The document outlines the concept and importance of nursing audits as a tool for assessing and improving the quality of nursing care. It details various types of audits, objectives, advantages, and disadvantages, as well as the auditing process which includes defining criteria, gathering data, analyzing results, and implementing changes. Additionally, it emphasizes the need for trained auditors and the establishment of audit committees to ensure effective nursing management and care.

1. By:
Dr.Rangappa.S.Ashi
Associate Professor
Ms. Prathyusha
M.Sc (N) II year
SDM Institute of Nursing Sciences
Shri Dharmasthala Manjunatheshwara University
Dharwad, Karnataka.

2. INTRODUCTION
Nursing audit one of the control tools, responsible
for controlling the activities of the nurses that focuses
on providing the best possible nursing care. The actual
nursing rendered is compared with the standards. This
is mainly refers to clinical nursing audit. The nursing
management audit is an evaluation of nursing
management as a whole. It is critically examination of
the entire nursing management process.

3. MEANING
Nursing audit-
(a) It is the assessment of the quality of nursing care,
(b) Uses a record as and aid in evaluating the quality of
patient care.

4. DEFINITIONS
 'Nursing audit refers to assessment of the quality of
clinical nursing.
-Elison
 'Nursing audit is a formal detailed systematic review of
records or observation of nursing actions in order to
evaluate the quality of nursing care by comparing the
documented evidence with accepted standards and
criteria'.
-RANF, 1985

5.  'It is an exercise to find out whether good nursing
practices are followed. Audit is a mean by which
nurses they can define standards from their point of
view and describe th actual practice of nursing
-Goster Walfer
 It is the examination of a patient record to determine
the degree to which nursing care was satisfactor
according to prescribed standards and to collect data
as a base for corrective action.
-Donovan
 It is the process of evaluating appropriateness and
effectiveness of nursing care measures.
-Cott, 1987

6. CLINICAL AUDIT
 The clinical audit has been defined the systematic and
critical treatment, the associated use of resources and
the effect Care has on the outcome and quality of life
for the patient.
-Department of Health, London, 1993
 Clinical audit is multi-professional, patient focused
audit, leading to cost effective, high quality care
delivery in the clinical teams.
-Batstone and Edwards

7. OBJECTIVES OF NURSING AUDIT
 To measure the degree of quality of patient care
against a defined criteria.
 To decrease the cost of nursing care.
 To provide a basis for determining nursing negligence.
 To take the remedial measures towards cost
effectiveness.
 To provide education to all the nursing personnel by
the of self education.

8.  To provide data base for planning resources by getting
the information on what resources are being used
redeployment for effective use.
 To enhance professional knowledge from past
experiences by learning from past mistakes in records.
 To avoid external auditing.

9. IMPORTANCE
 It serves as a valuable indicator to measure quality
care.
 It focuses on care provided and not on care provider.
 It helps in improving the quality of nursing.
 It facilitates to attain more efficient use of health care
resources.
 It facilitates to maintain the quality and accuracy of
nursing records.

10. ADVANTAGES
 It can be used as a method of measurement in all the
areas of nursing.
 It may be a useful tool as a part of quality assurance
programme in areas where records are kept.
 It is very simple process, results are easily understood.

11. DISADVANTAGES
 Since many of the components overlap that make the
analysis difficulty.
 It is time consuming.
 It requires a team of trained auditors.
 It deals with a large number of information.

12. FLOW CHART
Nursing auditors
Resources
Activities
Nursing standards
Quality
Credit items
Debit items
Bases

13. Bases of Nursing Audit
 The bases of nursing audit in the hospital setting are
debt items, credit items, nursing auditors, definition
of quality , development of nursing standards, defined
activities, and resources.
 Debit Items
These includes the items like, death of the
patient, complication of disease, hospital infections,
errors in treatment, patients left against medical
advice, unto ward reactions etc. These criteria or
variables are against the quality of care.

14.  Credit Items
These are the items or the variables that gives
credit to the care rendered Number of recovered
patients expansion of health knowledge in patient
population. Ex: Shorter stay in hospital.
 Nursing Auditors
Nursing auditors required are of two types:
internal and external. These should be trained
auditors.
 Quality
It is a degree of excellence that needs to be
defined and predetermined on the basis: the nursing
audit is to be done.

15.  Nursing Standards
These should be valid and explicit statements
about the quality of facts of nursing care.
These are classified as: structure, process and
outcome.
The structure relates to the characteristics of
health care institution and man, money, material,
methods required for the nursing organization
process. The performance of nursing care delivered by
the care providers, and outcome indicates the end
results in relation to objectives of nursing organization
and that of health care institution.

16.  Activities
These are the goal oriented transactions required
to carry out for auditing.
 Resources
There are in relation to human and material
required for auditing and desired health care.

17. Types of Nursing Audit
 Methodology : According to the type of methodology
adopted by the auditors, the audits can be of three
types: retrospective, concurrent or prospective.
Retrospective and concurrent
 Retrospective: This means looking back at what has
happened in the past. This type of audit takes place by
the use of records maintained by the nurses for the
care of patients and for doing other administrative or
managerial work.

18.  Concurrent (prospective): Audit takes place while the
patient is receiving care in the hospital. They may be
observed directly. Sometimes, the nurse may be
interviewed for the care rendered to the patient.
Observation check list or interview guide, rating
scales, Opinionnaire will be used.
 Retrospective and Concurrent: Both methods are
used for auditing the care received by patients.
Observation, interviewing, and questionnaires are the
techniques used for this purpose.

19. Auditors :Audits can be categorized as per the auditors
appointed for auditing. These are internal and external
audits.
 Internal audit: Review of work is done by peers or
nursing personnel continuously. The internal auditors
abstract and classify clinical records and evaluate the
quality of nursing care.
 External audit: The audit is carried out by the outside
agency Usually periodically tests, completeness and
accuracy of internal audit is done. Review is done by
non nursing administrators.

