Internal Audit as a Quality Assurance Tool to Ensure Staff and Patient Safety During COVID-19 Pandemic

We present the process of development and implementation of an internal audit for prevention of spread of COVID-19 at a tertiary eye hospital, which can be used for further improvement of the system and be utilized by similar organizations to enhance patient and staff safety and quality of service. It is a Single center prospective audit. Based on the guidelines put forth by various international (Centers for Disease Control and Prevention, World Health Organization) and Indian (Ministry of Health and Family Welfare, All India Ophthalmological Society) authorities, preventive protocols were formulated. To ensure compliance of these protocols, audit sheets in the form of checklists and questionnaires were prepared. Facility and process audits were undertaken for registration, outpatient department and pre-surgical counseling. Pilot audits were carried out to develop more detailed audits, and implemented for one week. There was 100% compliance from the staff in personal protective equipment usage and hand hygiene. However, 21 incidents of physical distancing not being maintained by them were noted. Though there was 100% compliance in use of facemask by the staff and patients, 34.5% of patients were noticed wearing the mask improperly. It was also noted that, at the entry, thermal screening was not performed at 6/53 (11.3%) observations with no thermal screener at 3/23 instances. This study describes the process of formulating and conducting audits as a monitoring and evaluation tool, which is most relevant in ongoing COVID-19 pandemic to ensure safety of patients and health care workers.