Nursing Audit

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1. NURSING AUDIT DR. N. C. DAS

2. Nursing audit is a way of ensuring quality nursingcare.Nursing audit is a detailed review and
evaluationof selected clinical records by qualifiedprofessional personnel to identify, examine,
orverify the performance of certain specified aspectsof nursing care by using established
criteria.Quality nursing care has become essential onday to day functioning.With the
implementation of CPA professionalaccountability to an enlightened public can nolonger be
ignored by nursing staff.NURSING AUDIT
3. Whilst Codmans clinical approach is in contrast withNightingales epidemiological audits, both
methods serve tohighlight the different methodologies that can be used in theprocess of providing
quality patient care.Another famous figure who advocated clinical auditwas Ernest Codman
(18691940) by monitoring surgicaloutcomes .Florences gift of statistic kept meticulous records
of themortality rates among the hospital patients.She and her team of 38 nurses applied strict
sanitaryroutines and standards of hygiene to the hospital andequipment,On arrival at the medical
barracks hospital in Scutari in1854, Florence was pained by the unsanitary conditions andhigh
mortality rates among injured or ill soldiers.One of first ever clinical audits was undertaken by
FlorenceNightingale during the Crimean war of 1853-1855.HISTORY OF NURSING AUDIT
4. The program is reviewed from record nursing plan,nurses notes, patient condition, nursing
care.For the next 15 years, nursing audit is reported fromstudy or record on the last
decade.First report of Nursing audit of the hospitalpublished in 1955.Before 1955 very little was
known about the conceptof nursing audit.
5. PURPOSES OF NURSING AUDIT1.Evaluating Nursing care given,2. Achieves deserved and
feasiblequality of nursing care,3. Stimulant to better records,4. Focuses on care provided andnot
on care provider,5. Contributes to research.
6. TYPES OF NURSING AUDIT NURSING AUDITINTERNAL EXTERNAL
7. TYPES OF NURSING AUDIT1) Internal auditing:Internal auditing is a control technique
performedby an external auditor who is an employee of theorganization. He makes an independent
appraisalthe policies, plans and points the deficits in thepolicies or plans and give suggestion for
eliminatingdeficits2) external auditing:it is an independent appraisal of the organizationsfinancial
account and statements. The externalauditor is a qualifed person who has to certify theannual
pprofit and loss account and prepare abalance street after carefull examination of therelevant
books of accounts and documents
8. INTERNAL AUDIT RETROSPECTIVE EVALUATION : Retrospective audit is amethod for
evaluating the quality of nursing care by examiningthe nursing care as it is reflected in the patient
care records fordischarged patients. In this type of audit specific behaviors are described then
theyare converted into questions and the examiner looks for answersin the record.For example the
examiner looks through the patients recordsand asks :a. Was the problem solving process used in
planning nursing care?b. Whether patient data collected in a systematic manner?c. Was a
description of patients pre-hospital routines included?d. Laboratory test results used in planning
care?e. Did the nurse perform physical assessment?f. How was information used?g. Were nursing
diagnosis stated?h. Did nurse write nursing orders? And so on.
9. Reviewing the patients record and care plan.III. PEER REVIEW : In nurse peer review nurses
functioning inthe same capacity that is peers appraise the quality of care orpractice performed by
others equally qualified nurses.The peer review is based on pre-established standards
orcriteria.There are two types of peer reviews:a) individual peer review; focuses on the
performance of anindividual nurse.b) nursing audit; focuses on evaluating nursing care through
thereview of records.Interviewing the staff responsible for this care .It includes assessing the
patient at the bedside in relation topre-determined criteria,The evaluations conducted on behalf of

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patients who are stillundergoing care.II. CONCURRENT AUDIT : It is performed during

