Reflections on clinical audit in palliative care following an attempt to audit urinary catheterization

Audit has a high profile within palliative care quality initiatives. However, there are numerous potential pitfalls to auditing. We had hoped to perform a multicentred multiprofessional audit on urinary catheterization of hospice patients. Unexpectedly, the problems encountered highlighted numerous flaws in our approach to audit. An initial standard-setting pilot study, using a prospective observational methodology, generated results for 25 patients. The audit cycle was not pursued, as the data and the process did not appear valid. Conversely there were valuable lessons from reflecting on our mistakes and reviewing historical 'wisdom'. For example, audit's interface with research can easily be misunderstood and the difficulties of audit in palliative care can be underestimated. Particularly concerning was the potential for harm from insufficient rigour within audit processes, in allowing invalid data to influence practice. Conversely, despite risks, robust studies within audit may inform the limited palliative care research base.