Multiple Audit Research Articles

G516 Improving paediatric prescribing practice in a district general hospital through implementation of a quality improvement project

Context This quality improvement project was carried out in the paediatric ward of a district general hospital in Northern Ireland. This work was carried out as part of a cross-border patient safety collaborative organised by the Co-operation and Working Together Group (CAWT). Problem Prescribing errors are a recognised cause of adverse incidents having a direct effect on patients. They impact on the doctor-family relationship and result in breakdown of trust. The existing incident reporting system underestimates medication prescribing errors. Assessment of problem and analysis of its causes A retrospective analysis of prescribing errors between January and December 2013 identified two errors, felt to be secondary to underreporting. Subsequently a baseline audit was performed reviewing patient demographics, allergy status, generic prescribing, drug dosage, timings, drug reconciliation, antibiotic prescribing (indication and duration) and legibility. Twelve drug charts were analysed highlighting 32 errors. A driver diagram identified three components contributing to prescribing errors and relevant tests of change were developed. The three primary drivers included; education and communication, practical prescribing changes and medicine reconciliation. Intervention Seven tests of change were implemented comprising of: presentation of baseline data, staff completion of an online learning module, introduction of a safety notice board, inclusion of data to the nursing safety brief, introducing a medication administration checklist, ensuring staff access to a regional patient information system, appointment of a ward pharmacist and finally developing a pocket-sized antibiotic reference tool. Study design This was a quality improvement project performed using plan-do-study-act (PDSA) cycles and multiple audit cycles. Strategy for change Each intervention was implemented sequentially over a 6 month period and effectiveness assessed by ongoing audit. Ten drug charts were selected at random by the staff nurse allocated to medications on the day of audit. Results were collated in a run diagram in order to disseminate progress to the team. Measurement of improvement The charts were audited using a predesigned proforma and the total number of errors counted. These were subcategorised and results displayed in graphical format after each intervention. In total seven audit cycles were completed. The number of errors including percentage change following each intervention is as follows: Intervention 1; 32 (+19%), Intervention 2; 31 (+15%), Intervention 3; 17 (-37%), Intervention 4; 12 (-56%), Intervention 5; 15 (-44%), Intervention 6; 7 (-74%), Intervention 7; 10 (-63%). Effects of changes The changes led to a global improvement in paediatric prescribing- a reduction in errors of 63%. This represents a significant improvement in prescribing practice thereby reducing the potential impact on patients of prescribing errors. The main difficulty encountered during the PDSA cycles was regarding resistance to change and buy-in from junior medical staff. Continued encouragement helped to address these issues. Lessons learnt There were two unsuccessful PDSA cycles; presentation of baseline data and completion of an online learning module. This quality improvement project was performed in the six months prior to changeover of staff. It would have been a beneficial project during the initial six month period in order to improve sustainability and patient safety within the trust. Message for others We need to introduce permanent and successful measures to reduce prescribing errors in order to minimise the impact of staff changeover and knowledge deficits. The most significant change followed the introduction of a patient safety notice board which reduced the number of errors from 31 to 17. This represents a percentage reduction of 45% following a single intervention. It follows from this that education and awareness is paramount to continued professional development and quality improvement.

Audit Games with Multiple Defender Resources

Modern organizations (e.g., hospitals, social networks, government agencies) rely heavily on audit to detect and punish insiders who inappropriately access and disclose confidential information. Recent work on audit games models the strategic interaction between an auditor with a single audit resource and auditees as a Stackelberg game, augmenting associated well-studied security games with a configurable punishment parameter. We significantly generalize this audit game model to account for multiple audit resources where each resource is restricted to audit a subset of all potential violations, thus enabling application to practical auditing scenarios. We provide an FPTAS that computes an approximately optimal solution to the resulting non-convex optimization problem. The main technical novelty is in the design and correctness proof of an optimization transformation that enables the construction of this FPTAS. In addition, we experimentally demonstrate that this transformation significantly speeds up computation of solutions for a class of audit games and security games.

