From the Evidence Base to the Audit Standard
It is essential to have a standard against which to compare the observed
practice. Many activities undertaken in occupational medicine and health
do not have a wide enough consensus or a solid scientific basis to serve
as a "gold standard", although local debate could provide the basis of
a provisional standard. This is especially true if there is additional
local divergence on, say, the means of rehabilitating workers with musculoskeletal
injury, or on the extent of counselling for psychological stress. This
page will illustrate how an evidence base can be used to derive a practice
guideline or protocol and hence a standard to be used for criterion based
audit or as a performance indicator. Thus it can maintain and improve quality
both for the purposes of benchmarking the organisation as a whole, and
for clinical governance.
Example: Respiratory Health Surveillance (with special reference
to occupational asthma)
Scientific Evidence Base
Good Practice Guidelines
Quality or Audit Criteria or Standard / Performance Indicators
.
In the text which follows, the summary of the evidence base is expressed
in bold, whereas the resultant Good Practice Guideline which in
turn can be readily translated into a Standard for Audit is expressed in
italics. :-
Example: Respiratory Health Surveillance Item 1
The type and degree of exposure to sensitisers is a very important determinant
of the risk of adverse health effects
Systematic hazard identification is needed together with steps to substitute
(e.g. latex), and to reduce personal exposure (e.g. colophony).
Example: Respiratory Health Surveillance Item 2
Atopy per se has a poor predictive value in relation to pre-employment
assessment
Applicants for jobs exposed to respiratory sensitisers should not be
excluded on the basis of atopy alone.
Example: Respiratory Health Surveillance Item 3
Defined questions on respiratory symptoms (e.g. wheeze and dyspnoea
improving when off work) are a sensitive way of identifying occupational
asthma.
The first line of health surveillance of employees with significant
exposure, (e.g. to di-isocyanates), should consist of a questionnaire with
the appropriate items administered at intervals.
This page is:
http://www.agius.com/hew/audit/5.htm
You may also wish to access the following
URL:
http://www.agius.com/hew/resource/quality.htm
Raymond Agius ©
Copyright 1995-2007
IN PREPARATION FOR THE NEXT PAGE consider what activity consumes
most of your time resource. For many occupational health practitioners,
consultations/clinical encounters with workers constitute the commonest
activity. How could you audit these? Make a few notes. After you
have done so, go to the next page.
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