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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.
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Clinical Audit Proposal Form

Clinical Audit Proposal Form

Project Title

Type of Audit

Background/Rationale (Why is the clinical audit being done?)

Additional Reasons (Select all that apply)

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)

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

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