2. DEFINITION
• AUDIT: An audit is an examination, a verification
or accounting of predetermined indicators.
• NATIONAL HEALTH SERVICE(1983):
Monitoring of current practices against standard,
preferably employing criteria derived from
research findings on best practices as well as
professional management, judgment and
consumer preference.
3. NURSING AUDIT
• 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
4. OBJECTIVE OF NURSING AUDIT
• TO PROVIDE EVIDENCE OF QUALITY
OF NURSING SERVICES BEING
RENDERED
5. PURPOSES OF NURSING AUDIT:
• Evaluation of nursing care given
• Achieved quality of nursing care
• Stimulant to better records
• Focuses on care provided and not on care
provider
• Contributes to research
6. 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 corrective
action
• Appropriate recording of the audit
7. ADVANTAGES OF NURSING
AUDIT
It can be used as a method of measurement
in all areas of nursing
Better planning can be done through nursing audit
Patient is assured of good service
Assesses the work of all those involve in recording
care
Helps in reallocation of resources
It is useful as a part of quality assurance program
Administrators are also sure that patients are getting
quality care
8. DISADVANTAGES OF NURSING
AUDIT
• It is not useful in areas where the nursing
process has not been implemented
• Many of its component overlaps making analysis
difficult
• It is time consuming
• It requires a team of trained auditors
• It only serve to improve documentation, not
nursing care
• It is considered as a source of punishment to a
professional group.
9. TYPES OF NURSING AUDIT
BASE ON THE FORM OF AUDIT
• STRUCTURE AUDIT
• PROCESS AUDIT
• OUTCOME AUDIT
10. Characteristics of process audit
• It measure the performance or non
performance of accepted diagnostic and
therapeutic practices
• They are task oriented
• They are based on nursing assessment
and nursing management
• Do not recognize variations in process
that may result from the exercise of
professional judgement
Most successfully identify the level of
nursing care
11. Problems of process audit
• They are time consuming
• Professional judgement is difficult because
of conflicting views and variety of
standards
12. ON THE BASIS OF
METHODOLOGY:
• CONCURRENT AUDIT:
• RETROSPECTIVE AUDIT
13. Advantages of concurrrent audit
• Identification of problems at the time of
care given.
• Provision of mechanism for identifying and
meeting client’s needs during care.
• Implementation of measures to fulfill
professional responsibilities.
• Provision of mechanism for
communicating on behalf of the client
14. Disadvantages of concurrent audit
• It is time consuming
• It is more costly to implement the
retrospective audit.
• It does not present the total picture of care
that the client will ultimately receive.
15. Advantages of retrospective audit
• It is less time consuming
• Less expensive
• It encourages accurate recording
16. Disadvantages
• The focus of evaluation is directed away
from ongoing care
• Client’s problems are identified only after
discharge so corrective action can only be
used to improve the care of future clients
• Care giver may chart care activities
without giving care to the client
18. READY MADE NURSING AUDIT
SYSTEM
• CLOSED AUDIT SYSTEM (The Phaneuf
procedure)
• OPEN AUDIT SYSTEM
a) Commission on Administrative service in
Hospital (CASH) scale
b)The Slater Nursing Competencies Rating
Scale:
c) Quality Patient Care Scale(QualPaCS):
QualPaCS
d)Medicus Corporation Nurses Audit
19. Examples of areas to be audited
• Nursing care plans
• Provisions for safe and comfortable patient
environment
• Meeting physical needs of patients
• Meeting physiological needs of patients
• Meeting psychological, social, and religious
needs of patients
• Implementing medical regimen for patients
• Teaching patients and/ family
• Keeping records of nursing care given to
patients
• Evaluating the patient’s responses to nursing
interventions
20. GUIDELINES TO DEVELOP
AUDIT TOOL
1 SET AUDIT CRITERIA
2. PREPARE AUDIT PROTOCOL FORM
3. PREPARING FOR AUDIT:
– Timing:
– Preparatory work:
– Audit record
• Audit objective
• Sample
• Time frame
• Auditors
21. – Date
– Identification code for each patient/client
– Totals
– Compliance rate for each criterion
– Comments
• Ethical considerations
22. • CONDUCTING AN AUDIT
– Checking the structure criteria
– Observing the clinical environment
– Auditing the documentation
– Reviewing responses to questionnaires
– Observing practices and interactions between
practitioners and clients including non-verbal
communication
– Talking to clients
– Talking to relatives
– Talking to practitioners and other members of
staff.
23. • AUDIT REPORTS
– The audit objective
– The name of auditors
– Date of the audit
– The audit methods used,sample size and time
frame
– The findings in relation to criterion
– Selected comments from questionnaires and
suggestions for improvement
24. The nursing audit committee
• REPRESENTATIVE FROM EACH
CLINICAL UNIT
• CURRENTLY IN DIRECT NURSING
CARE ACTIVITIES
• COMPETENT, ABLE TO WORK IN
GROUP
25. USE OF NURSING AUDIT
RESULTS
• Modifying nursing care plans and the nursing
care process, including discharge planning.
• Implementing a program for improving
documentation of nursing care through
improved charting policies methodologies and
forms
• Focusing of nursing rounds and team
conferences
• Focusing supervisory attention upon areas of
weakness identified
• Designing responsive orientation and in service
education programmes
26. • 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 outcomes.
27. For Nurse Administrators
• Provide evaluation of particular programs,
• Support requests for accreditation or for
financing for a particular program
• Serve as bases for planning new program or
program changes
• Identify areas of strength and weakness in the
total nursing program
• Determine the influence of varied staffing
patterns
• May be used as a data in cost effectiveness
studies
28. For Supervisors and head
nurses
• Identify areas of needed patient care
improvements
• Provide bases for planning in service
education programs
• Identify teaching/supervision needs of staff
members who give direct care to patients
29. For head nurses and staff nurses
• Provide a ‘self’ examination of care in
their specific nursing unit
• Identify types of care in which practice
may be improved merely by increased
attention and conscientiousness
• Identify types of care in which
improvement will depend on the staff’s
acquiring additional knowledge and skill.