Maintain the Consistency of Auditing Cloud

In day to day life cloud is most essential part. Now cloud storage are use for business purpose the cloud is popular due to their huge amount of advantages the cloud is portable we can able to access the cloud anywhere globally. A cloud service provider maintains much duplication and each piece of data are globally distributed on servers. The main problem of cloud is to handle duplication of data which is too costly to achieve powerful consistency on world wide .In this paper we present a novel consistency service model which contain a large amount of data cloud and multiple audit clouds In The Consistency Service model . a data cloud is maintain by Cloud service Provider (CSP) and the number of user constitute group and that group of user can constitute an audit cloud Which can check whether the data cloud provides the valid level of consistency or not we suggest the 2 level auditing architecture, two level auditing architecture requires a loosely synchronize clock in the audit cloud. Then, design algorithms to quantify the commonality of violations metrics, and the staleness of the value of a read metrics. Finally, a Analytical Auditing Strategy (AAS) to shows as many violations as possible. Thus system performed using a combination of simulations and real cloud deployments to validate Analytical Auditing Strategy (AAS). KeywordsGlobal Consistency Auditing, Local Consistency Auditing, Analytical Auditing Strategy (AAS). __________________________________________________*****_________________________________________________

Pilot implementation of allied health assistant roles within publicly funded health services in Queensland, Australia: results of a workplace audit.

BackgroundAllied health assistants provide delegated support for physical therapists, occupational therapists and other allied health professionals. Unfortunately the role statements, scope of practice and career pathways of these assistant positions are often unclear. To inform the future development of the allied health assistant workforce, a state-wide pilot project was implemented and audited.MethodsNew allied health assistant positions were implemented in numerous settings at three levels (trainee level, full (standard) scope and advanced scope level). Six months after implementation, 41 positions were audited, using a detailed on-site audit process, conducted by multiple audit teams.ResultsThematically analysed audit findings indicated that both the full (standard) scope and the advanced scope positions were warranted, however the skills of the allied health assistants were not optimally utilised. Contributing factors to this underutilization included the reluctance of professionals to delegate clinical tasks, inconsistencies in role descriptions, limitations in training, and the time frame taken to reach an effective skill level.ConclusionsOptimal utilisation of assistants is unlikely to occur while professionals withhold delegation of tasks related to direct patient care. Formal clinical supervision arrangements and training plans should be established in order to address the concerns of professionals and accelerate full utilisation of assistants. Further work is necessary to identify the key components and distinguish key features of an advanced allied health assistant role.

Increasing on-treatment visit compliance for radiation therapy cancer patients.

175 Background: Weekly on-treatment-visits (OTVs) represent standard care in radiation oncology and have significant impact on the quality of patient care. Ensuring that OTVs are completed might decrease the severity of acute treatment-related side effects by facilitating timely treatment of symptoms. This study evaluates factors contributing to missed OTVs and formulates a plan to mitigate this problem. Methods: A multidisciplinary team of radiation oncology staff members reviewed clinical work flow data to determine the number of patients missing their weekly OTVs. These numbers generated benchmarks for the QIP. The team used 30 patient questionnaires and 291 electronic medical records to identify the causative factors for missing the OTVs. After analyzing these results the team generated an action plan for multiple interventions and future audit protocols. Results: On average, 5% of patients miss their weekly OTVs during radiotherapy course. The identified reasons which affected patient compliance with OTVs include: patient inconvenience waiting for the MD, parking concerns, difficulty navigating the clinic to find the exam room, failure of therapist to send the patient for OTVs, changes in MD’s schedule, lack of patient awareness about expected treatment related side effects and importance of immediate treatment of their symptoms. We developed a multidisciplinary plan to minimize patients missing OTVs which includes electronic medical record alerts, communication cues, physical triggers and improved patient education. Additionally, electronic data collection has been implemented for OTV performance metrics and auditing. Conclusions: Patients missing their weekly OTVs during radiotherapy course might be at risk for more severe treatment-related side effects. The details of this multidisciplinary QIP implementation and its impact on quality of care will be presented at the meeting.

