Clinical audit
Our free resources will introduce you to different QI techniques, and help you understand the processes you can put in place to help improve outcomes.
Clinical Audit CPD Course (CPD: 60 minutes)
You can find courses on:
These links will open in a new window and require registration with our dedicated online learning portal.
Tools to assist in clinical audit
This document highlights the difference between clinical audit and research and addresses ethical issues that may be encountered when undertaking a clinical audit [667KB PDF] (Published August 2023).
A handy infographic that explains the process of performing a clinical audit. Ideal to print! [PDF 611KB] (Updated December 2019).
You can use this template to assist you in performing a clinical audit in your practice. Once downloaded, please 'save as' and reopen from saved location [Word 46KB] (Updated July 2019).
Use this checklist when planning and completing your audit to help you remember the steps [PDF 172KB] (Published November 2021).
Use this poster to display your Quality Improvement projects, plan further projects and track their progress. You can use this poster as a focal point for your Quality Improvement discussions. This poster is designed to be professionally printed, and laminated, on A2 paper. [PDF 61KB] (November 2022).
The National Audit for Small Animal Neutering (NASAN) is a national anomymised audit for post-operative complication rates for small animal neutering. Use this poster to display your National Audit for Small Animal Neutering results and compare them with your practice and the national benchmark. You can use this poster as a focal point for your Quality Improvement discussions. This poster is designed to be professionally printed, and laminated, on A2 paper. [PDF 73KB] (November 2022)
This document included examples of Quality Improvement principles and tools which can be implemented within your practice to form your clinical governance plan. You should adapt this for your own practice, or local circumstances. Once downloaded, please 'save as' and reopen from your saved location [Word Doc 174KB] (Published July 2021).
National anonymised audit tools
A simple audit for practices to share their data anonymously to establish UK benchmarks in post-operative complications rates for neutering of small animals. This link will take you to the RCVS Knowledge vetAUDIT site.
A registry for the surgical management of Cranial Cruciate Ligament Rupture in UK canines. The registry provides feedback to clinicians in order to evaluate which surgical techniques and implants lead to improved patient outcomes and minimised complications. This link will take you to the RCVS Knowledge Canine Cruciate Registry site.
An audit freely available to all, run by the University of Liverpool’s Small Animal Veterinary Surveillance Network (SAVSNET) for UK practices to share their data anonymously to establish benchmarks for antibiotic prescription rates for small animal patients. Data can be from an individual practitioner, a branch practice, or from the whole practice group. This link will take you to the RCVSKnowledge vetAUDIT site.
Clinical Audit Case Examples
Anaesthesia and surgery
In this award-winning case example, the team at Vets Now identified room for improvement in the care of dystocia cases. A working group was created to support clinicians with decision-making and improve patient welfare by using audit and benchmarking data to inform guidelines and resources relevant to care provided by Vets Now Ltd. The level of engagement in the audit highlighted team-wide commitment to improving patient outcomes [PDF 335KB] (Published January 2023).
You can also read the full article in the Vet Record.
Leicester, L. et al. (2022) Applying clinical audit for quality improvement in canine dystocia cases seen at a UK primary-care emergency practice. Veterinary Record, p. e2485. https://doi.org/10.1002/vetr.2485 (CPD: 40 minutes)
Donview Veterinary Centre, part of the VetPartners group, demonstrated a strong learning culture and a dedication to improvement through an initiative aimed at improving post-operative temperatures. Working together, the team performed audits and used the results to assess where they can improve. Suggestions from the team were successfully implemented across the practice, and investments in new equipment were made. The audit showed a robust dedication to improvement, with the whole team working together to identify gaps in care [PDF 287KB] (Published September 2022).
Anderson Moores Veterinary Specialists introduced a Notice to Anaesthetists (NOTAN), a notice inspired by the aviation industry that highlights any changes that might have safety implications. The NOTAN was introduced after a team survey identified gaps in knowledge about the latest information on anaesthesia practice, protocols, and equipment. The team agreed that an electronic notification would be an effective change and increase confidence. Follow up team engagement showed that a simple, effective initiative can create measurable improvements [PDF 259KB] (Published July 2022).