20. CLINICAL AUDIT CYCLE
 Usually clinical audit cycle has six stages that must be
undertaken to ensure an audit is systematic and
successful. The stages are:
 Identify a topic
 Set criteria or standard
 Collect data
 Compare results with criteria and standard
 Implementing change
 Re-audit.

21. NURSING AUDIT PROCESS
Nursing audit process is divided into the following
phases:
1. Describing phase
2. Preparing phase
3. Implementing phase
4. Analysis and concluding phase

22. Describing Phase
IDENTIFY TOPIC OR ISSUE OR PROBLEM
 This stage involves the selection of a topic or issue to
be audited. The topic should be important or
significant and interest those conducting the audit.
The topic can be selected from various sources. The
sources can be:
 Standards given by Indian Nursing Council
 Problem encountered in practice.
 Recommendation of patients and public.
 If there is a scope for improving service delivery.
 Area of high volume, high risk or high cost, in which
improvement can be made.

23. IDENTIFY CORE GROUP AND FORM AN AUDIT
TEAM OR COMMITTEE
Audit committee comprising of minimum of
 Five members either from
 Uni disciplinary or multidisciplinary,
 Who are interested in quality assurance, are
 Clinically competent
 Able to work together in a group.
 Preferably the audit committee should have
 Chairman,
 Clinical consultants,
 Representative of hospital administrator,

24.  Statistical record officer,
 Representatives of nursing personnel of all levels,
 Special invitee members.
 Make sure who all involved in auditing.
 Agree with the topic selected and also make sure that
no other team is conducted the audit on the same
topic.

25. SET AUDIT CRITERIA AND STANDARDS
 An audit criterion is a measurable outcome of care
aspect of practice in a statement form that can be used
to assess the quality.
 A standard is the threshold of the expected
compliance for each criterion.
 These are usually expressed in percentage and
represent the minimum level of acceptable
performance for that criterion.
 Based on evidences and research studies, if not
available should be developed on a consensus
agreement by members of team. The developed
criteria should have objectivity, verifiability,
uniformity, specificity and acceptability.

26. DEVELOP AN AUDIT PROTOCOL
An audit protocol should include:
 Audit objectives
 The target group
 Selection of audit sample
 The method of data collection: Questioning,
observation, data collection sheets. The electronic data
is preferred as it is likely to be quicker and more
accurate.

27.  Tools to be prepared: Various tools should be ready
based for failure on the information need to be
gathered related to staff, report standards of care,
patient satisfaction and effect on organization through
patient satisfaction survey, staff satisfaction survey,
nursing records audit , throughput and bed occupancy,
length of stay of patients, supply and demand study,
staff development, sickness and absenteeism, analyze
medical audit of post operative complications.
Electronic change audit tools if used should be
checked thoroughly otherwise should there is a
possibility of emerging any sort of problem.

28. PREPARING AND IMPLEMENTING
PHASE
DEFINE CRITERIA AND PREPARE AUDIT TOOLS
Prepare a rough draft of audit tools after refining criteria.
Check the validity and reliability of tools.
MAKE A PLAN FOR GATHERING INFORMATION
The plan should include
 Who is going to gather the information?
 Select the auditors. The auditors or the facilitators should be
trained. They are to be given the orientation from where the data
is collected and also how to record and collect information
before they actually audit the work assigned to them. Know the
subject matter and handle the problem. if arises during
gathering information.
 When to gather the information? Time period should be
specified.
 How large the target group at one time?

29. GET ETHICAL APPROVAL FROM ETHICAL
COMMITTEE
In order to avoid any doubt regarding any ethical
issues, get cleared from ethical committee of the
institute especially for clinical audit. Get permission
from the subjects as per the criteria laid down.
GATHER DATA
 After getting ready with every formality ,
collect the audit data as per developed plan and
protocol. Use tools and audit forms carefully.

30. ANALYSIS AND CONCLUDING
PHASE
Analyze Data and Compare Results with Criteria
and Standards.
 After collection, analyze the data.
 Apply appropriate statistics, usually data is calculated
in percentage in order to determine the level standard.
Compare the data with set or predetermined criteria
and standard.

31. Make an Audit Summary
Specify how far the standards have been met and
the reasons for failure to meet the standards in some
cases. Make a brief report and give recommendation
after discussion with audit team.
Plan and Implementing Change
This stage is one of the most crucial and the most
difficult. After analyzing and discussion, audit
committee need to decide what changes are required
to be implemented. A detailed action plan should be
made specifying in detail who, when, what and how
the changes are to be implemented. All the members
of the committee are required to be informed and
members are to be assigned to monitor the changes
implemented.

32. Re-audit
This is the final stage of audit process. Re-audit is
undertaken to ensure that the changes have been
made in response to first audit and that the practice
has improved or how effective the first audit.

33. TIPS TO PRACTICE NURSING AUDIT
Nursing audit can be practiced by the nurse
administrators in the hospital setting. Following are
fifteen golden rules to implement audit process:
 Appoint an audit committee with approval from
appropriate authority.
 Select committee members keeping in mind
unidisciplinary or multidisciplinary type of committee.
 Conduct regular meetings with members.
 Make a priority list of problems and issues.

34.  Develop standardized tools and should be available
with the with the committee members.
 Orient the auditors for data collection and data
analysis.
 Be honest while gathering information.
 Be sensitive to the attitude and feelings of subjects.
 Make realistic recommendation for improvement or
change, if required.
 Ready with the action plan.
 Implement the change and monitor the progress.
 Make the audit a continuous process by implementing
and re-auditing.
 Keep a record of all the information and remedial
action.