Health Regulation Department
Approved

Clinical Governance Office

Audit Ref No.

Clinical Audit Report

PART - A
Project Title:___________________________________________________________________________
Date Started: __________________
Date Completed: _______________
Audit Lead: Name: __________________________________Professional Title: ______________________
Other individuals involved: (please specify names & professional titles):
1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________
Name of the Department:______________________________________
Hospital: ___________________________________________________
Contact Address: _____________________________________________
Work Telephone Number: ______________________________________

Background Rationale for Clinical Audit Project

Provide reasons for choosing the topic? Was it considered to be important?

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Overall Aim includes:

To improve :

Patient health outcome

Patient satisfaction

Staff satisfaction

Delivery of care

Use of resources

Others: please specify__________________________

Source of Standards
Professional organizations' guidelines
Local guidelines/protocols
National standards
Observation of current practice
Others: please specify ___________________

Standard Sets
1. _______________________________________________Target_______________________%
2. _______________________________________________Target_______________________%
3. _______________________________________________Target________________________%
(any additional standard sets, please continue on same sheet)
Data collection
Source of data: (e.g. Case notes, patients, observation of sessions)
Sample:
Type of population:
Size:
Sample selection:
(e.g. random selection for a period of 3 months)
Data collection process
Data collection tool :
(e.g. interview, questionnaire, record form)
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Please attach blank copy of data collection tool
Data analysis
How was the data analyzed? Please outline your method

Feedback of findings
To whom were the results communicated and how?

Suggestions for change

What suggestions for changes in practice you would like to make based on the results of the clinical audit?
1.
2.
3.

PART-B

Meeting with stakeholders

Members :
Medical Director of the hospital
Head of the department (optional)
Head of Clinical Governance Office
Audit team lead
Clinical Auditor(s)
Any others involved for change implementation.

Action plan Implementation & monitoring change

Recommendations
Responsible person
1.

Estimated time to accomplish

Please complete
Audit Action Follow up form after accomplishing the recommendations as proposed.

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Re-audit
Date planned for/carried out:
Key findings of re-audit (if conducted):

How regularly do you plan to re-audit this area?

Feedback of the Audit

Problems encountered (if any):
____________________________________________________________
Ways in which the clinical audit design could have been improved:
____________________________________________________________
Strengths of clinical audit design:
____________________________________________________________
Benefits experienced from clinical audit:
_____________________________________________________________
Advice to others attempting a similar project:
_____________________________________________________________

Name of the Project lead:

Signature:

Date:

Head of the Department:

Signature:

Date:

NB: Clinical Audit Report Writing [CARW] should be forwarded with complete data entered with signatures.
CARW should include the minutes of meeting related to discussion on action plan recommendations,
Proforma or Audit tool, Action plan follow up form duly filled and evidence of results disseminated in the
unit with Head of Department e.g. Power Point Presentation PPP.

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