The Random Audit QI tool allows you to customize a review of factors related to errors, error-prone situations, lapses in quality and safety in the hospital environment. Using checklists, real-time data capture, and immediate feedback, the audits are low cost, rapid, and usually well-received by staff–in fact, auditing responsibilities can be rotated among the care team.

Generally, you select 10 or so processes that relate to your question–e.g., infection. An audit card can be created for each practice, with columns for a number of patients (de-identified as patient 1,2,3, etc.). The rows are used for adherence to the practice (Yes), failure to observe the practice (No), an N/A, an unknown, and room for comments–to briefly describe errors found. Multiple cards for each practice are made into a deck and then shuffled and placed in a box, in plain view of staff. When a staff member pulls a card to conduct an audit, it is unknown to others what is being audited. The cards are then returned to the box and analyzed periodically.

All patients can be sampled (exhaustively) or by using a a subset–see Sampling. Audits can take place daily or whenever it is convenient.

The results (% or number per patients observed) can show change over time and opportunities for improvement. It is critical that the feedback be non-punitive, in a culture of no blame.

This tool was created by The Center for Patient Safety in Neonatal Intensive Care, in conjunction with the Vermont Oxford Network. Robert Ursprung, MD, of Cook Children’s Hospital, is a thought leader in this methodology and has offered his counsel via e-mail.

REFERENCE: Ursprung R et al. Real time patient safety audits: improving safety every day. Quality and Safety in Health Care 2005;14:284-289.