nursing audit

1. Delmar LearningDelmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Nursing AuditNursing Audit
Ujjwal Sharma
M. Sc Nursing

2. Chapter 14 Copyright © 2003 Delmar Learning, a Thomson Learning company 2
MeaningMeaning
 Quality - Is a judgment of what constitutes good or
bad.
 Audit - a systematic and critical examination of
activities.

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NURSING AUDIT -NURSING AUDIT -
It is the assessment of the quality of nursing care
According to Elison "Nursing audit refers to assessment of the
quality of clinical nursing".
 Another definition
Nursing Audit is an exercise to find out whether good nursing
practices are followed.

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MEDICAL AUDITMEDICAL AUDIT
It is 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

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Purposes of Nursing AuditPurposes of Nursing Audit
 Evaluating Nursing care given,
 Achieves deserved and feasible quality of nursing
care.
 Stimulant to better records.
 Focuses on care provided.
 Contributes to research

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Methods of Nursing AuditMethods of Nursing Audit
1. Retrospective review –
This refers to an in-depth assessment of the quality after
the patient has been discharged. It is reflected in the
patient care records.

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For example the examiner looks through the
patient's records and asks :
 Was the problem solving process used in planning nursing care?
 Whether patient’s data was collected in a systematic manner?
 Was a description of patient's pre-hospital routines included?
 Laboratory test results used in planning care?
 Did the nurse perform physical assessment?
 Were nursing diagnosis stated?
 Did nurse write nursing orders? And so on.

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2. The concurrent review –
This refers to the evaluations conducted on behalf of
patients who are still undergoing care. It includes
assessing the patient at the bedside in relation to pre-
determined criteria, interviewing the staff responsible for
this care and reviewing the patients record and care plan.

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Audit CommitteeAudit Committee
Before carrying out an audit, an audit committee should be formed,
comprising 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.

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Criteria for AuditCriteria for Audit
 Define patient population.
 Identify a time framework for measuring outcomes of care.
 Identify common nursing problems.
 Implementation of nursing care plan
 State patient outcome criteria.
 State acceptable degree of goal achievement.
 Specify the source of information.
 Design and type of tool.

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Audit as a Tool for Quality Control Audit as a Tool for Quality Control
 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.

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Audit as a Tool for Quality Control contd.Audit as a Tool for Quality Control contd.
1. Outcome audit
Outcomes are the end results of care. 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.

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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.

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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.

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Advantages of Nursing Audit 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 part of a quality assurance
programme in areas where accurate records of care are
kept.

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Disadvantages of the Nursing AuditDisadvantages of the Nursing Audit
 Many of the components overlap making analysis difficult
 It may be 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

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ConclusionConclusion
 A profession concerns for the quality of its service
constitutes the heart of its responsibility to the public.
An audit helps to ensure that the quality of nursing
care desired and feasible is achieved. This concept is
often referred to as quality assurance.