AN

ASSIGNMENT ON
NURSING AUDIT
SUBJECT: Nursing Management

Submitted To: Submitted By:

Ms. Rajlaxmi Mansi Dabola
Tutor M.Sc. Nursing 2nd year
Rufaida college of nursing Rufaida college of nursing
 NURSING AUDIT
INTRODUCTION
An audit has become a mechanism for assessing and improving the quality work and identify
ways of improving the efficiency of care. Due to increase in the complexity in the health care
and awareness among people for their rights necessitate that nurses to became accountable
for their practice
HISTORY OF NURSING AUDIT
Nursing audit is an evaluation of nursing service. Before 1955 very little was known about
the concept. It was introduced by the industrial concern and the year 1918 was the beginning
of medical audit.

George Groword, pronounced the term physician for the first time medical audit. Ten years
later Thomas R Pondon MD established a method of medical audit based on procedures used
by financial account. He evaluated the medical care by reviewing the medical records.

First report of Nursing audit of the hospital published in 1955. For the next 15 years, nursing
audit is reported from study or record on the last decade. The program is reviewed from
record nursing plan, nurses notes, patient condition, nursing care.

DEFINITION

I. According to Elison "Nursing audit refers to assessment of the quality of clinical

nursing".

II. According to Goster Walfer

a. Nursing Audit is an exercise to find out whether good nursing practices are
followed.

b. The audit is a means by which nurses themselves can define standards from their
point of view and describe the actual practice of nursing.

III. Nursing audit is defined as: It is a part of the cycle of quality assurance. It incorporates
the systematic and critical analysis by nurses, midwives and health visitors, in conjunction
with other staff, of the planning, delivery and evaluation of nursing and midwifery care, in
terms of their use of resources and the outcomes for patients/clients, and introduces
appropriate change in response to that analysis

OBJECTIVES OF NURSING AUDIT

  To evaluate and try to improve the expected quality of nursing
 To measure the level of quality of patient care against standards
 To minimize the cost of rendering nursing care
 To have a basis for detecting nursing negligence
 To take remedial measures towards cost- effectiveness
 To provide education to all nursing personnel through self-education
 To prevent shortcomings from reoccurring

IMPORTANCE OF NURSING AUDITS

 It serves as a valuable indicator to measure quality care

 It focuses on care provided and not on the care provider
 It helps in improving the quality of nursing
 It facilitates to attain more efficient use of health care resources
 It assists in maintaining the quality and accuracy of nursing records

ADVANTAGES AND DISADVANTAGES OF NURSING AUDIT

ADVANTAGES

 Its utilization as a method of measurement is in all area of nursing

 It may be a useful tool as a part of the quality assurance program in documentation
 It is a process to understand its outcomes

DISADVANTAGES

 Since many of the components overlap that makes analysis difficulty

 It is time consuming
 It requires a team of trained auditors
 It deals with information

BASES OF NURSING AUDIT: The nursing audit in the hospital settings includes

1. Debit items: These are items that gave discredit to institutes, for examples: several
deaths, complications of the disease, hospital infections etc.
2. Credit items: These are items or the variables that give credit to the care rendered for
example: several recovered / discharge patients etc
3. Nursing auditors: There are the personnel trained as auditors. They are both internal
and external. Internal auditors work within an organization and responsible for
internal auditing. External auditors are external parties
4. Quality: it is a degree of excellence that needs to define and predetermine based on
nursing audit
 5. Nursing standards: Nursing standards are valid and explicit statements about the
quality of facts of nursing care. These are structure, process, and outcome standards
6. Defined activities: These are goal-oriented transections required to carry out for
auditing
7. Resources: Resources include human, and material required for auditing and desired
health care