Dr. Jessica Pennock from CVS South Hub was awarded as a Knowledge Champion for her outcome audit on peri-operative hypothermia. The audit was inspired after the practice purchased a warm air circulating blanket for anaesthetic procedures, prompting the team to perform a process audit to ensure that the equipment was being utilised, and an outcome audit to see if the equipment was having a positive effect on patient care and recovery. The results demonstrate what can be achieved with an accessible audit that will have a positive impact on patient welfare [PDF 301KB] (Published June 2021).
Roundhouse Referrals, based at the The Roundhouse Veterinary Hospital, Glasgow and part of the Pets'n'Vets Family, initiated this excellent Quality Improvement programme, using audits, benchmarking and continuous improvements to objectively assess and identify areas to enhance their clinical and customer service. Roundhouse referrals were awarded Highly Commended for their audit in the 2021 Knowledge Awards. [PDF 296KB] (Published November 2021)
This case example shows how Holly Warrilow RVN performed several audits over short periods to identify whether patient temperatures were being taken during the peri-operative period and to implement improvements to benefit patient care within the same period. Holly was awarded Highly Commended in the 2020 Knowledge Awards for her QI initiative [PDF 227KB] (Published November 2020).
This case example shows how Kay Lockwood, from Riversbrook Veterinary Group, performed an audit to see if feline patients were receiving local anaesthetic nerve blocks when having dental extractions. This audit was part of a case example that was awarded Highly Commended in the 2020 Knowledge Awards [PDF 215KB] (Published November 2020).
This award-winning case example shows how Louise Northway completed an audit and identified changes that were required regarding IV catheter use during general anaesthesia. This audit is part of a larger case example that Louise Northway VNCert(ECC) NCert(Anaesth) RVN performed to win an RCVS Knowledge Champion Award in 2019 for her work in this area [PDF 280KB] (Published November 2020).
This case example shows how Sandra Hunt and her team at The Laurels performed an audit to see if post-operative temperatures were being taken in practice. Once they had identified their inhouse benchmark, they then set out to improve, and re-audit to measure their improvement. This audit was part of a case example that was awarded Highly Commended in the 2020 Knowledge Awards [PDF 3008KB] (Published November 2020).
This case example shows how Samantha Thompson RVN initiated a clinical audit to identify hypothermia in post-operative patients and used the results to make changes within practice. Samantha was awarded Highly Commended in the 2020 Knowledge Awards for her QI initiative [PDF 547KB] (Published August 2020).
Listen along to the podcast that accompanies this audit here.
This case example shows how the team at Newnham Court Equine implemented a surgical safety checklist to improve patient safety. Completion of the checklist is monitored through regular auditing. The team were awarded Highly Commended in the 2020 Knowledge Awards for their QI initiative [PDF 471KB] (Published July 2020).
This award-winning case example shows how post-operative neutering complications were monitored using the National Audit for Small animal Neutering. Complications were cut down by half by assessing hygiene and post-operative care guidelines. Louise Northway VNCert(ECC) NCert(Anaesth) RVN became a Knowledge Champion for the second year running due to her work on this continuous quality improvement cycle [PDF 781KB] (Published March 2020).
This case example shows how Vale Vets performed a post-operative complication audit on neutered cats and dogs to identify where any improvements were required. This case example was one of the initiatives that made Vale Vets a 2020 Knowledge Award Champion Practice [PDF 536KB] (Published March 2020).
This case example shows the national audit undertaken on cruciate surgical outcomes at PDSA. By auditing patient outcomes, PDSA could identify whether the current surgical technique offered was suitable, and to implement a simple but effective technique to reduce their number of patients lost-to-follow-up. This case example was one of the initiatives that made PDSA a 2020 Knowledge Award Champion Practice [PDF 657KB] (Published March 2020).
This case example shows the national process audit undertaken after implementing a national pain protocol at PDSA. By identifying which areas had successfully implemented the change, assistance could be provided to those that required further support. This case example was one of the initiatives that made PDSA a 2020 Knowledge Award Champion Practice [PDF 632KB] (Published March 2020).
This award-winning case example shows how Louise Northway completed an audit to look for trends and complications that could be addressed for improvements to patient care. Louise Northway VNCert(ECC) NCert(Anaesth) RVN won an RCVS Knowledge Champion Award in 2019 for her work in this area [PDF 797KB] (Published May 2019).
