NURSING AUDIT

AUDIT

Audit is the term derived form latin word auditus “ a hearing”

It meant the hearing of the facts and arguments about a situation
to determine the truth
 DEFINITION : NURSING AUDIT

Nursing audit refers to assessment of the quality of clinical

nursing : - Elison

Nursing audit is an exercise to find out whether good nursing

practices are followed

 MEANING

Quality : a judgement of what constitutes good or bad

Audit : a systematic and critical examination to examine or verify

PURPOSE OF NURSING AUDIT

Evaluates 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
 ESSENTIAL CHARACTERISTICS OF NURSING AUDIT

Written standards of care against which to evaluate nursing care

Evidence that actual practice was measured against such standards
Examination and analysis of findings
Evidence of corrective action being taken
Evidence of effectiveness of correction action
Appropriate recording of the audit program
 METHODS OR TYPES OF NURSING AUDIT 148 VAATI

 Retrospective method : 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. It is an in-depth assessment of the
quality after patient has been discharged
 Concurrent / prospective method : this refers to the evaluation conducted on
behalf of patients who are still undergoing care. It includes assessing the patients
at the bedside in relation to predetermined criteria, interviewing the staff
responsible for this care and reviewing the patient’s record and care plan.
 POINTS TO BE REMEMBERED

 Quality assurance must be a priority

 Those responsible must implement a program not only a tool
 A coordinator should develop and evaluate quality assurance activities
 Roles and responsibilities must be delivered
 Nurses must be informed about the process and the result of the program
 Data must be reliable
 Adequate orientation of data collection is essential
 Quality data should be annualized and used by nursing personnel at all levels
AUDIT COMMITTEE

Audit committee should comprise minimum of five members

whose are interested in quality assurance, clinically competent
and able to work together in a group
Proper training should be provided to the auditors
 AUDIT REPORT

The audit objective

The name of auditors
Date of audit
The audit methods used, sample size and time frame
The findings in relation to criterion
Selected comments from questionnaires and suggestions for
improvement
AUDIT CYCLE

There are four stages in an audit cycle

Set standards
Observe practice
Compare with standards
Implement change
AUDIT CYCLE

Set
standards

Implement Observe
changes practice

Compare
with
standards
 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 provides managers with a means of
applying control process to determine the quality of service rendered
 Nursing audit is a process of analysing data about the nursing process of patient
outcomes to evaluate the effectiveness of nursing intervention
 The audit most frequently used in quality control include outcome, process and
structure audits
 AUDIT AS A TOOL FOR QUALITY CONTROL : OUTCOME AUDIT

Outcome audit : outcomes are the end results of care; the changes in
the patients health status and can be attributed to delivery of
healthcare services
This audit assumes the outcome accurately and demonstrates the
quality of care that was provided.
Examples of outcomes traditionally used to measure quality of
hospital care include mortality, its morbidity and length of hospital
stay
 AUDIT AS A TOOL FOR QUALITY CONTROL : PROCESS AUDIT

Process audit : process audit are used to measure the process of

care or how the care was carried out.
Process audit is task-oriented and focuses on whether or not
practice standards are being fulfilled.
 AUDIT AS A TOOL FOR QUALITY CONTROL : STRUCTURE AUDIT

Structure audit : structure audit monitors the structure or setting in

which the patient care occurs, such as finances, nursing service,
medical records and environment
This audit assumes that a relationship exists between quality care and
appropriate structure
 ADVANTAGES OF NURSING AUDIT

 Can be used as a method of measurement in all areas of nursing

 Scoring system is fairly simple
 Results easily understood
 Assesses the work of all those involved in recording care
 May be a useful tool as a part of a quality assurance program in areas where accurate records of care are kept
 It gives a biographical index of quality of nursing each patient has achieved
 Patient is assured of good services
 It will give valuable and pertinent information about the staff, improvement in quality of nursing as well as
strengths and weakness in nursing service are revealed
 It will lead to better cooperation and communication among the nurses and health team members as a a result if
improved quality of nursing notes
 ADVANTAGES OF NURSING AUDIT

 It will help each professional nurse in her self-evaluation

 It helps the administration as better planning can be done through nursing
audit. It enables the nurse administrator to uncover the inefficient service
and point the ways to elevation of standards
 It will reduce the incidence if medico-legal complications arising out of
incomplete or inaccurate records maintained by nurses.
 It will broaden and strengthen nursing service in the hospital
 DISADVANTAGES OF NURSING AUDIT

 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
 Required a team of trained auditors
 Deals with a large amount of information
 Only evaluates record keeping
 It is considered as a source of punishment by the professional group
 It is only served to improve the documentation not nursing care
 UTILIZATION OF RESULTS OF NURSING AUDIT

For nursing service

 Modifying nursing care plans and the nursing care process, including discharge planning, for selected patient
population
 Implementing a program for improving documentation of nursing care through improved charting policies,
methodologies and forms
 Focusing on supervisory attention upon areas of weakness identified, such as one particular nursing unit or
specific employee
 Focusing on nursing rounds and team conferences
 Designing responsible orientation and in-service education programs
 Gaining administrative support for making changes in resources including personnel
 Using the evaluation based on nursing audit criteria to focus staff attention on individual patient outcome
 UTILIZATION OF RESULTS OF NURSING AUDIT

For nursing administrators

 Provide evaluation of particular program such as orientation of personnel or establishment of
patient teaching program
 Support requests for accreditation or for financing of a particular program
 Serve as a basis for planning new programs or program changes
 Serve to identify areas of strength and weakness in the total nursing program, in specific
areas of the program, and in various settings in which a program exists
 Determine the influence of varied staffing patterns
 May be used as data in cost-effective status
 UTILIZATION OF RESULTS OF NURSING AUDIT

For supervisor and head nurse

Identify the areas of needed patient care improvement
Provide basis for planning in-service education program
Identify teaching / supervision needs of staff members who give
direct care to patients
UTILIZATION OF RESULTS OF NURSING AUDIT

For staff nurse

 Provide self examination of care in their specific nursing unit or settings
 Identify particular types of care in which practice may be improved
merely by increased attention and consciousness
 Identify types of care in which improvement will depend on the staff’s
acquiring additional knowledge and skill
 Beena MR, Harikrishna, Kiruba JC
 Textbook of management of nursing service and education for bsc nursing students
 First edition 2022
 CBS publishers and distributers pvt. Ltd.
 206 - 211