TYPES OF NURSING AUDITING

ACCORDING TO METHDOLOGY

1. Retrospective Audit: Retrospective audits involve reviewing claims that have

already been submitted and preferably adjudicated as either paid, denied, or pending.
The goal of a retrospective audit is to do a 'deep dive' on the internal claims process
and identify underlying problems or high-risk areas based on the adjudication results.
2. Concurrent Audit: Nursing audit is the process of collecting information
from nursing reports and other documented evidence about patient care and assessing
the quality of care by the use of quality assurance programmes. A concurrent nursing
audit is performed during ongoing nursing care.
3. Mixed Method Audit: These are both retrospective and concurrent. Both methods
used for auditing patient care. Observation, interviewing, questionnaires, and record
analysis the techniques used for this purpose

ACCORDING TO AGENCY CARRIED OUT

1. INTERNAL AUDIT: The peer and nursing personnel conduct audits

continuously. They are the employees if an organization and appointed by the
authority in the audit committee
2. EXTERNAL AUDIT: The outside agency conducts the external audit. Usually
periodically tests, completeness or accuracy of internal audits are done by external
auditors annually. Sometime non- professional administration conduct and audit.

NURSING AUDIT PROCESS

1. PLANNING PHASE: This includes:

a. Identify subjects
b. Constitute audit committee
c. Set criteria and standards
d. Develop an audit protocol

2. PREPRATION PHASE: This includes:

a. Define criteria and prepare audit tools
b. Develop an action plan
c. Seek ethical approval
 3. IMPLEMENTATION PHASES: In this gathering of data is there. Effectively use of
tool is there
4. ANALYSIS AND FINDING GAP PHASE
a. Analyze data
b. Compare data
c. Identify gaps and make an audit summary

5. IMPROVEMENT PHASE
a. Development of revised action plan
b. Implementation of revised action plan
c. Reauditing

6. SUSTAINING IMPROVEMENT PHASE: This phase describes the ways of

continuing improvement in nursing practice. It needs the development of guidelines,
standards, policies, and monitoring.
ROLE OF NURSE MANAGER IN NURSING AUDIT
Nurse managers in hospital setting can play an essential role in initiating and implementing
nursing audit. These are follows:
1. Appoint an audit committee with approval from an appropriate authority
2. Constitute audit committee, select members
3. Conduct regular meetings with members
4. Have a grand round with audit committee members
5. Make priority list of problems and issues
6. Follow all steps of audit process
7. Plan and conduct an orientation programme for auditors
8. Ready with action plan
9. Use the guideline approach rather than fault findings
10. Keep a record of the information and remedial action taken
FUNCTIONS OF NURSE MANAGER
1. In conjunctions with other personnel in the organization establishes clear cut,
measurable standards of care and determines the most appropriate methods for
measuring if those standards have been met.
2. Selects and uses process, outcome and structure audits appropriately as quality
control tools
3. Assesses appropriate sources of information in data gathering for quality control tools.
4. Determines discrepancies between care provided and unit standards and seeks further
information regarding why standards were not met.
5. Uses quality control findings as a measure of employee performance and rewards,
coaches, counsels or disciplines employees accordingly.
6. Keeps abreast of current government and licensing regulations that affect quality
control

CONCLUSION
A profession concerns for the quality of its service constitutes the heart of its responsibility to
the public. An audit helps to ensure that the quality of nursing care desired and feasible is
achieved. This concept is often referred to as quality assurance.

BIBLIOGRAPHY

Books:
 Jogindra vati, Principle and Practice of Nursing Management Administration 2nd
edition Jaypee Brothers Medical Publishers (P) Ltd.
 Nisha Clement, Essentials of Management of Nursing Service & Education, Jaypee
Brothers Health Sciences publishers (P) Ltd.

 G Johnston. Reviewing audit: barriers and facilitating factors for effective clinical-
audit. J. Quality in health care.
 FM Cheater and M Keane. Nurses participation in audit: A regional study. J. Quality
in health care. 1998.

Websites:
 http://www.interscience.willey.com
 http://www.ebscohost.com/ebooks/medical.