- * Knowledge Award 2019 Champion Practice* General anaesthetic monitoring in an emergency setting with the Clinical Audit template (CPD: 15 minutes)
This award-winning case example shows how the Vets Now Macclesfield team conducted quarterly audits to improve general anaesthetic monitoring in an emergency setting. As a result, the practice suffered zero patient deaths or significant events related to anaesthesia or sedation. Vets Now Macclesfield won the RCVS Knowledge Practice Champion Award in 2019 for their work in this area [PDF 544KB] [Excel 81KB] (Published May 2019).
This case example shows the initial audit of an equine practice and its postoperative equine castration complications. Watch this space for the re-audit after a period of updated protocols and guidelines [PDF 141KB] (Published January 2020).
Inpatient care
This excellent case example shows how Rosevean Veterinary practice used clinical audits of their admission procedures to adapt to the changes imposed by Covid-19 with admission appointments needing to be conducted outside to keep everyone safe whilst continuing to provide good service to their clients. Charlotte Thomas was awarded Highly Commended in the 2021 Knowledge Awards for her initiative. [PDF 261KB] (Published November 2021).
This case example shows how the team at The Laurels initiated a clinical audit to monitor hand hygiene and compliance to uniform protocols within practice. Sandra Hunt, practice manager of The Laurels, was awarded Highly Commended in the 2020 Knowledge Awards for this QI initiative [4687KB] (Published September 2020).
This case example shows how Vale Vets performed a hygiene audit through self-assessment to maintain a just culture and to identify any at-risk areas and further training required. This case example was one of the initiatives that made Vale Vets a 2020 Knowledge Award Champion Practice [PDF 1134KB] (Published March 2020).
This case example shows how Gillivervet Equine Practice performed a process audit on the completion of dental charts after dental examinations [PDF 113KB] (Published January 2020).
Listen along to the podcast that accompanies this audit here.
Vets Now Referrals Glasgow was highly commended for its clinical audit which assessed adherence to WHO handwashing guidelines [PDF 922KB] (Published June 2019).
This case example shows how one practice implemented a peripheral catheter care checklist, and monitored its use and effectiveness through clinical audit [PDF 662KB] (Published September 2019).
Pharmacy
This excellent, award-winning case example shows how the Hub Clinical Leads within CVS audited the use of ear cytology on a national scale, over a long period of time, which resulted in an increase in diagnostic tests and a reduction of antibiotic use across a wide range of practices. [PDF 299KB] (Published December 2021).
This award-winning case example shows how Plymouth Veterinary Group created guidelines for performing cytology on patients presenting with ear pathology, utilising the whole teams’ skillset to improve the patient journey for a common and often persistent presentation. The application showed a bottom-up approach – increasing training, utilising RVN skills and demonstrating strong evidence that their changes led to an overall decrease in the number of antibiotics prescribed [PDF 275KB] (Published June 2021).
You can read more about the Plymouth Veterinary Groups award winning application to the RCVS Knowledge Awards 2021 in the Knowledge Natter: Q&A with Louise Northway and Nicola Lakeman.
This case example shows how Meghan Conroy RVN performed audits on whether aural cytology was being performed before antibiotic treatment was given, and after the treatment ended. Meghan was awarded Highly Commended in the 2020 Knowledge Awards for her QI initiative (Published November 2020).
Listen to the podcast from Meghan Conroy.
This case example shows how Kay Lockwood, from Riversbrook Veterinary Group, performed an audit to measure and monitor antibiotic use during dental extractions. This audit was part of a case example that was awarded Highly Commended in the 2020 Knowledge Awards [PDF 213KB] (Published November 2020).
This case example shows the national audit undertaken on clinical incidents throughout PDSA. By identifying where incidents were reported, the organisation could identify where they needed to focus their efforts on to make changes and create improvements. This case example was one of the initiatives that made PDSA a 2020 Knowledge Award Champion Practice [PDF 548KB] (Published March 2020).
This award-winning case example shows how Angela Rayner, CVS PLC, completed audits into the recording of methadone and ketamine which resulted in improvements within the practice group. Angela Rayner, BVM&S MRCVS won an RCVS Knowledge Champion Award in 2019 for her work in this area [PDF 546KB] (Published May 2019).
When the dispensing protocol was not being followed, Charlotte Hartley REVN performed a process audit and changed protocols to improve compliance and help avoid dispensing errors [PDF 142KB] (Published January 2020).
Updated April 2023
