oa Southern African Journal of Anaesthesia and Analgesia - Obstacles faced when conducting a clinical audit in Botswana : special report



A clinical audit is a method of addressing the clinical environment to bring about change and improvement. This paper describes the obstacles encountered while carrying out a clinical audit in a national referral teaching hospital in Botswana.

A record was kept over a period of three months of reasons for the referral and admission of patients to the intensive care unit (ICU) and of major obstacles that could not be overcome during a clinical audit. This paper discusses the obstacles that may be faced in this regard.
The following obstacles were found when carrying out the clinical audit. The medical records were difficult to find, both in the unit and in the medical records department. This led to abandonment of a retrospective pilot of the audit. When the medical records were available, the documentation was poor and unsatisfactory for the purposes of the study. Lack of local criteria and guidelines for ICU admission resulted in inappropriate referrals. Proposed guidelines had still not been adopted after 10 years. There was a fear by the many departments that refer patients to ICU of being "audited", which resulted in reluctance to participate in the audit without assurance from hospital management.
Although the problems that were faced during our audit are not novel to the auditing process, it is important that they are resolved in order to develop an audit culture.


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