Clinical Audit

Clinical Audit, Service Evaluation and Quality Improvement

By completing this form you are agreeing for your information to be emailed to the UHP Clinical Audit Team for processing. You may be contacted for further information.

For reference you can read The National Research Ethics Service Defining Research Leaflet here.

Clinical audit form

Note: Questions marked by * are mandatory

*This is a mandatory field. Declaration: I have discussed my Audit/Evaluation/Quality improvement Project plan with my supervisor/department and I have support for this project

Yes
No

*This is a mandatory field. Does the project involve the use of any untested clinical intervention, test a hypothesis, or seek to create a new knowledge base? If you are unsure please refer to the ‘The National Research Ethics Service Defining Research Leaflet’ (above).

*This is a mandatory field. Does the audit collect or disclose any data that could be used to identify any patient or practitioner?

*This is a mandatory field. Does the audit pose any risk or burden to a patient beyond those of his or her usual clinical routine (e.g. collection of sensitive or time-consuming information directly from the patient or a carer)?

*This is a mandatory field. Does the audit allow those carrying out this activity to obtain access to patients’ records or information that was not previously available to them?

If ‘Yes’ or if you want to give any further information that you feel would be pertinent, such as the legal basis/justification, please give details here:

*This is a mandatory field. Name of the person(s) completing the project

*This is a mandatory field. Email address

*This is a mandatory field. Job title(s)

*This is a mandatory field. Contact number

*This is a mandatory field. Service Line/Department

*This is a mandatory field. Are you Ministry of Defence (MOD) Personnel?

*This is a mandatory field. Type of project

*This is a mandatory field. Title of project

*This is a mandatory field. Objective (Why is the project important? What is the significance for the department/patient care?):

*This is a mandatory field. What standard is the audit being measured against (e.g. NICE/Royal College/Trust policy or relevant literature) and what does the standard/literature state?

*This is a mandatory field. Project method (What is the process for data collection? How will the data be analysed & results presented? Any inclusion & exclusion criteria? Expected sample size? Re-audit plan?)

*This is a mandatory field. Estimated completion date

*This is a mandatory field. Name of supervisor

Job title of supervisor

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