Publication - Advice and guidance

Quality Standards for Paediatric Audiology Services

Published: 27 April 2009
Topic: Health and social care
ISBN: 9780755919871

Quality Standards for Paediatric audiology services.

Improving quality and outcomes in Paediatric Audiology Services through critical evaluation

A quality rating tool for service providers

Foreword

This quality rating tool ( QRT) for Paediatric Audiology service providers and their partners has been developed to highlight best practice in Paediatric Audiology service provision in order to ensure local Audiology services meet population requirements and address health inequalities.

The QRT has been developed to assist providers of Paediatric Audiology services

in assessing their ability to deliver services to meet the needs of their local population against the Quality Standards in Paediatric Audiology.

It is envisaged that service providers will find the format of the tool helpful in measuring their progress towards meeting and indeed exceeding the quality standards. Beyond use by providers for self assessment, the tool could also be employed within an external (independent) assessment process. The publication of externally verified service quality ratings could also help potential service users make more informed decisions on the services that they choose to access.

The Quality Rating Tool can be implemented in different ways, depending on the medium used, but on-line self assessment can be readily achieved.

Using the Quality Rating Tool

This quality rating tool covers 9 Quality Standards in Paediatric Audiology.

Standards are only part of the cycle within which services are delivered and

reviewed/monitored. Assessment against the standards will inform participating stakeholders of areas of good practice and areas in need of development, performance management and consolidation. Assessment should be an ongoing service management function. External quality assurance programmes will reinforce local ratings and contribute additional objectivity and transparency.

Each section contains several quality statements relating to different criteria within the quality standards. Providers can rate their current activity against the scale 1-5 where 1 means that no elements of the quality statement are met/implemented and 5 represents full compliance with good to best practice, with graduations in between. Examples of what a score of 1 and 5 might look like have been given so that users of the tool can make better judgements about where on the scale the service corresponds. The 5 positions are:

1. No elements of the quality statement are met (or not evident*)

2. Few elements of the quality statement are met

3. Meets around half of the elements of the quality statement

4. Almost fully meets the quality statement

5. Fully compliant with good to best practice as indicated by quality statement criteria

In judging evidence of performance (assigning an overall score for each standard) those completing assessment should consider the following elements of compliance:

• All examples of best practice (where there is more than one)

• The population served, (eg, all geographical areas, and all facilities)

• Reflecting practice over the preceding 12 week period as a minimum (prior to the

date of the assessment)

NB Evidence must always be provided to support scores.

In addition, a separate field provides suggestions of evidence to assist users of the tool in their rating assessment and direct discussion for any external quality assurance visit. On completion of the Quality Rating Tool, an overall position will indicate those areas that require further development and review.

Understanding the score

The underlying assumption used here is that, when scoring each standard, all quality

statements (criteria) are equally important and therefore carry the same score weighting.

Some criteria may have more aspects than others but each criteria should only be scored once. For instance when a criteria achieves 2 out of 4 different standards that the service should meet then appropriate approximate score would be 3 out of 5. A reminder of how to score the standards can be found in the rating scale at the top of each standard. For each standard, a percentage quality score can be calculated and an interpretation given of the meaning of these scores (eg needs urgent attention, needs attention, does not need attention). For instance; if a service scores a total of 32 out of 40 then the service is deemed to have 80% compliance with standard 1.

Standard 1 - Access

1a. All children shall have access to the audiological services they require in a timely fashion, with clearly defined referral pathways to audiological services that are widely disseminated and reviewed regularly.

1b. Service demand and referral data are accurately monitored, reviewed and reported to guide service planning.

Rating Scale

No elements of the quality statement criteria are met (or not evident)

Few elements of the quality statement criteria are met

Meets around half of the elements of the quality statement criteria

Almost fully meets the quality statement criteria

Fully compliant with good to best practice as indicated by quality statement criteria

Please use the rating scale and examples given in the 1 and 5 columns as an indicator to help you score the self-assessment table below. Each table should only ever have 1 self-assessment score. When you perceive there to be more than 1 aspect of the table that you could give a score for, please use an average of each of the aspects.

Criteria 1a.1 - Referral Pathways

Quality Statement rationale Correct referral information results in more efficient use of available resources.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
There are no clear referral pathways and pathways are not disseminated.	Clearly defined written referral pathways from all referral sources (eg newborn hearing screening, ENT, speech and language therapists, paediatricians, health visitors, GPs, education services and parents) are in place and monitored regularly.
Evidence Written referral pathways, written referral criteria, written policy on communication with referrers and audit, evidence of training in Primary Care

