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. DESIGN 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.