¶ … Best Practice/Making Improvements A clinical audit is an integral part of the healthcare system. Ferris (2002) defined Clinical Audit as the comparison of the actual clinical practice against the agreed and documented evidence-based standards in an effort of improving the level of patient care as cited in ACGW and Daly (2008,p.4).

Importance of Clinical Audit

There are several reasons as to why a clinical audit is crucial in clinical practice. The main reason is that it is important in improving the quality of health care service that is offered to patients and the general community. The absence of a clinical audit would make it extremely difficult to gauge if one is practicing effectively. A demonstration of one's performance is also made difficult. The benefits of clinical audit are;

Its importance in the identification as well as demonstration of good practice that can lead to the improvement on the level of service delivery as well as the user outcomes.

It can effectively provide the information that is needed in showing others that the level of service being provided is effective (cost effectiveness) and therefore ensure the development of then service

3. A clinical audit can provide opportunities for education and training

4. A clinical audit is important in ensuring that the available resources are used better in order to increase the level of efficiency.

5. A clinical audit is important since it can help in improving the relationships, level of communication as well as act as a liaison between the staff, users and also between agencies.

Suicide risk assessment audit

In this paper, we present a clinical audit for the suicide risk assessment tools and procedures.This is because it has effectively been identified that in the Queensland Coroners Court, the general lack of the appropriate Policy and Procedure on the clinical risk management has generally resulted in a lack of recognition of suicidal risk in several cases such as the one where a clinical mental health client suicide successfully a day after contacting a mental health clinician / professional (Hodgins, 2010,p.11).

The clinicians who assess suicidal risk usually rely on the reflective approach (O'Connor, 2004) that is heavily reliant on the clinicians' judgment in the evaluation of the quality as well as the appropriateness of the information that is available in the process of deciding the suicide risk rating (p.356).The rate of suicide in Australia is alarming. Brunero et al. (2008) pointed out that in the last few decades, the rate of death due to suicide has been higher than the ones due to road a highest cause of human death and ranks as the third cause of death among the American youth (p.113). The assessment of both suicide ideation as well as behavior is complex and extremely difficult. This is due to the large number of variables related to risk as well as protective factors that vary with gender and age and occurring in combinations with variance over time as pointed out by Gangwisch (2010,p.114).Suicide risk assessment among the teenagers is noted to be very challenging (Murray,2006) as a result of the fact that their presentation vary due to their ever changing behavior (p.157).

A competent assessment of suicide risk is noted to be one of the most challenging tasks in clinical psychiatry (Simon,2009). It has generally been recognized that a pre-existing mental health problems can be regarded as a major indicator in the suicide risk debate. The level of risk is however increased in combination of the psychosocial issues as observed by Gangwisch (2010,p.114).All these factors together with the fact that close to 90% of individuals who successful commit suicide are noted by McAuliffe (2007,p.295) to have at least some diagnosable element means that the current suicide risk assuagement tools and procedures should be revised. This can best be done by a rigorous clinical assessment audit.

The clinical assessment audit

Audit cycle

The audit cycle is the period of time in which an audit is carried out. This activity varies according to type of audit being conducted .The suicide risk assessment audit should be conducted annually. In order to ensure that all changes in the outcomes of the suicide audit are monitored, NZGG (2011,p.10) recommends the carrying out of re-edits each and every 2 years as an integral part of the audit cycle. This would allow for the monitoring of any changes as well as the current performance of the system against the set targets while allowing the putting in place of mechanisms that can help in the achievement of a continuous improvement in quality.

Preparing for audit

Good preparation is crucial for the achievement of a successful clinical audit (NICE,2002,p.10). The two main areas of preparation are;

Project management: This includes the selection of the topic, project planning as well as resources and communications

Users in this case refers to patients, carers, group and organization members who deal with suicide cases.
Selection of topic

Definition of the purpose of the given audit

Identification of the skills as well as people who are needed in conducting the audit as well as training of staff while encouraging participation.

User involvement

It is a fact that the focuses of any audit project are the people who are receiving the given care. These users can be regarded as genuine collaborators as opposed to mere data sources. In this case the users cannot involve patients since the dead can never talk. Their relatives, carers as well as other individuals who were part of suicide victims' last few moments before death are to be regarded as sources of data as indicated by Balogn et al. (1995).

Sources of information for the suicide risk audit

The sources of data for the clinical audit are varied. They include the following;

Letters that contain both comments and complaints

Reports of critical incidents

Stories as well as feedback from the focus groups

Direct observation of at-risk patients

Direct conversation of at-risk patients.

NICE (2002,p.11) mentioned that the most common technique of involving users in a given clinical audit is the employment of a satisfaction survey. The involvement of the users in the negotiations and planning for a suicide audit is not very common. Kelson (1996,p.1) also advocates for the involvement of 'users' / 'consumers' (patients, service users, carers, local communities as well as the general public) in clinical trials.

National involvement audits at a national level. At this level, there is the responsibility as well as need to ensure that the clinical audit is made part and parcel of the clinical governance strategies as well as quality improvement programmes. The good and poor practices must be cited.

The users in the audit project teams

Kelson (1998,p.7) pointed out that users are being increasingly involved in the clinical audit project teams as active members. When involved in this manner, there is a need to be concerned about or rather address issues regarding access, project preparation as well as access.

Selection criteria

Criteria are used within the clinical audit framework in the assessment of the quality of care that is provided by a person, team or an organization. The defining criteria is made up of the following (NICE,2002,p.22);

Explicit statements necessary for defining of the variable being measures.In this case it is suicide risk

A representation of the elements of care that are objectively measurable

Criteria is defined as the systematically developed set of statements that can be employed in the assessment of the level of appropriateness of a specific healthcare service, decision and outcome (Institute of Medicine,1992, p.27).

The advantages that are associated with the appropriate categorizing of the criteria are attributed to the fact that should an outcome not be achieved and the processes and structure are already identified, then the source of the problem becomes easier to isolate and identify. There are three forms of criteria; structure, process and outcome criteria.

The structure criteria

In regard to structure criteria, we deal with the resources that are required for the completion of the project. This includes the number of staff as well as skill mix that is required for the suicide risk audit in Australia. The provision of physical space and equipment forms part of these criteria.

The process criteria

These criteria denote the decisions as well as actions that are undertaken by users as well as practitioners in the execution of the suicide risk audit. The actions under this criteria includes the communication, investigation assessment, prescription of therapeutic interventions, documentation as well as the general evaluation of the clinical audit. There is an argument that the process criteria acts as an encouragement of the clinical teams to focus on matters that directly contribute to the improvement of health outcomes. In regard to a suicide risk audit, these criteria dictate how the audit process would take place as well as how well the quality the final outcome would be.

Outcome criteria

These are a measure of the behavioral as well as physical responses to a given intervention, level of knowledge, health status…