A clinical audit proposal form specifies the background/rationale, aims/objectives, sample inclusion criteria, standard statement, and method of data collection prior to a local or national government-initiated clinical audit. Identify potential stakeholders and patients or service users to be involved and specify anticipated audit dates with the use of this clinical audit proposal form. Before submission, the audit lead and the audit sponsor, usually a senior supervisor, can digitally affix their signatures in this clinical audit proposal form.
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Title Page
Work Base
Audit Lead Name & Job Title
Conducted on
Clinical Audit Proposal Form
Project Title
Type of Audit
Background/Rationale (Why is the clinical audit being done?)
Additional Reasons (Select all that apply)
Patient centeredness
High volume activity
High risk activity
High cost activity
Policy/guideline recommendation
Professional delvelopment
Service improvement
Risk management
Aims/Objectives (How will the clinical audit improve patient care?)
Have all the potential stakeholders been identified?
Are these stakeholders aware of this audit?
Will patients/service users be involved?
How? What are your inclusion criteria?
Estimated Sample Size
What standards will you be auditing against?
Type of Data Collection
Specify
Method of Data Collection
Specify
Data Source (Select all that apply)
Focus Groups
Interviews
I.T. Systems Data
Observation
Patient Records
Peer Review
Questionnaire
Telephone Survey
Other
Specify
Anticipated Audit Dates
I confirm that the information provided on this form is accurate to the best of my knowledge. By signing this form I agree to ensure that this project will be completed, the results disseminated and a report and action plan will be given to both the Quality & Governance Team and Division.
Audit Lead Name & Signature
Senior Supervisor Name & Signature
SafetyCulture Staff
Clinical Audit Proposal Form
A clinical audit proposal form specifies the background/rationale, aims/objectives, sample inclusion criteria, standard statement, and method of data collection prior to a local or national government-initiated clinical audit. Identify potential stakeholders and patients or service users to be involved and specify anticipated audit dates with the use of this clinical audit proposal form. Before submission, the audit lead and the audit sponsor, usually a senior supervisor, can digitally affix their signatures in this clinical audit proposal form.
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions.
The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction.
You should independently determine whether the template is suitable for your circumstances.