Criteria 1a.2-1a.3 - Speed of Access

Quality Statement rationale Early identification of permanent hearing problems and subsequent intervention leads to improved outcomes for the child at a later date. Parents support the principle of early identification and intervention. Fluctuating hearing loss can have a disadvantageous effect on the child's development.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assessment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Routine referrals are not seen within 6 weeks and urgent referrals are not seen at the next available appointment or within 4 weeks receipt of referral.	Routine referrals are seen within 6 weeks of receipt of referral. Urgent referrals are seen at the next available appointment or within 4 weeks of receipt of referral.
Evidence Written referral pathways, written referral criteria, Waiting times data

1b.1-1b.2 - Monitoring of Inappropriate Direct and Specialist Service Referrals

Quality Statement rationale The number of incorrect referrals to the specialist medical route informs the effectiveness/clarity of the criteria and compliance of referrers to those criteria. Improvements can then be made to ensure that children are correctly referred to appropriate services.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Inappropriate referrals are not monitored for either direct or specialist medical services.	The number of inappropriate referrals is monitored for both direct referrals to audiology and referrals to specialist medical services. Action plans are implemented to address any non-compliance with the referral criteria for direct referrals to audiology and referrals to specialist medical services, rather than audiology.
Evidence Audit (ideally over several time points to indicate trend)

1b.3 - Monitoring of Waiting Times

Quality Statement rationale Effective allocation of health resources is reliant upon accurate information on the balance between demand for services and available resources. It is important that waiting times for all stages of the patient pathway are collected and monitored in an effective manner. The use of IT systems to compute information such as demographic data and waiting times will inform allocation of services.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Waiting times are not measured at all within the department.	Waiting times are monitored within the department based upon robust data collection.
Evidence Audit (ideally over several time points to indicate trend) Waiting times data to hand

1b.4 - Service Planning

Quality Statement rationale Effective allocation of resources relies upon information on actual demand and potential/ projected demand for specific services.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
No data is collected, reviewed and used for annual service review.	All the following data is collected, reviewed and used in annual service review: demographics of locally served populations, including factors such as ethnic diversity, social deprivation and age, ¹⁷ the number of children referred to Audiology services and their associated demographic information, the uptake of NHS hearing aids in the local population compared with the predictive need for services and the number and type of surgical interventions required for children referred to Audiology services.
Evidence Data on hearing aid uptake, Data on referrals to audiology services, Data on patient demographic, Annual service review.

Standard 2 - Assessment

2a. All referred children receive audiological assessment commensurate with their age and stage of development. In some cases this will form part of a multidisciplinary team approach of which parents are key members. The range of audiological assessments available enables definition of degree and nature hearing loss.

2b. The outcome of the assessment should inform a clearly defined management plan.

Rating Scale

No elements of the quality statement criteria are met (or not evident)

Few elements of the quality statement criteria are met

Meets around half of the elements of the quality statement criteria

Almost fully meets the quality statement criteria

Fully compliant with good to best practice as indicated by quality statement criteria

Criteria 2a.1-2a.3 - Comprehensive Assessment

Quality Statement rationale Accurate and complete assessment is required to inform decisions and discussions regarding support and management options. It is important to be able to assess hearing status in children who may have other social, educational and medical difficulties; a multidisciplinary approach will assist with this. Parental involvement in the assessment and habilitation process improves outcomes for the child. The range of audiological assessments available should enable definition of degree and nature of hearing loss.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The service cannot carry out a full range of audiological assessments, Local care pathways do not detail type, order, and timing of assessment, There is no multidisciplinary/ parental involvement in assessment and Assessments are not carried out in accordance with recognised national standards - where standards are available.	A comprehensive range of audiological assessments is available, either in the local audiology department or by a pre-arranged referral pathway with an alternative service. Local care pathways detailing type, order, timing and multidisciplinary/parental involvement in assessment are available. Assessments are carried out in accordance with recognised national standards - where available.
Evidence Multi-disciplinary team, Written protocols, Case audit,

Criteria 2a.4-2a.8 - Assessment Equipment and Conditions

Quality Statement rationale The quality of assessment is more likely to be assured if undertaken in accordance with nationally recommended procedures. Measures are compromised if not gathered using equipment calibrated to national and international standards and in a quiet test environment.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Equipment does not meet national and international standards, Equipment is not calibrated annually, Daily checks are not carried out and documented to international standards. Procedures do not follow national standards/guidelines - where they exist and Assessments are never carried out in acoustical conditions conforming to national standards.	All audiological procedures use equipment which meets national and international standards. All equipment is calibrated at least annually, and documented to international standards. Daily checks are carried out and documented to international standards. All audiological procedures follow national standards/guidelines, where these exist. Assessments are carried out, where possible, in acoustical conditions conforming to national standards.
Evidence Written protocols, Calibration and equipment check logs/certificates, Audit

Criteria 2b.1-2b.2 - Assessment Outcome

Quality Statement rationale Prompt, accurate and complete audiological information informs the amplification process. The outcome of assessments should contribute in sufficient detail to establishment of aetiology, prognosis and further management.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Assessments are never interpreted with the development status of the child or any co-existing medical conditions being taking into account and There are no local protocols defining appropriate management options arising from assessment.	All assessments are interpreted taking into account the developmental status of the child and any co-existing medical conditions. Written local protocols exist which define appropriate management options arising from the assessment (such as decisions to refer, review or discharge).
Evidence Written protocols, Case audit, Peer review of cases

Standard 3 - Developing an Audiology Individual Management Plan

3a. An Audiology Individual Management Plan ( IMP) is:

Developed for each child, initially based on the information gathered at the assessment phase taking into account the child's developmental age, other medical needs and the child and parental views.
Updated on an ongoing basis and
Accessible to the clinical team.

