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Clinical Audit Proposal Template

This document outlines a template for a clinical audit proposal. It includes sections for the audit title, standards being audited against, stakeholders, sample size, timeline, and requires signatures of the audit lead and sponsor. The template requests information to justify and plan the audit.

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akcabhay9
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84 views2 pages

Clinical Audit Proposal Template

This document outlines a template for a clinical audit proposal. It includes sections for the audit title, standards being audited against, stakeholders, sample size, timeline, and requires signatures of the audit lead and sponsor. The template requests information to justify and plan the audit.

Uploaded by

akcabhay9
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

S AMPLE TEMPLATE FOR CLI NI CAL AUDI T PROPOS AL PROFORMA

Name Department

Contact
Title
details

Audit title

I s this a re- audit? Yes No If Yes, have previous audit’s actions been implemented?

Why are you propos ing to conduct this audit? Why was this topic chosen?

What s tandards will you be auditing against? Please attach a copy of the relevant standard( s) to
the submission

Describe the audit tool you intend to use? Please attach a copy of the audit tool to the
submission

Please tick additional reasons ( if any) for carrying out this audit:
Patient centeredness Professional development
High volume activity S ervice improvement
High risk activity Re- audit
High cost activity Risk management
Policy/ guideline recommendation S pecify if: Local National

Other, please state:

_____________________________________________________________________

Each audit should satisfy all of the following:


 It should aim to improve patient care.
 It should be multidisciplinary where possible.
 It should have support within your department, including a willingness to
implement changes.
 Data Protection legislation.

Have all the potential stakeholders been identified? Yes No

List relevant stakeholders by name Are these stakeholders


aware of this audit?
Yes No
Yes No
Yes No
Yes No

Has a literature search been undertaken? Yes No


S ample size:
Length of time to audit and target completion date: date

I confirm that all data collection/ storage will comply Yes


with ( insert name of service provider) ICT policies:

The final section of the clinical audit proposal submission will depend on the
resources/ supports available within the service i. e. request for assistance with carrying out
the clinical audit, who has the authority to approve performance of the audit etc.

S igned: S igned:
Audit lead Audit sponsor

Date received: Date discussed:

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