Nursing Audit

Quality
 a judgment of what constitutes good or bad

Audit
 a systematic and critical examination to examine or verify
Nursing audit
 (a) it is the assessment of the quality of nursing care
 (b) uses a record as an aid in evaluating the quality of patient
care

Medical audit
 the systematic, critical analysis of the quality of medical care,
including the procedures for diagnosis and treatment, the use
of resources, and the resulting outcome and quality of life for
the patient
 Elison
 “Nursing audit refers to assessment of the quality of clinical
nursing”.

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.
 Brief 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.
Purposes of Nursing Audit

1. Necessitating adequate documentation of nursing care

provided to the client through the entire nursing process.
2. Directing attention to the design and utility of the charting
record.
3. Encouraging the use of the problem oriented nursing
system.
4. Supporting and becoming an integral part of nursing by
objective program

5. Facilitating the co-operative planning and delivery of client

care by physicians and nursing employees

6. Increasing the priority for a results oriented performance

evaluation program for nursing service employees.

7. Enriching and providing direction to in service education

effects.
8. Providing a specific management technique in carrying out
evaluation and control function.

9. Identifying ways to improve patient care.

10. Providing a meaningful ways for nursing staff members to

participate and achieve career growth.
TYPES OF AUDITORS:

Auditing whether general as nursing can be conducted by two

types of auditors.

1. Internal auditors
2. External auditors
Internal Auditors:

In nursing auditing, internal auditors are the nursing experts as

specialists in the hospital appointed by the hospital
management

eg : Nurse Manager, Director

External Auditors:

The experts from the external statutory agencies to the

auditing process

eg : inspectors from TNAI, KNC etc.

Nursing Audit has become mandatory for 3 basic reasons.
1. The increasing cost of the care.
2. The need to improve the quality of care.
3. The need for the proof of the quality of care actually
delivered, proof for the–
a) Nurse, b) Agency, c) Client
STEPS OF NURSING AUDIT PROCESS: (Logufo
and Brook (1984))
1. Selection of a topic for study
2. Selection of explicit criteria for quality care
3. Review of records to determine whether criteria are met.
4. Peer review of all cases that do not meet criteria.
5. Specific recommendations to correct problem
6. Fallow-up to determine whether problems have been
eliminated.
AUDIT CYCLE:
The nursing audits are mainly of 3 types

1. Concurrent audit
2. Retrospective audit
3. Prospective audits
Concurrent Audit
The concurrent audit has also been called as the open chart audit
because it is done while the patient is receiving care. It is a
process audit that evaluates the quality of ongoing care being
perceived by clients by looking at the nursing process.
Purpose: To assess the past and present care given to a client.
Components:
1. Assessing the client
2. Interviewing the nursing staff
3. Reviewing the clients record and care plan.
Advantages of Concurrent Audit:
1. Indications of problems at the time of caring

2. Provision of a mechanism for identifying and meeting clients’

needs during care

3. Implementation of measures to fulfill professional

responsibilities.

4. Provision of a mechanism for communicating on behalf of the

client.
Disadvantages of Concurrent Audit:

1. Concurrent audit is a time consuming procedure

2. It is costly to implement than the retrospective audit

3. Does present the total picture of care that the client ultimately
well receive

4. Rosenthal effect: changing results at expectations of care gives

Retrospective Audit
Refers to an in-depth assessment of the quality, after the client
has been discharged, having the client chart as a source of
data.
Focuses in 2 factors – Discharge status and complications the 3
components of discharge status are:
Health - Activity - Knowledge
Advantages:
1. Comparison of actual practice to standards of care
2. Analysis of actual practice findings
3. A total picture of care given
4. More accurate data for planning corrective action

Disadvantages:
1. The focus of evaluation is directed away from ongoing care
2. The clients’ problems are identified after discharge
OTHER TYPES OF NURSING AUDITS
(i) Structure audit:
The inspection of the management process as carried out and documented by
the nurse manager.
(ii) Process audit:
In this type of audit inspection of the nursing process, as carried out and
documented by staff nurses to evaluate competence with established
standards of nursing care.
(iii) Outcome audit:
It mainly identifies client outcomes (satisfactory and unsatisfactory and the
patterns of nursing care that appears to be responsible.
NURSING AUDIT COMMITTEE
Membership
- Client care coordinators
- Supervisors
- Head nurses
- Clinical specialists
- Nurse clinicians
- Licensed practical nurses
- Nursing assistants
- Other client care personnel
- Medical records administrator
FUNCTIONS OF THE AUDIT COMMITTEE

 Development of purposes and objectives

 Establishing standards and criteria
 Establishing guidelines for conducting audits
 Deciding upon auditing forces (JCAH forms)
 Initiating the auditing process
 Keeping up brief, pertinent minutes
RESPONSIBILITIES OF NURSING AUDIT
COMMITTEE:
1. Planning audit sessions and scheduling
2. Arrange for medical records to pull charts for retrospective audits and
retrieve data.
3. Evaluating audit results in committee.
4. Conducting process audits
5. Preparing summaries of all audits
6. Teaching professional nursing personnel the auditing process
7. Assisting nursing staff in using audits results
8. Making recommendations
9. Keeping brief pertinent minutes of audit committee meetings.
FACTORS AFFECTING AUDITING
PROCESS IN NURSING:
- Lack of resources
- Personnel problems
- Unreasonable clients and attendants
- Improper maintenance
- Absence of well-informed population
- Absence of accreditation laws
- Legal restore
- Lack of incident review procedure
- Lack of good hospital information system
- Absence of survey condition routine
- Lack of nursing case records
- Miscellaneous factors
ADVANTAGES OF NURSING AUDIT:
- Method of measurement
- Functions are easily understood
- Scoring system is fairly simple
- Results are easily understood
- Assess the work of all those involved in recording case.
- May be useful tool as part of a quality assurance program in
area where accurate records of case are kept.
DISADVANDAGES
- It is not so useful in areas where the nursing process has not
been implemented.
- Many components overlap making analysis difficult
- It is time consuming
- Requires a team of trained auditors.
- Deals with a large amount of information.
- Only evaluates record keeping