Multiple individual audit outcome web—a novel tool to evaluate patient outcomes

Multiple individual audit outcome web—a novel tool to evaluate patient outcomes

Multiple Individual Audit Outcome Web—a novel tool to evaluate patient outcomes

Multiple Individual Audit Outcome Web (MIAOW) is a pictorial representation of outcomes, which is used widely in industry, finance, and sports, but not, to the best of our knowledge, in our specialty. It was developed to display multiple audit outcomes for patients in cleft surgery and we show its use in that area, but equally it could be applied to other areas such as orthognathic surgery, and head and neck oncology. We report how it can be used to display surgical outcomes.

Who You Know Matters: Evidence of Fee Discounts for Clients with Well-Connected Audit Committees

Referrals and recommendations from clients are important for audit firms to develop their client portfolios. Client audit committees are one source of those recommendations, particularly when audit committee members hold multiple audit committee memberships. In this study, we measure the connectedness of audit committees to potential audit clients and we examine the effect of this connectedness on audit fees. Based on negotiation theory and the social norm of reciprocity, we expect and find a negative association between an audit client’s connectedness and audit fees. Our results suggest that audit committee connections result in auditors offering first-year discounts of approximately 4.2 and 7.1 percent per connection for non-expert and expert auditors, respectively. We also provide evidence that first-year discounts are provided only to companies with well-connected audit committees and not to the population of audit clients generally. Finally, we find that auditors are able to leverage these audit committee connections into new clients.

Auditing Multiple Public Clients and Audit Quality

We provide a partner level study on the association between auditing multiple public clients and audit quality. Using a sample of 10,876 Chinese firm-year observations for the years 2000-2009, we find that audit partners with more public clients are negatively associated with audit quality, consistent with the “busyness” effect that auditing multiple clients constrains audit partner effort and thus reduces audit quality. However, the negative association is significant only for auditors with short tenure, supporting the idea that the lack of client specific knowledge exacerbates the busyness effect. Collectively, these results contribute to our understanding of partner-level auditor behavior.

Differential Sox Regulation Regimes and ICFR Disclosure Quality

Although prior studies indicate that compliance with Section 404 of SOX, which requires both high-effort management disclosure and internal control audit, is costly, no consistent conclusion can be drawn from prior research that Section 404 can improve the disclosure quality of internal control over financial reporting (ICFR). By analyzing incremental and joint implementation of multiple SOX-based ICFR disclosure and internal control audit mandates, we examine the differential effects of alternative ICFR regulations on the quality of ICFR related public disclosure. Our results reveal that companies subject to full Section 404 issue higher-quality internal control reports than those subject to Section 302 or Section 404(a) only. However, we find no supporting evidence that companies subject to Section 404(a) issue better quality internal control reports than those subject to Section 302 only. This study provides evidence for policymakers to assess the effectiveness of internal control reporting regulations in the future.

Capital Structure and Corporate Governance Quality: Evidence from the Institutional Shareholder Services (ISS)

Grounded in agency theory, this study explores how capital structure is influenced by aggregate corporate governance quality. We employ broad-based governance measures that encompass multiple factors, including boards, audit quality, charter/bylaws, director quality, executive compensation, ownership, and state of incorporation. We document a robust negative association between leverage and governance quality. The evidence reveals that firms with poor governance are significantly more leveraged. It appears that leverage substitutes for corporate governance in alleviating agency conflicts. We also present supportive evidence that leverage helps firms raise capital by sending a signal to the capital markets about the firm’s governance. Finally, we utilize empirical methods that control for potential endogeneity and show that poor governance quality likely brings about, and does not merely reflect, higher leverage. Our results are important as they show that the overall quality of corporate governance has a material impact on critical corporate decisions such as capital structure choices.

Internet Voting Protocol Based on Improved Implicit Security

This paper presents an improved protocol for Internet voting that allows recasting of ballots to eliminate voting errors, encourages early voting, and provides an opportunity for changing votes as the election campaign progresses. The protocol is able to meet the competing requirements of verifiability and privacy by using a distributed security architecture involving multiple servers and multiple audit channels. It also detects servers that might be cheating.

