NURSING AUDITThe world trend of professionalaccountability to an enlightened public canno longer be ignored by nursing. We nurseseasily use the worlds “quality nursing” buthave we defined what we mean by quality?Do you know our deficiencies? Are we readyto admit our deficiency to our peers? Are wetaking steps to remedy them? Only by suchself regulation we can relate our identity withthe health professional as nature partners.
Brief history of nursing audit• Nursing 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 being of medical audit.• George Groword pronounced the term physician for the first time medical audit ten years later Thomus R Pandon MD established a method of medical audit based on procedures used by financial account. He evaluated the medical care by reviewed the medical records.• First report of nursing audit of the hospital published in 1955. For the next 25 years nursing audit is reported from study or records on the last decade. The programmer is reviewed from record nursing plan, nursing care.
Meaning of termsQuality A judgment of what constitute good or badAudit A systematic and critical examination to examine or verifyNursing audit 1) It is the assessment of the quality of nursing care 2) Uses a record as an aid in evaluating the quality of patient care
Nursing standards Defines a standard as the desirable and achievable level of performance against which actual practice is compared. The standards must meet the needs of the patient
Definition:1) According to elision ‘nursing audit refers to assessment of the quality of clinical nursing’2) According to Goster welfare 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 nursing3) A nursing audit is a method of evaluating care that evolve reviewing patient records to assess the outcomes were achieved
Nursing care audit Audit related to the planning, delivery and evolution of care. It is an important component of nursing careMedical audit; the systematic critical analysis of the quality of medical care including the procedures for diagnosis and treatment the use of resource and the result sing outcome and quality of life for the patient
Types of audit1) Internal auditing Internal auditing is a control technique performed by an external auditor who is an employee of the organization. Makes an independent appraisal the policies, plans and points the deficits in the policies or plans and give suggestion for eliminating deficits2) External auditing It is an independent appraisal of the organizations financial account and statements. The external auditor is a qualified person who has to certify the annual profit and loss account and prepare a balance street after careful examination of the relevant books of accounts and documents
Evaluation of nursing audit• There are 3 types of evaluation of nursing audit: 1) Retrospective evaluation 2) Concurrent evaluation 3)Peer review
Retrospective evaluation :• It means relating to past events. It is the evaluation of a clients record after discharge from agency.• It may use post discharge questionnaires patient interview( by telephone , face to face ) or chart review, Nursing audit to collect data.• The type of retrospective audit most familiar to nurses working in hospitals is the retrospective chart review. This activities body initially required hospitals to conduct certain number of per year.
Concurrent audit :• It is the evaluation of a client’s health care while the client is still receiving care from the agency.• These evaluation use interviewing direct observation of nursing care and review of clinical records to determine whether the specific evaluative criteria have been met.
Peer review :• In nurse peer review nurses functioning in the same capacity that is peer’s appraise the quality of care or practice performed by others equally qualified nurses. The peer review is based on pre-established standards or criteria.There are two types of peer reviews. Individual and nursing audit• a) Individual peer review; focuses on the performance of an individual nurse• b) Nursing audit; focuses on evaluating nursing care through the review of records
Purposes of nursing audit1) Evaluating nursing care given2) Achieves deserved and feasible quality of nursing care3) Stimulant to better records4) Focuses on care provided and on care provider5) Contributes to research
Methods of nursing audit1) define patient population2) identify a time framework for measuringoutcomes of care3) identify commonly recurring nursingproblems presented by the defined patientpopulation4) state patient outcome criteria5) state acceptable degree of goal achievement6) specify the source of information
7) design and type of tool a) quality assurance must be priority b) those responsible must implement a programmer not only a tool c) a coordinator should develop and evaluate quality assurance activity d) roles and responsibilities must be delivered e) nurses must be informed about the process and the result of the programmed f) data must be reliable g) adequate orientation of a data collection is essential h) quality data should be analyzed and used by nursing personnel at all levels
Audit cycleSet standardsImplementation change observepracticeCompare with standard
Advantage of nursing audit1) Can be used as a method of measured in all areas of nursing2) Seven function are easily understood3) Scoring system is fairly simple4) Results easily understood5) Assess the work of all those involved in recording care6) May be useful tool as part of a quality assurance program in areas where accurate records of care are kept
Disadvantage of nursing audit1) Appraises the outcomes of the nursing process , so it is not so useful in areas where the nursing process has not been implemented2) Many of the components overlap making analysis difficult3) Is time consuming4) Requires a team of trained auditors5) Deals with a large amount of information6) Only evaluates record keeping. It only serves to improve documentation not nursing care
Audit committee Before carrying out an audit committee should be informed comprising of a minimum of five member 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 minute. If there are less than 150 discharge per month. Then all the records may be audited if they all the records to be audited then an auditor may select 10% of discharge
ConclusionA professional concerns for the quality of its service constitute the heart of its responsibility to the public. An audit helps to ensure that quality of nursing care desired and feasible is achieved. This concept is often referred to as quality assurance.