The use of audit as a means of improving the quality of a health promotion intervention An example from the Manchester School Fluoride Milk Scheme

Currently more than 16,000 children in Manchester receive plain milk or milk with added fluoride (dental milk) at school. The health benefits of drinking plain or dental milk can be maximised by ensuring high levels of uptake by maintaining good quality in the supply process. In response to Clinical Governance requirements to measure and improve quality and in response to adverse comments from consumers of school milk in Manchester, a simple audit of milk quality was carried out in June 2003 and repeated in 2004. The aim was to investigate quality issues and take action to make improvements where possible, to maximise the number of children drinking milk in school. Four audit standards were set relating to the accuracy of deliveries, milk freshness, quality of packaging, and milk temperature. The audit tools were a questionnaire designed to be completed by school pupils and an electronic milk thermometer. Fourteen schools took part in the initial audit, each completing a questionnaire on five different days. The results revealed that incorrect deliveries were received on 19 of the 70 days, all milk was fresh enough to consume (was within specified use-by date) and leaking cartons were received on 13 of the 70 days. The mean temperature of milk on delivery was 14.5 degrees C (sd 3.43) and at consumption 10.9 degrees C (sd 3.96). The results from the second cycle of the audit show some areas of improvement. The audit process proved to be an excellent exercise in collaborative working and facilitated efforts to improve this health promotion intervention.