Rating Scale

No elements of the quality statement criteria are met (or not evident)

Few elements of the quality statement criteria are met

Meets around half of the elements of the quality statement criteria

Almost fully meets the quality statement criteria

Fully compliant with good to best practice as indicated by quality statement criteria

Criteria 3a.1 - Agreement by First Appointment and Updates

Quality Statement rationale An Audiology individual management plan is required as each child needs to be treated as an individual case as circumstances, medical condition, audiological status and family needs will vary.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The Audiology IMP is not agreed at the end of the first appointment and is not updated at subsequent appointments thereafter.	The Audiology individual management plan is agreed at the end of the first appointment and updated at subsequent appointments thereafter.
Evidence Documented dates of IMP development from patient records. Audit of patient records.

Criteria 3a.2 - Programme of Management

Quality Statement rationale An individual management plan is required as each child needs to be treated as an individual case as circumstances, medical condition, audiological status and family needs will vary.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The audiology IMP does not include any kind of initial programme of audiological management and does not include details of ongoing assessment when required.	The Audiology IMP includes an initial programme of audiological management [including provision of hearing aids where appropriate], and details of ongoing assessment as required.
Evidence Audit of case studies, Record of individual management plans, Documented plans

Criteria 3a.3 - Assessment of Priorities

Quality Statement rationale An Audiology individual management plan is required as each child needs to be treated as an individual case as circumstances, medical condition, audiological status and family needs will vary. There is evidence that families value joint working as it avoids duplication and there is less conflict of information.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The Audiology IMP does not include any kind of assessment of current priorities.	The Audiology IMP includes an assessment of current priorities including the level and type of service needed from: Audiology, Education, Paediatrics, Speech and language therapy and Social work.
Evidence Audit of case studies, Records of individual management plans, Documented plans

Criteria 3a.4-3a.6 - Further IMP Documentation

Quality Statement rationale There is evidence that families value joint working as it avoids duplication and there is less conflict of information. Parental involvement improves the outcomes for the child.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The Audiology IMP does not detail any requirements families have for information, family support and practical advice, The audiology IMP does not include details of service provision from those currently involved with the child and family and The specific goals of the individual elements of the IMP and their timing are not documented and circulated to any other members of the team.	The Audiology IMP details any requirements families have for information, family support and practical advice. The Audiology IMP includes details of service provision from those currently involved with the child and family. The specific goals of the individual elements of the IMP and their timing are documented and circulated to all members of the team.
Evidence Audit of case studies, Records of individual management plans

Standard 4 - Implementing an Audiology Individual Management Plan

4a. The Audiology Individual Management Plan is implemented for each child and reviewed at subsequent appointments.

4b. Where provision of hearing aid(s) is required, the service ensures:

hearing aids fitted are functioning correctly,
nationally agreed procedures and protocols are followed at a local level and
performance or hearing aid(s) is carefully matched to individual requirements and settings are recorded.

Rating Scale

No elements of the quality statement criteria are met (or not evident)

Few elements of the quality statement criteria are met

Meets around half of the elements of the quality statement criteria

Almost fully meets the quality statement criteria

Fully compliant with good to best practice as indicated by quality statement criteria

Criteria 4a.1 - Regularly Updated Objectives

Quality Statement rationale Regular revision allows the management plan to be responsive to the child's changing needs. It also gives the plan the flexibility to incorporate additional information for the benefit of the child's management. Planned and coordinated intervention leads to better outcomes.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The Audiology IMP does not, at any stage, include a set of achievable objectives.	The Audiology IMP includes a set of achievable objectives which are reviewed and updated regularly.
Evidence Records from management plan, Case Audit

