for medical decision-making. Recipient selection criteria vary from center to center but for the most part include age, disease status, Karnofsky Performance Status (KPS) and co-morbidity index (HCT-CI). Patient age has been studied relatively extensively in this framework and has previously been shown to have little association with treatment related mortality. Additionally, outcomes based on disease status at the time of transplant have been previously well defined. It is well established that overall functional status of a recipient as scored by the KPS tool alone can be subjective between providers. The HCT-CI has been shown to accurately capture the prevalence and level of severity of various organ impairments before HCT though the relationship is vague between psychosocial variables and patient outcomes after allogeneic hematopoietic stem cell transplantation. Whether patient-specific factors can contribute to prediction of outcomes after allogeneic HCT is not well characterized and there is currently no consensus for including these variables in HCT-CI risk-assessment stratification. As a process improvement project to improve one year survival a full scale audit of all allo transplants performed from 2013-2017 was conducted. Results of the audit revealed KPS range of 50-100% and a HCT-CI score mean of 2.7. Disease status at time of transplant was CR1 or CR2. As a result of these findings a deeper delve was completed. Upon reviewing medical histories of all recipients there was significant findings for history of psychiatric illness and illicit drug/alcohol abuse. All recipients were divided into 3 groups as depicted in the table below. NOTE: Per center guidelines: Psychiatric evaluations are completed on all allogeneic recipients, drug screens are completed on patients with a history of abuse and must be negative for 3 months prior to transplant. Conclusion: As a small program, each death greatly impacts a center's overall one year survival which in turn impacts accreditation and insurance Center of Excellence status. After completion of the internal audit, the findings have caused a change in practice to include a critical evaluation for substance abuse that is more restrictive than a three month history of non-use. Additionally a frailty index has been added along with a modification of the HCT-CI for increased scoring for dual history of psych and drug/alcohol abuse. Further studies are needed to evaluate the impact of a dual diagnosis history.

Surgical audit: are we not closing the loop?

PurposeA clinical audit is a key component of the clinical governance framework. The rate of audit completion in general surgery has not been investigated. The purpose of this paper is to assess the rates of audit activity and completion and explore the barriers to successful audit completion.Design/methodology/approachThis was a multi-centre study evaluating current surgical audit practice. A standardised audit proforma was designed. All clinical audits in general surgery during a two-year period were identified and retrospectively reviewed. Data held by the audit departments were collated, and individual audit teams were contacted to verify the data accuracy. Audit teams failing to complete the full audit cycle with a re-audit were asked to explain the underlying reasons behind this.FindingsOf the six trusts approached, two refused to participate, and one failed to initiate the project. A total of 39 audits were registered across three surgical directorates. Only 15 out of 39 audits completed at least one audit cycle, with 4 deemed of no value to re-audit. Only seven audits were completed to re-audit. Achieving a publication or a presentation was the most cited reason for not completing the audit loop.Originality/valueThis study demonstrates that the poor rates of audit completion rate found in other areas of clinical medicine pervade general surgery. Improved completion of an audit is essential and strategies to achieve this are urgently needed.

Change in Food and Beverage Availability and Marketing Following the Introduction of a Healthy Food Financing Initiative-Supported Supermarket.

The Healthy Food Financing Initiative (HFFI) aims to expand access to healthy foods in low-resourced communities across the United States. This study examined changes in food and beverage availability and marketing in nearby small food stores after the opening of an HFFI-supported supermarket in a predominately low-income and African American community. Natural experiment. Rockford, Illinois. A full audit was conducted of the small grocery and limited service stores located in a 1-mile radius around the new supermarket (N = 22) and a 1-square mile area within a nearby demographically matched comparison community (N = 18). Stores were audited in 2015 (1 month preopening) and 2016 (1 year afterward). Store characteristics, item availability, and interior and exterior promotions/advertisements were examined. Difference-in-difference (DID) regression models assessed pre- and postintervention changes in availability and marketing between small food stores in the intervention and comparison communities. The DID regression models indicated no difference between intervention and comparison communities with respect to changes in availability and marketing of all food items with the exception of frozen vegetables which had higher availability postintervention in the comparison community versus intervention (β for interaction term = .67; standard error: 0.33; P = .04). After the opening of the HFFI-supported supermarket, food and beverage availability and marketing in nearby small food stores did not change significantly. However, the wide range of staple foods offered by the supermarket contributed to the expansion of healthy food retail in the intervention community.