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Nursing Audit

Nursing audit assists in:
1. Evaluating Nursing care given,
2. Achieving deserved and feasible quality of nursing care,
3. Stimulating better nursing records maintenance,
4. Focuses on patient care provided and not on care provider,
5. Contributes to research in nursing.

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Nursing Audit

  2. 2. NURSING AUDITWith the implementation of CPA professionalaccountability to an enlightened public can nolonger be ignored by nursing staff.“Quality nursing care” has become essential onday to day functioning.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.
  3. 3. HISTORY OF NURSING AUDITOne of first ever clinical audits was undertaken by FlorenceNightingale during the Crimean war of 1853-1855.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.She and her team of 38 nurses applied strict sanitaryroutines and standards of hygiene to the hospital andequipment,Florences gift of statistic kept meticulous records of themortality rates among the hospital patients.Another famous figure who advocated clinical auditwas Ernest Codman (1869–1940) by monitoring surgicaloutcomes .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.
  4. 4. Before 1955 very little was known about the conceptof nursing audit.First report of Nursing audit of the hospitalpublished in 1955.For the next 15 years, nursing audit is reported fromstudy or record on the last decade.The program is reviewed from record nursing plan,nurses notes, patient condition, nursing care.
  5. 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.
  7. 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. 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. 9. II. CONCURRENT AUDIT : It is performed during ongoingnursing care.The evaluations conducted on behalf of patients who are stillundergoing care.It includes assessing the patient at the bedside in relation topre-determined criteria,Interviewing the staff responsible for this care .Reviewing the patients record and care plan.III. PEER REVIEW : In nurse peer review nurses functioning inthe same capacity that is peer’s 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.
  10. 10. QUALITY AUDIT1. OUTCOME AUDIT:Outcomes are the end results of care;The changes in the patients health status and can beattributed to delivery of health care services.Outcome audits determine what results if any occurred asresult of specific nursing intervention for clients.These audits assume the outcome accurately anddemonstrate the quality of care that was provided.Outcomes traditionally used to measure quality of hospitalcare include mortality, its morbidity, and length of hospital stay.
  11. 11. 2. PROCESS AUDIT:Process audits are used to measure the process of care or howthe care was carried out.Process audit is task oriented and focus on whether or notpractice standards are being fulfilled.These audits assumed that a relationship exists between thequality of the nurse and quality of care provided.3. STRUCTURE AUDIT:Structure audit monitors the structure or setting in which patientcare is provided.Such as the finances, nursing service, medical records andenvironment.This audit assumes that a relationship exists between qualitycare and appropriate structure.These above audits can occur retrospectively, concurrently andprospectively.
  14. 14. AUDIT COMITTEEBefore carrying out an audit, an audit committeeshould be formed, comprising of a minimum of fivemembers who are interested in quality assurance, areclinically competent and able to work together in agroup.It is recommended that each member should reviewnot more than 10 patients each month.That the auditor should have the ability to carry outan audit in about 15 minutes. If there are less than 50 discharges per month, thenall 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.
  15. 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. 16. PLANNING MEDICAL CAREa. Collects patient data in a systematic manner,. includes description of patients pre-hospitalroutines, has information about the severity of illness, has information regarding lab tests, has information regarding vital signs, 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,
  18. 18. SELECTING A TOPIC-starting point-careful thought and planning- There seems little point in trying to audita rare condition, with an insignificantoutcome
  19. 19. PLANNING AUDITInvolve ALL the people concern. Fix time and Plan resourcesAccess the evidence/dataMethodology to be followedPilot studyReport for ActionRe-auditAll activities should be documented.
  20. 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 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. 21. MEASURING LEVEL OF PERFORMANCE•The data collected are to be precise•Essential data•Completed data•Adequate data•User group to be includedExample:Immunisation status of pregnant women•Do 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 information-Compare performance against the criteria-Keep focused on the objective of the audit
  22. 22. MAKING IMPROVEMENTSIDENTIFYING BARRIERS TO CHANGE:- Fear- Lack of understanding- Low morale- Poor communication- Individual Culture- Doubt of outcome-Consensus not gainedSYSTEMATIC APPROACH:•identification of local barriers to change•change culture•support of teamwork•use of a variety of specific methods like delegation andaccountability
  23. 23. SUSTAINING IMPROVEMENTMONITORING AND EVALUATION:systematic approach to changing professional practiceshould include plans to:•monitor and evaluate the change•maintain and reinforce the changeREINFORCING IMPROVEMENT:•reinforcing or motivating factors by the management .•integration of audit•strong leadership6. RE-AUDIT:-Review evidence-Measure effectiveness-Decide how often to re-audit- Ongoing process monitoring-Adverse incidents-Significant events audit
  24. 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. 25. CONCLUSIONA profession dedicated for thequality of its service to patientsconstitutes the heart of itsresponsibility to the public.An audit helps to ensure that thequality of nursing care desired andfeasible is achieved.This concept is often referred to asquality assurance.
  26. 26. hospiad Hospital Administration Made Easy http// An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. DR. N. C. DAS
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Nursing audit assists in: 1. Evaluating Nursing care given, 2. Achieving deserved and feasible quality of nursing care, 3. Stimulating better nursing records maintenance, 4. Focuses on patient care provided and not on care provider, 5. Contributes to research in nursing.


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