Criteria 4b.1-4b.7 - Verification of Hearing Aids

Quality Statement rationale Audiologists ensure that the aid is working to specification before fitting it to a child so that the aid does not cause harm. Professional bodies and national guidelines are followed to ensure provision meets the needs of the individual. Evidence suggests that hearing aids are most effective when their performance is carefully matched to the requirements of the individual.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Hearing aids never have their technical performance tested to specification.	Prior to issue every hearing aid has its technical performance tested to specification. Local protocols which comply with the latest professional bodies' and national guidance are in operation concerning selection, fitting and verification of hearing aids. Real Ear Measurement ( REM) / Real Ear to Coupler Difference ( RECD) of hearing aid performance is used to verify at least 95% of hearing aid fittings, unless clinically contraindicated for individual children. Where REM / RECD is performed, the acoustical target is verified at three different input levels (50, 65 and 80 dB) in more than 95% of cases. Where REM / RECD is performed, measurements do not deviate from the recommended target at more than one frequency (in 95% of cases) unless clinically indicated Where REM / RECD is not possible, current internationally-recognised age-related predicted values are used in hearing aid verification. When REM/ RECD is not attempted/ completed an explanation is recorded in the Audiology IMP.
Evidence Records from management plan, Case Audit; Interviews with parents

Standard 5 - Outcomes

5a. The outcome and effectiveness of the interventions contained within the Audiology Individual Management Plan ( IMP) are evaluated and recorded following an assessment of the impact of intervention.

5b. All children are offered referral for appropriate aetiological investigations as part of their ongoing management.

Rating Scale

No elements of the quality statement criteria are met (or not evident)

Few elements of the quality statement criteria are met

Meets around half of the elements of the quality statement criteria

Almost fully meets the quality statement criteria

Fully compliant with good to best practice as indicated by quality statement criteria

Criteria 5a.1-5a.2 - Outcome Measures

Quality Statement rationale The management of hearing impairment, within a comprehensive management plan, involves more than a simple technical matter of hearing aid fitting. It involves the provision of a systematic approach, supported by evidence, which addresses not only the hearing impairment, but also the impact on other related activity. This requires a multi-disciplinary approach. Subjective outcome measures, in the form of questionnaires, can assess the impact of a hearing impairment on the child's communication functioning and activity limitation. This can then be used in the evaluation process to measure the effectiveness of the intervention. Audiology IMPs help to record multiple management outcomes such as functional benefit, satisfaction and quality of life. Measurement of outcome is required to shape further progression of Audiology IMPs. Measurement of outcome is required to: - obtain feedback (including a progressive evidence base) on the effectiveness and benefit associated with the service delivered to the patient group and facilitate further development of the Audiology IMP and judge progress on the child's outcomes.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
No outcome measures are administered and The clinical record contains no information about goals and outcomes.	Appropriate outcome measures are administered to evaluate the outcome of intervention and further develop the Audiology IMP. Clinical records are used to facilitate further development and monitoring of children's progress. The records contain information about the extent to which the interventions helped meet the specified goals (outcomes) and document information about how each element of the Audiology IMP has been implemented, including reasons for changes or omissions.
Evidence Case audit, Records from management plan

Criteria 5b.1-5b.3 - Aetiological Investigations

Quality Statement rationale The outcome of aetiological investigations, as part of the ongoing management, may lead to a better understanding and management of not only the hearing loss but also the whole child. It may also provide an opportunity to identify co-existing medical conditions and prevent further deterioration of these and the hearing loss in some cases.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
There are no local guidelines in place regarding aetiological investigations and Outcomes from investigations are not recorded in the child's medical records or outcomes are not shared with any members of the multidisciplinary team.	Local referral guidelines are in place regarding aetiological investigations for children with hearing loss. Local guidelines, which reflect national guidelines, are in place regarding aetiological investigations for children with hearing loss. Outcomes from investigations are documented in the Audiology IMP and, as appropriate and with the family's permission, shared with other members of the multidisciplinary team.
Evidence Local guidelines Medical records

Standard 6 - Professional Competence

6a. Each audiology service demonstrates that within their team they have the clinical competencies necessary to support the assessments and interventions they undertake.

Rating Scale

No elements of the quality statement criteria are met (or not evident)

Few elements of the quality statement criteria are met

Meets around half of the elements of the quality statement criteria

Almost fully meets the quality statement criteria

Fully compliant with good to best practice as indicated by quality statement criteria

Criteria 6a.1-6a.3 - Experienced, Trained and Qualified Staff

Quality Statement rationale Children and young people who require ongoing health interventions must have access to high quality evidence based care, delivered by staff who have the right skills for diagnosis, assessment, treatment and ongoing care and support. Audiology departments have a duty of care to children and families and must ensure that assessments and interventions are delivered by appropriately trained, qualified and registered clinicians. Through the clinical governance framework organisations can manage their accountability for maintaining high standards.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Audiological assessment and support is not undertaken by experienced staff capable of performing and interpreting such testing, Staff working in paediatric Audiology do not hold the necessary qualifications and are not registered with the appropriate professional registration body and Staff in senior positions are not trained to post-graduate level and do not have practical experience in paediatric audiology.	Audiological assessment and support is undertaken by experienced staff capable of performing and interpreting such testing. All professional staff working in Paediatric Audiology hold the necessary qualifications and are registered with the appropriate professional registration body. Staff in senior positions are trained to post-graduate level supplemented by suitably assessed practical experience in Paediatric Audiology.
Evidence CPD evidence, Certificates of attendance at training, Qualification Certificates

