Brooks-Hill R W, Buckingham R A
CMAJ. 1986 Feb 15;134(4):350-2.
Medical auditing has moved beyond the traditional chart review to the process audit, which identifies deficiencies in care and suggests remedies. In 1981 the audit committee of the Department of Psychiatry at Toronto General Hospital audited the use of hypnotic drugs in the inpatient unit. The audit produced two recommendations: that nursing staff record sleep graphs for inpatients more often, and that an educational program be instituted to change the physicians' patterns of prescribing hypnotics. In 1983 the audit was repeated to test the effectiveness of the 1981 auditing process. The 1981 recommendation produced the desired improvement in recording of sleep graphs. However, the medical staff failed to change their patterns of prescribing hypnotics: oxazepam remained the preferred hypnotic. For the process audit to be effective in improving patient care those using it must ensure that the methods reflect the nature and structure of the professional group they are trying to influence.
医疗审计已从传统的病历审查发展到流程审计，后者可识别护理缺陷并提出补救措施。1981年，多伦多综合医院精神科审计委员会对住院部催眠药物的使用情况进行了审计。审计提出了两条建议：护理人员应更频繁地为住院患者记录睡眠图表，并且应开展一项教育计划以改变医生开具催眠药物的模式。1983年，再次进行审计以检验1981年审计流程的有效性。1981年的建议使睡眠图表记录得到了预期的改善。然而，医务人员并未改变他们开具催眠药物的模式：奥沙西泮仍然是首选的催眠药。为使流程审计在改善患者护理方面有效，使用该审计的人员必须确保其方法反映他们试图影响的专业群体的性质和结构。
