Step 5: Audit

The fifth and final step in the EBP process is Audit, and in this context involves checking whether patient care is evidence-based.

Assess and adjust: evaluate your performance with this patient / the population and the outcomes of your intervention and adjust management accordingly.

In terms of the patient - pracitioner relationship concerning the management of a condition, this would involve requesting the patient to return if problems persist, or to actively make a follow-up date for reviewal of the management planned. If issues arise, such as side-effects or new symptoms, then these can be assessed and management changed as appropriate. Thus, this final step of EBP is an essential element of clinical practice - and is understood to be the basic practice cycle of presentation, investigation, decision, treatment and review.

More formally, audit involves an analysis of clinical decisions (e.g. referral or prescription) in types of patient cases, and this may be retrospective via clinic records, or prospective. Audit is a time consuming process, but an important one, since it can identify factors that are limiting EBP. The Australian Centre for Evidence-based Clinical Practice produced an online tool (the Auditmaker) to facilitate this process.

The UK National Institute for Health and Clinical Excellence (NICE) guidelines include guidance on clinical audit (the Nice Clinical Audit tools), including materials to help the practitioner to maintain records on the basis of clinical decision-making. These records can be reviewed over time to review the extent to which decisions were based on the best available evidence at the time. Records of this kind (with adaptations for the types of clinical questions arising in practice) are an important way of monitoring and evaluating EBP. Note that it is important that for each clinical decision, a record is kept of the factors influencing the decision in addition to research evidence, including lower level evidence (such as discussions with colleagues), the practitioner’s own experience and expertise, and the patient’s preferences. This is because, when reviewing the data, the decision may be based on low level evidence, but in fact may be consistent with EBP when all factors are taken into account.

The audit process can identify gaps between the best available research evidence and actual practice, and this has been done by many studies in which practitioners may information is obtained on practitioner behaviour (clinical decision making) either by asking (e.g. through questionnaires) or observing (e.g. by using dummy patients).

This audit process is intended to ensure that evidence-based practice is critically reviewed periodically, to ensure that it is taking place and to identify any impediments to its implementation.