Criteria 6a.4-6a.6 - Staff Competency and CPD

Quality Statement rationale Paediatric audiology is a rapidly changing field and clinical competency must, therefore, be maintained through continuing professional development. Peer review provides a useful approach to help ensure clinical competencies are maintained.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Competency for all clinical procedures is not verified formally by peer review observation at least every 2 years and local Audiology centres never carry out informal assessments of all clinical staff's competency, Assistant staff are not able to demonstrate additional competency training in paediatric audiology and cannot demonstrate continuing professional development ( CPD) in the areas they are currently working and. Staff do not have basic training in child protection and deaf awareness.	Competency for all clinical procedures is verified formally by peer review observation at least every 2 years for all clinical staff undertaking such procedures. Ongoing assessments of all clinical staff's competency should also be carried out informally by local Audiology centres. All assistant staff are able to demonstrate additional competency training in paediatric audiology along with continuing professional development ( CPD) in the areas in which they are currently working. All staff have basic training in child protection and deaf awareness.
Evidence Written documentation of peer review assessments CPD evidence,

Criteria 6a.7 - Referral Routes to External Providers

Quality Statement rationale Departments have a duty of care to children and families and must ensure that assessments and interventions are delivered by appropriately trained, qualified and registered clinicians.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
There are no referral routes to external providers in situations where the competencies required are not held within the service.	Where the competencies required by an Audiology IMP are not held within a service, clear referral routes to external providers exist.
Evidence Adequate written documentation on alternative providers for care services not offered.

Standard 7 - Information Provision and Communication with Children and Families

7a. Each service has in place processes and structures to facilitate communication with children and families.

Rating Scale

No elements of the quality statement criteria are met (or not evident)

Few elements of the quality statement criteria are met

Meets around half of the elements of the quality statement criteria

Almost fully meets the quality statement criteria

Fully compliant with good to best practice as indicated by quality statement criteria

Criteria 7a.1 - Written Information to Families Prior to Appointment

Quality Statement rationale Children and families need clear and timely information to facilitate attendance and reduce anxiety.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
No written information regarding the audiology appointment is provided as part of the appointment process.	Written information regarding the audiology appointment (directions, maps, parking facilities, appointment duration, procedures, facilities, desirable baby state) is provided as part of the appointment process.
Evidence Written information leaflets or letters, Case audit, Interview with families

Criteria 7a.2-7a.5 - Information Given to Parents after Assessment

Quality Statement rationale Children and families need clear and timely information to facilitate attendance and reduce anxiety. It is important that information is provided in an appropriate format. Effective communication enables children and families to participate in the development of the individual management plan and multi-agency support plan, to understand information and make informed decisions.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Children and families do not receive appropriate verbal explanation of the audiological assessment results on the same day that the assessment is carried out. Children and families are not provided with written information about the outcome of assessments and any supporting literature within 7 working days of the assessment, Children and families are not offered information on local and national voluntary support groups, such as NDCSand Children and families do not have access to information in their preferred language via the provision of translated written material, interpreters, use of language line etc.	Children and families receive verbal explanation of the audiological assessment results on the same day that the assessment is carried out. Children and families are provided with written information about the outcome of assessments and any supporting literature within 7 working days of the assessment. Children and families are offered information on local and national voluntary support groups, such as NDCS. Children and families have access to information in their preferred language via the provision of translated written material, interpreters, use of language line etc.
Evidence Interview with families, Written information provided to children and families, Written assessment material available in different languages, Copies of invoices for use of interpretation services,

Criteria 7a.6 - Deaf Awareness and Communication Training

Quality Statement rationale It is important that information is provided in an appropriate format. Children and families need clear and timely information to facilitate attendance and reduce anxiety. Effective communication enables children and families to participate in the development of the individual management plan and multi-agency support plan, to understand information and make informed decisions.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Staff (including reception and admin staff) do not receive deaf awareness and communication training as part of their induction.	All staff (including reception and admin staff) receive deaf awareness and communication training as part of their induction which is then updated every 3 years. This training is approved by a relevant third party such as a voluntary sector organisation.
Evidence Written documentation, such as, certificates of attendance at training events.

Standard 8 - Multi-Agency Working

8a. Each paediatric Audiology service works within a multi-agency team, which includes each child and his/her parents.

8b. Each multi-agency team has in place processes and structures to underpin effective collaborative working and communication within the team and with outside agencies and services.

8c. Each service has a major role in facilitating the development and ongoing review of a multi-agency support plan ( MASP) for each child who has an ongoing significant hearing loss. The MASP takes into account the individual needs of the child and family, reflects the child and parental views and is clear, coordinated and flexible.

