NURSING AUDIT

BY
PRAVEENA BHASKER .P.G
 INTRODUCTION

Audit in nursing management is the professional

evaluation of the quality of the patient care, by
analysing through all the facilities , services
rendered, measures involved in diagnosis,
treatment and other conditions and activities that
affect the patients.
 Nursing audit, is a review of the patient record designed
to identify, examine, or verify the performance of certain
specified aspects of nursing care by using established
criteria.
 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.
 Nursing audit is a detailed review and evaluation of
selected clinical records by qualified professional
personnel for evaluating quality of nursing care
 MEANING

 Quality - a judgement 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.
 DEFINITION

✓ Nursing audit refers to the assessment of the quality

of clinical nursing.
- Elison
✓ Nursing audit is the means by which nurses
themselves can define standards from their point of
view and describe the actual practice of nursing.
-Goster Walfer
✓ Nursing audit isdefined as:
….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
-(NHS ME, 1991 Framework for Audit for Nursing
Services).
 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

 Evaluating Nursing care given,

 Achieves deserved and feasible quality of
nursing care,
 Stimulant to better records,
 Focuses on care provided and not on care
provider,
 Contributes to research.
 CHARACTERISTICS
 It improve the quality of nursing care .
 It compares actual practice with agreed standards of
practice.
 It is formal and systemic.
 It involves peer review.
 It requires the identification of variations between
practice and standards followed by the analysis of causes
of such variations.
 It provides feedback for those whose records are audited.
 It includes follow- up or repeating an audit sometimes
later to find out if the practice is fulfilling the agreed
standards.
OBJECTIVES
 To evaluate the quality of nursing care given.
 To achieve the desired and feasible quality of care.
 To provide a way for better records.
 To focus on care provided and care provider.
 To provide rationalized care thereby maintaining uniform
standards worldwide.
 To contribute to research.
METHODS OF AUDIT

There are mainly two methods :-

❖Retrospective view-
❖Concurrent view-
Retrospective view

 This refers to an in-depth assessment of the quality after

the patient has been discharged, have the patients chart
to the source of data.

 Retrospective audit is a method for evaluating the

quality of nursing care by examining the nursing care as
it is reflected in the patient care records for discharged
patients. In this type of audit specific behaviors are
described then they are converted into questions and the
examiner looks for answers in the record.
➢ For example the examiner looks through the patient's
records and 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 patient's pre-hospital routines
included?
d. Laboratory test results used in planning care?
e. Did the nurse perform physical assessment? How was
information used?
f. Were nursing diagnosis stated?
g. Did nurse write nursing orders? And so on.
Concurrent view

o This refers to the evaluations conducted on behalf of

patients who are still undergoing care.

o It includes assessing the patient at the bedside in relation

to pre-determined criteria like errors, omissions,
deficiencies, as well as efficiencies, involves direct and
indirect observation , interviewing the staff responsible for
this care and reviewing the patients record and care plan.

o It can be also done to identify the job satisfaction of staff

nurses in accordance with their work performance.
PROCESS OF NURSING AUDIT

A) Set the key criteria (item)

B) Prepare audit protocol
C) Design the type of tool
D) Plan and implement the tool
E) Recording / analysis, concluding
F) Using results
A) Set the key criteria (item) : it should be
measurable against identifiable values, set standard
and interms of desired patient outcome.

Method to Develop Criteria :

 Define patient population.
 Identify a time framework for measuring outcomes of
care,
 Identify commonly recurring nursing problems
presented by the defined patient population,
 State patient outcome criteria,
 State acceptable degree of goal achievement,
 Specify the source of information.
B) Prepare audit protocol :-
keeping in mind audit objectives , target groups,
methods of information gathering ( by asking,
observing, checking records), criterion are
measuring , identifying the time framework for
measuring outcome of care, identifying commonly
recurring nursing problems, state acceptable goal
achievement
C) Design the type of tool

o Quality assurance must be a priority.

o Those responsible must implement a programme not only
a tool.
o Roles and responsibilities must be delivered.
o Nurses must be informed about the process and the
results of the programme.
o Data must be reliable.
o Adequate orientation of data collection is essential.
o Quality data should be annualized and used by nursing
personnel at all levels.
D) Plan and implement the tool
o What is to be evaluated?
o Who is going to collect the information?
o How many sample in the target group?
o Time period?

E) Recording / analysis, concluding

Record the information , analyse the information,
make a summary and compare with set standard ,
conclusion.

F) Using results
The result aid to modify nursing care plan and
nursing care process .
STEPS TO PROBLEM SOLVING PROCESS IN
PLANNING CARE :

I. Collects patient data in a systematic manner,

1. includes description of patients pre-hospital
routines,
2. has information about the severity of illness,
3. has information regarding lab tests,
4. has information regarding vital signs,
5. Has information from physical assessment etc.
II . States nurses diagnosis,
III. Writes nursing orders,
IV. Suggests immediate and long term goals,
V. Implements the nursing care plan,
VI. Plans health teaching for patients,
VII. Evaluates the plan of care,
PREREQUISITES OF NURSING AUDIT

AUDIT COMMITTEE

 Before carrying out an audit, an audit committee should

be formed.

 It comprises of a minimum of five members who are

interested in quality assurance, are clinically competent
and able to work together in a group.
 It is recommended that each member should review not
more than 10 patients each month and that the auditor
should have the ability to carry out an audit in about 15
minutes.

 If there are less than 50 discharges per month, then all the
records may be audited, if there are large number of
records to be audited, then an auditor may select 10 per
cent of discharges.
 AUDIT AS A TOOL FOR QUALITY
CONTROL
▪ An audit is a systematic and official examination of a
record, process or account to evaluate performance.
 Auditing in health care organization provide managers
with a means of applying control process to determine the
quality of service rendered.
 Nursing audit is the process of analyzing data about the
nursing process of patient outcomes to evaluate the
effectiveness of nursing interventions.
 The audits most frequently used in quality control include
outcome, process and structure audits.
1. Outcome audit

➢ Outcomes are the end results of care; the changes in the

patients health status and can be attributed to delivery of
health care services.
➢ Outcome audits determine what results if any occurred as
result of specific nursing intervention for clients.
➢ These audits assume the outcome accurately and
demonstrate the quality of care that was provided.
➢ Example of outcomes traditionally used to measure
quality of hospital care include mortality, its morbidity,
and length of hospital stay.
2. Process audit

➢ Process audits are used to measure the process of care or

how the care was carried out.

➢ Process audit is task oriented and focus on whether or not

practice standards are being fulfilled.

➢ These audits assumed that a relationship exists between the

quality of the nurse and quality of care provided.
3. Structure audit

➢ Structure audit monitors the structure or setting in which

patient care occurs, such as the finances, nursing service,
medical records and environment.

➢ This audit assumes that a relationship exists between

quality care and appropriate structure.

➢ These above audits can occur retrospectively,

concurrently and prospectively.
 ADVANTAGES
 Can be used as a method of measurement in all areas of
nursing.
 Seven functions are easily understood,
 Scoring system is fairly simple,
 Results easily understood,
 Assesses the work of all those involved in recording
care,
 May be a useful tool as part of a quality assurance
programme in areas where accurate records of care are
kept.
 DISADVANTAGES
 Appraises the outcomes of the nursing process, so it is not
so useful in areas where the nursing process has not been
implemented,
 Many of the components overlap making analysis
difficult,
 Is time consuming,
 Requires a team of trained auditors,
 Deals with a large amount of information,
 Only evaluates record keeping. It only serves to improve
documentation, not nursing care