ongoingnursing care.
10. Outcomes traditionally used to measure quality of hospitalcare include mortality, its morbidity,
and length of hospital stay.These audits assume the outcome accurately anddemonstrate the
quality of care that was provided.Outcome audits determine what results if any occurred asresult
of specific nursing intervention for clients.The changes in the patients health status and can
beattributed to delivery of health care services.Outcomes are the end results of care;QUALITY
AUDIT1. OUTCOME AUDIT:
11. These above audits can occur retrospectively, concurrently andprospectively.This audit
assumes that a relationship exists between qualitycare and appropriate structure.Such as the
finances, nursing service, medical records andenvironment.Structure audit monitors the structure
or setting in which patientcare is provided.These audits assumed that a relationship exists
between thequality of the nurse and quality of care provided.3. STRUCTURE AUDIT:Process
audit is task oriented and focus on whether or notpractice standards are being fulfilled.Process
audits are used to measure the process of care or howthe care was carried out.2. PROCESS
AUDIT:
12. AUDIT CYCLEAUDIT IS A CYCLIC PROCESS
13. PRE-REQUISITE FOR NURSING AUDIT CLINICAL AUDITCLINICAL AUDIT PLANNING
COMMITTEE MEDICAL CARE RE ORIENTATION OF AUDITORS
14. If there are large number of records to be audited,then an auditor may select 10 per cent of
discharges. If there are less than 50 discharges per month, thenall the records may be
audited,That the auditor should have the ability to carry outan audit in about 15 minutes.It is
recommended that each member should reviewnot more than 10 patients each month. who are
interested in quality assurance, areclinically competent and able to work together in
agroup.Before carrying out an audit, an audit committeeshould be formed, comprising of a
minimum of fivemembersAUDIT COMITTEE
15. RE ORIENTATION OF AUDITORSa. A detailed discussion of the seven components
ofcriteria.b. A group discussion to see how the group rates thecare received using the notes of a
patient who hasbeen discharged,c. These should be anonymous and should reflect atotal period of
care not exceeding two weeks inlengthd. Each individual auditor should then undertake thesame
exercise as above.e. This is followed by a meeting of the wholecommittee who compare and
discuss its findings, andfinally reach a consensus of opinion on each of thecomponents.
16. Has information from physical assessment etc.b. State nurses diagnosis,c. Writes nursing
orders,d. Suggests immediate and long term care,e. Implements the nursing care plan,f. Plans
health teaching for patients and students,g. Evaluates the plan of care at own level, has
information regarding vital signs, has information regarding lab tests, has information about the
severity of illness,. includes description of patients pre-hospitalroutines,PLANNING MEDICAL
CAREa. Collects patient data in a systematic manner,
17. SIX STAGES OF NURSING AUDIT STAGE I PREPARING FOR AUDIT STAGE II
SELECTING CRITERIA USING METHODS STAGE III CREATING MEASURING
PERFORMANCE ENVIRONMENT STAGE IV MAKING IMPROVEMENT STAGE V
SUSTAINING IMPROVEMENT STAGE-VI RE AUDIT
18. SELECTING A TOPIC-starting point-careful thought and planning- There seems little point in
trying to audita rare condition, with an insignificantoutcome
19. Re-auditAll activities should be documented.Report for ActionPilot studyMethodology to
be followedAccess the evidence/data Fix time and Plan resourcesInvolve ALL the people
concern.PLANNING AUDIT
20. DEVELOPING CRITERIA1. Define patient population.2. Identify a time framework for
measuring outcomes of care,3.Identify commonly recurring nursing problems presented by the
definedpatient population,4. State patient outcome criteria,5. State acceptable degree of goal
achievement,6. Specify the source of information.7. Design and type of toolPoints to be

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remembered:a. Quality assurance must be a priority,b. Those responsible must implement a

programme not only a tool,c. A coordinator should develop and evaluate quality
assuranceactivities,d. Roles and responsibilities must be delivered,e. Nurses must be informed
about the process and the results of theprogramme,f. Data must be reliable,g. Adequate
orientation of data collection is essential,h. Quality data should be annualized and used by nursing
21. MEASURING LEVEL OF PERFORMANCEThe data collected are to be preciseEssential
dataCompleted dataAdequate dataUser group to be includedExample:Immunisation status of
pregnant womenDo not try and collect too many items, keep it simple andshort.Computer stored
data, Case notes/Medical Records,Surveys , Questionnaires, Interviews Focus
Groups,Prospective recording of specific data- How will this be done to get required informationCompare performance against the criteria-Keep focused on the objective of the audit
22. MAKING IMPROVEMENTSIDENTIFYING BARRIERS TO CHANGE:- Fear- Lack of
understanding- Low morale- Poor communication- Individual Culture- Doubt of outcomeConsensus not gainedSYSTEMATIC APPROACH:identification of local barriers to changechange
culturesupport of teamworkuse of a variety of specific methods like delegation andaccountability
23. SUSTAINING IMPROVEMENTMONITORING AND EVALUATION:systematic approach to
changing professional practiceshould include plans to:monitor and evaluate the changemaintain
and reinforce the changeREINFORCING IMPROVEMENT:reinforcing or motivating factors by the
management .integration of auditstrong leadership6. RE-AUDIT:-Review evidence-Measure
effectiveness-Decide how often to re-audit- Ongoing process monitoring-Adverse incidentsSignificant events audit
24. ADVANTAGE Vs DISADVANTAGE ADVANTAGE DISADVANTAGE Can be used as a method
of appraises the outcomes of the measurement in all areas of nursing process, so it is not so
nursing. useful in areas where the Seven functions are easily nursing process has not been
understood, implemented, Scoring system is fairly simple, many of the components Results
easily understood, overlap making analysis difficult, is time consuming, Assesses the work of all
those requires a team of trained involved in recording care, auditors, May be a useful tool as part
of a deals with a large amount of quality assurance programme information, in areas where
accurate records of care are kept. only evaluates record keeping. It leading to improve
documentation, not nursing care
25. This concept is often referred to asquality assurance.An audit helps to ensure that thequality
of nursing care desired andfeasible is achieved.A profession dedicated for thequality of its
service to patientsconstitutes the heart of itsresponsibility to the public.CONCLUSION
26. hospiad Hospital Administration Made Easy http//hospiad.blogspot.com An effort solely to help
students and aspirants in their attempt to become a successful Hospital Administrator. DR. N. C.
DAS