Rating Scale

No elements of the quality statement criteria are met (or not evident)

Few elements of the quality statement criteria are met

Meets around half of the elements of the quality statement criteria

Almost fully meets the quality statement criteria

Fully compliant with good to best practice as indicated by quality statement criteria

Criteria 8a.1 - Expertise Required in Multi-Agency Team

Quality Statement rationale Working as a team leads to more effective use of time and resources. There is evidence that families value joint working as it avoids duplication and reduces the provision of conflicting information.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The service does not include any personnel with experience in: paediatric Audiology, development of language and speech skills, medical aspects of audiology or child development and family support.	Each Audiology service works within a multi-agency team, including parents, and members with expertise in: paediatric audiology, development of language and speech skills, medical aspects of audiology and child development and family support.
Evidence Multidisciplinary team evident in notes from management plan meetings, Evidence of expertise in specialist area (course certificates, qualifications, registration)

Criteria 8a.2 - Access to Other Specialist Services

Quality Statement rationale Working as a team leads to more effective use of time and resources. There is evidence that families value joint working as it avoids duplication and reduces the provision of conflicting information.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The multidisciplinary team does not have access to any other specialist services.	Each multi-agency team has access to: paediatric otology, social work services, education services and voluntary agencies.
Evidence Documented specialist service contacts, Evidence, at audit, that other specialist services are regularly used when developing MASPs.

Criteria 8a.3 - Roles and a Coordinator for the Multi-Agency Team

Quality Statement rationale Working as a team leads to more effective use of time and resources.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The multi-agency team does not define roles for staff working on a child's MASPand they do not have an appointed co-ordinator.	Each multi-agency team has: defined written roles including a "key worker" for each case and an appointed coordinator.
Evidence Notes of MASP meetings, Defined written roles for team members; Identified coordinator; Identified key worker.

Criteria 8b.1-8b.2 - Child Information Updates for Referrer and Other Relevant Professionals

Quality Statement rationale Sharing of information between agencies in a timely manner ensures that all involved are kept informed, enabling them to provide the most appropriate support to the child and family.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Results of audiological assessments are not reported to the referrer, GP, Child Health department and any other relevant professionals within 7 working days and Non attendance is not reported to the referrer and an appropriate professional e.g. HV, Child Health, in accordance with local guidelines/protocols.	Results of audiological assessments are reported to the referrer, GP, Child Health department and any other relevant professionals within 7 working days of the assessment. Non attendance is reported to the referrer and an appropriate professional e.g. HV, Child Health, in accordance with local guidelines/protocols.
Evidence Case audit, Interviews with key referrers, Review of written patient records received and kept by referrers and other professionals.

Criteria 8b.3-8b.5 - Referral to Other Services

Quality Statement rationale There is evidence that families value joint working as it avoids duplication and reduces the provision of conflicting information. Sharing of information between agencies in a timely manner ensures that all involved are kept informed, enabling them to provide the most appropriate support to the child and family.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
There are no systems in place to manage the referral of families to other agencies and services involved in the management of children with hearing impairment. There is no communication between Audiology and other services and agencies when a family is referred from Audiology to another service or agency and The Audiology service neither encourages nor facilitates referral of families to appropriate voluntary organisations and parent support groups.	Systems are in place for the referral of families to other agencies and services involved in the management of children with hearing impairment. When Audiology refers families to other agencies and services, there is ongoing sharing and exchange of information between Audiology and these services and agencies. The Audiology service encourages and facilitates referral of families to appropriate voluntary organisations and parent support groups.
Evidence Case audit, Review of written patient records received and kept by referrers and other professionals, Interviews with key referrers, Interview with families.

Criteria 8b.6 - Transition from Paediatric to Adult Audiology Service

Quality Statement rationale Working as a team leads to more effective use of time and resources. There is evidence that families value joint working as it avoids duplication and reduces the provision of conflicting information. Sharing of information between agencies in a timely manner ensures that all involved are kept informed, enabling them to provide the most appropriate support to the child and family.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
There are no systems in place to manage the transition from paediatric to adult Audiology services.	Systems are in place to manage the transition from paediatric to adult Audiology services.
Evidence Written local protocols on the transition from paediatric to adult service. Case audit of transitions from paediatric to adult service. Interview with recent transitional patients.

Criteria 8b.7 - Children's Hearing Service Working Group ( CHSWG)

Quality Statement rationale Working as a team leads to more effective use of time and resources. There is evidence that families value joint working as it avoids duplication and reduces the provision of conflicting information.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
A Children's Hearing Services Working Group, including parent representatives does not meet up at all to consider the developments and delivery of services for hearing impaired children and their families.	A Children's Hearing Services Working Group, including parent representatives, meets regularly to consider the development and delivery of services for hearing impaired children and their families. The remit will include the extent to which services meet the standards described in this document.
Evidence Minutes from CHSWG meetings.

