Spasticity management with botulinum toxin: development and evaluation of a tool for audit.
OBJECTIVE
To develop and evaluate tools for the audit of spasticity management with botulinum toxin.


METHODS
Audit tools to assess the organisation of services and process of care were developed with a consensus process. The tools were piloted across 8 services using a retrospective case note audit. Inter-rater reliability was assessed, using percentage agreement and kappa scores. Clinicians involved in the pilot were surveyed and qualitative feedback was analysed.


RESULTS
Eight services (100%) completed service Organisation tools and 7 (88%) returned process of Care tools. One hundred sets of clinical records were audited, with 34 used to assess inter-rater reliability. Eleven items on the process of care tool demonstrated a good degree of inter-rater agreement, but 6 require further development. In the qualitative analysis clinicians stated that the tools captured indicators of quality, and that they would use them again. They recommended that patient satisfaction was included as a measure of quality. The audit has been used practically in the pilot services to provide an impetus for quality improvement.


CONCLUSIONS
The majority of the audit questions showed a good level of reliability, and clinician feedback supports face validity but a larger scale evaluation is required.
Torbay and Southern Devon Care Trust, UK. rhoda.allison@nhs.net
Rhoda
R
Allison
Karen M
KM
Knapp
D001905:Botulinum Toxins / Q000627:therapeutic use*; D019538:Health Care Surveys; D006305:Health Status Indicators; D006801:Humans; D008485:Medical Audit / Q000458:organization & administration* / Q000592:standards; D009128:Muscle Spasticity / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies
D009465:Neuromuscular Agents; D001905:Botulinum Toxins