Development of a website for multiple sclerosis: Involving service users and providers

The Greater Manchester Multiple Sclerosis Management Audit was carried out in 2006 by Taylor and Walton to compare the management of multiple sclerosis (MS) in Greater Manchester against national recommendations for the management of MS set down by NICE (National Collaborating Centre for Chronic Conditions, 2004). This audit revealed that MS services in Greater Manchester were only partially compliant with the standards defined in this audit, which were derived from the NICE guidelines. Discussion within the MS Clinical Governance Group resulted in a proposal for a website to supply information about local services. This article discusses the development of the website with reference to the relevant audit results and the standards defined in the audit for information giving. It was identified at an early stage that service user involvement would be essential to the success of the website project. A period of consultation by MS Society branches was led by volunteers, followed by an email consultation of the health and social care professionals via the MS Special Interest Group. The website content was then agreed and compiled and the website went live in December 2007. The website gives details of local MS services as well as information about events and courses for people affected by MS, details of research trials and links to other relevant websites. A summary of service user and service provider feedback is included alongside quantitative data relating to the use of the website since going live.

An Examination of Memory Conjunction Errors in Multiple Client Audit Environments

This study is the first in an auditing context to examine auditor susceptibility to memory conjunction errors, a type of systematic memory error that is related to the memory reconstruction process. Conjunction errors occur when memory traces associated with one event are incorrectly attributed to another event during memory reconstruction. Auditors may be particularly susceptible to memory conjunction errors due to their simultaneous exposure to multiple audit clients and their use of standardized audit forms and checklists to capture information. Unrecognized, such errors could adversely affect the efficiency and/or effectiveness of the financial statement audit process. We conducted an experiment that employed practicing audit professionals addressing multiple audit clients. Consistent with our hypotheses, the results indicate that memory conjunction errors in an audit environment are a complex function of (1) the consistency between the audit evidence recalled from an unrelated audit and the characteristics of the client that is the target of the memory reconstruction, (2) the consistency between this recalled audit evidence and the characteristics of the client to which the evidence is actually associated, and (3) the level of risk present in the audit environment that is the target of the memory reconstruction. While research has shown that audit risk factors can generally serve to decrease some types of auditors' memory recognition errors in single client situations (e.g., Sprinkle and Tubbs 1998), our results show that increases in audit risk can actually exacerbate memory errors involving multiple audit clients and memory conjunction errors. Finally, the findings of the study suggest that auditors are not only susceptible to memory conjunction errors, but also that such errors may play a significant role in elements of the audit-planning process related to auditors' likelihood of material error assessments.

Probabilistic techniques for intrusion detection based on computer audit data

This paper presents a series of studies on probabilistic properties of activity data in an information system for detecting intrusions into the information system. Various probabilistic techniques of intrusion detection, including decision tree, Hotelling's T/sup 2/ test, chi-square multivariate test, and Markov chain are applied to the same training set and the same testing set of computer audit data for investigating the frequency property and the ordering property of computer audit data. The results of these studies provide answers to several questions concerning which properties are critical to intrusion detection. First, our studies show that the frequency property of multiple audit event types in a sequence of events is necessary for intrusion detection. A single audit event at a given time is not sufficient for intrusion detection. Second, the ordering property of multiple audit events provides additional advantage to the frequency property for intrusion detection. However, unless the scalability problem of complex data models taking into account the ordering property of activity data is solved, intrusion detection techniques based on the frequency property provide a viable solution that produces good intrusion detection performance with low computational overhead.

A BAYESIAN AUDITING MODEL

Abstract:A Bayesian procedure is demonstrated that binds together multiple audit tests in a multiple‐stage decision analysis. The analysis uses information provided by one test in the design of subsequent tests even when subsequent tests are directed at a different set of system characteristics. The analysis is applied to compliance and substantive tests undertaken to ascertain the fairness of a particular account balance. Although the analysis is not operational as presented, it provides a logical framework that clarifies the complex conceptual structure of the problem and enables the identification of impediments to its implementation.