Criteria 8c.1 - MASP Initial Development from Multi-Agency Assessment Phase

Quality Statement rationale When a number of different services work with a family, the multi-agency support plan ensures that individual components of the plan are understood in relation to one another and, more importantly, in relation to the overall aims and wishes of the family. Multi-agency support plans encourage: joint holistic discussions of an individual child's needs, agreement of priorities, engagement with and involvement of the family and regular reviews of any support that is being provided, resulting in improved quality of ongoing care.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The multi-agency support plan is not informed by the information gathered throughout the multi-agency assessment phase.	The multi-agency support plan ( MASP) is tailored by the information gathered throughout the multi-agency assessment phase.
Evidence Case audit of MASP to check map across from multi-agency assessment phase.

Criteria 8c.2 - Timeframe for Initial MASP Development

Quality Statement rationale When a number of different services work with a family, the multi-agency support plan ensures that individual components of the plan are understood in relation to one another and, more importantly, in relation to the overall aims and wishes of the family.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The MASP is not in place within 3 months of confirmation of a significant hearing loss.	The MASP is in place within 3 months of confirmation of a significant hearing loss.
Evidence Written documentation from patient records showing hearing loss confirmation and MASP. Case Audit

Criteria 8c.3 - Assessment of Priorities for MASP

Quality Statement rationale When a number of different services work with a family, the multi-agency support plan ensures that individual components of the plan are understood in relation to one another and, more importantly, in relation to the overall aims and wishes of the family. Multi-agency support plans encourage: joint holistic discussions of an individual child's needs, agreement of priorities, engagement with and involvement of the family and regular reviews of any support that is being provided, resulting in improved quality of ongoing care. There is evidence that families value joint working as it avoids duplication and reduces the provision of conflicting information.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The MASP does not include any assessment of priorities.	The MASP includes an assessment of current priorities including the level and type of service needed from: Audiology Education Paediatrics Speech and language therapy Social work Specialist services, e.g. cochlear implant team
Evidence Audit of case studies, Records of MASP's, Documented plans.

Criteria 8c.4-8c.5 - MASP Service Provision and Objectives

Quality Statement rationale Regular revision allows the multi-agency support plan to be responsive to the child's changing needs. It also gives the plan the flexibility to incorporate additional information for the benefit of the child's management. When a number of different services work with a family, the multi-agency support plan ensures that individual components of the plan are understood in relation to one another and, more importantly, in relation to the overall aims and wishes of the family. Multi-agency support plans encourage: joint holistic discussions of an individual child's needs, agreement of priorities, engagement with and involvement of the family and regular reviews of any support that is being provided, resulting in improved quality of ongoing care.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The MASP does not include details of service provision from those currently involved with the child and family and The MASP does not include a set of achievable objectives.	The MASP includes details of service provision from those currently involved with the child and family. The MASP includes a set of achievable objectives which are reviewed and updated regularly (at least 6 monthly for pre-school children and annually for school age children) and circulated to all members of the team.
Evidence Audit of case studies, Records of MASPs, Documented plans.

Criteria 8c.6 - The MASP Team: Collective Responsibilities

Quality Statement rationale When a number of different services work with a family, the multi-agency support plan ensures that individual components of the plan are understood in relation to one another and, more importantly, in relation to the overall aims and wishes of the family. Multi-agency support plans encourage: joint holistic discussions of an individual child's needs agreement of priorities engagement with and involvement of the family regular reviews of any support that is being provided, resulting in improved quality of ongoing care Regular revision allows the multi-agency support plan to be responsive to the child's changing needs. It also gives the plan the flexibility to incorporate additional information for the benefit of the child's management.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The team does not have a close working relationship - typified by them not meeting up at least every 6 months for MASPs of pre-school children and not meeting up at least annually for school age children.	The team has a close working relationship and meets on a regular basis (at least every 6 months for pre-school children and annually for school age children) to ensure that the support plan is being implemented in a coordinated way and in line with the wishes and needs of the family.
Evidence Case Audit, Documented evidence of MASP meetings - such as minutes and written documentation within patient record.

Criteria 8c.7 - The MASP Team: Individual Responsibilities

Quality Statement rationale Regular revision allows the multi-agency support plan to be responsive to the child's changing needs. It also gives the plan the flexibility to incorporate additional information for the benefit of the child's management.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Each agency does not carry out its own role in the further, more detailed assessments and information gathering necessary to complete the clinical, educational and social picture of the MASPand information is not fed back and shared with all other members of the multi-agency team.	Each agency carries out its own role in the further, more detailed assessments and information gathering necessary to complete the clinical, educational and social picture of the MASP. During this process, information is fed back and shared with all other members of the multi-agency team.
Evidence Case Audit, Written documentation of information shared between the MASP team,

Standard 9 - Service Effectiveness and Improvement

9a. Each service has processes in place to measure service quality and improvement.

9b. Each audiology service actively participates in the local Children's Hearing Service Working Group ( CHSWG). Where a CHSWG does not exist, the service is active in the setting up of such a group.

9c. Each service has processes in place to regularly consult with children, families and stakeholders.

Rating Scale

No elements of the quality statement criteria are met (or not evident)

Few elements of the quality statement criteria are met

Meets around half of the elements of the quality statement criteria

Almost fully meets the quality statement criteria

Fully compliant with good to best practice as indicated by quality statement criteria

Criteria 9a.1-9a.4. - Patient Satisfaction Surveys

Quality Statement rationale Measurement of qualitative and quantitative data helps to inform ongoing service improvement.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Children and/or families are not encouraged to complete any surveys to determine satisfaction with the service.	Children and/or families are encouraged to complete surveys on, at least, an annual basis to determine satisfaction with different elements of the service received. These include: - accessibility, proximity, information provision, professionalism of staff, care and treatment and overall service received. Participation rates in the survey are checked, annually, to ensure an acceptable proportion of patients have participated and a representative sample of the local population is covered (including gender and ethnicity). Sufficient analysis and interpretation of findings from satisfaction surveys are carried out annually by audiology services. Action plans are implemented, when needed, to address areas of concern arising from surveys ¹⁸and QRT data and performance.
Evidence Copies of surveys and responses Action plans

Criteria 9b.1 - CHSWG Review Meetings

Quality Statement rationale Close working with parents as well as across organisations will lead to improved services for deaf children and their families. Effective recruitment to CHSWGs will ensure appropriate representation for the child and family, and demonstrates a truly inclusive approach. CHWSGs can ensure that children's hearing services remain high on the agenda of those responsible for planning and delivering services at a strategic level. They can offer advice and guidance to ensure high quality services are available.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The CHSWG does not meet regularly to review the multi-agency services for children and their families known to have, or considered to be at risk of having, a hearing impairment.	The CHSWG meets regularly to review the multi-agency services for children and their families known to have, or considered to be at risk of having, a hearing impairment.
Evidence Written, documented minutes from CHSWG review meetings.

Criteria 9b.2 - CHSWG Support

Quality Statement rationale Close working with parents as well as across organisations will lead to improved services for deaf children and their families. Effective recruitment to CHSWGs will ensure appropriate representation for the child and family, and demonstrates a truly inclusive approach. CHWSGs can ensure that children's hearing services remain high on the agenda of those responsible for planning and delivering services at a strategic level. They can offer advice and guidance to ensure high quality services are available.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The CHSWG does not offer support to any agencies involved with hearing loss.	The CHSWG helps to develop and improve the services delivered to deaf children and their families through the processes of ongoing support to all agencies involved.
Evidence Evidence of contact and correspondence between agencies as a result of CHSWG meetings. Minutes/action log from CHSWG meetings..

Criteria 9b.3 - CHSWG Monitoring

Quality Statement rationale Close working with parents as well as across organisations will lead to improved services for deaf children and their families. Effective recruitment to CHSWGs will ensure appropriate representation for the child and family, and demonstrates a truly inclusive approach. CHWSGs can ensure that children's hearing services remain high on the agenda of those responsible for planning and delivering services at a strategic level. They can offer advice and guidance to ensure high quality services are available.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
CHSWG does not monitor the extent to which services meet the standards detailed in this document.	CHSWG monitors the extent to which services meet the standards detailed in this document.
Evidence Written documentation of CHSWG monitoring/reporting how well services meet these standards. Review of QRT scoring on CHSWG agendas.

Criteria 9c.1 - Service Consultation with Children, Families and Stakeholders

Quality Statement rationale Paediatric Audiology services that seek, consider and respond to the views of users will be more likely to meet their needs.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
The audiology service does not have any kind of framework in place to ensure regular consultation with children, families and stakeholders.	The audiology service has a framework in place to ensure regular consultation with children, families and stakeholders.
Evidence Evidence of feedback questionnaires, Protocols on how to gather feedback, Documentation of consultation mechanisms. Audit

Criteria 9c.2 - Dissemination of Satisfaction and QRT Scores

Quality Statement rationale Paediatric Audiology services that seek, consider and respond to the views of users will be more likely to meet their needs.
1 No elements of the quality statement criteria are met (or not evident)	5 Fully compliant with good to best practice as indicated by quality statement criteria	Self assess-ment score based on evidence sources	QA visitor score and comments	Actions / comments	Good practice example
Results of satisfaction surveys and service QRT scores are not publicly made available.	Results of satisfaction surveys and service QRT scores are made available and discussed with children and families on an annual basis.
Evidence Results from service satisfaction/ QRT scores physically available at the service. Results from service satisfaction/ QRT scores published, disseminated by service. Audit of whether patients are made aware of results from satisfaction/ QRT scores.

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