2. HISTORY OF NURSING AUDIT
• Before 1955 very little was known about the
concept of “Nursing Audit”.
• George Groward a physician was the first one
to pronounce the term medical audit in 1918.
• Ten years later Thomas. R. Pondon HD
established a method of Medical Audit based
on procedures used by financial account.
• The 18th report of Nursing Audit of the
hospital published in 1995.
3. MEANING
• The word “audit” comes from the Latin
word “Auditus” means a “hearing”. It
originally meant hearing of facts and
argument about a situation to determine
truth.
• Nursing audit is a useful tool for
measuring the quality of nursing received
by patients.
4. • Like financial audit nursing audit also have
debit and credit concept.
• The debit in terms are --- death of patients
(gross or net), complications, infection, error
in procedures, absconded patients and
patients left against medical advice etc.
• The credit in terms are---- recovered patients,
cured patients, health educational activities,
preventive services performed etc.
5. DEFINITIONS
• Nursing audit is an objective technique
by which the level of nursing care and
services delivered to patients by nursing
personnel is determined by systematic
critical analysis of nursing records.
• According to Elison “Nursing Audit refers
to a assessment of the quality of clinical
nursing”.
6. • According to Goster Walfer
–Nursing Audit is an exercise to find out
whether good nursing practices are
followed.
–The audit is a means by which nurses
themselves can define standards from
their point of view and describe the
actual practice of nursing.
7. PURPOSES OF NURSING AUDIT
• To orient nurses with the quality control
programme for nursing.
• To evaluate the degree of quality patient care
against defined criteria.
• To justify cost-incurred on human and material
resources.
• To take remedial action towards cost
effectiveness.
• To justify the proposal for additional staffing or
resources to the management.
• To stimulate better records.
8. • To facilitate research activities.
• To facilitate the co-operative planning and
delivery of client care by physicians and
nursing employees.
• To Enrich and provide direction to in service
education effects.
• To provide a specific management technique
in carrying out evaluation and control
function.
• To identify ways to improve patient care.
9. CHARACTERISTICS
• It improve the quality of nursing care
• It compares actual practice with agreed standards
of practice.
• It is formal and systemic.
• It involves peer review.
• It requires the identification of variations between
practice and standards of followed by the analysis
of causes of such variations.
• It provides feedback for those whose records are
audited.
• It includes follow up or repeating an audit
sometimes later to find out if the practice is
fulfilling the agreed standards.
10. METHODS OF NURSING AUDIT
• There are two methods:
• Retrospective view –
• The concurrent review—
11. OTHER TYPES OF NURSING AUDITS
• Structure Audit:
• Structure audit monitor 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 these above audits can
occur retrospectively, concurrently and
prospectively.
12. 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 focuses on whether or not practice
standards are being fulfilled. These
audits assume that a relationship exist
between the quality of the nurse and
quality of care provided.
13. Outcome Audit:
• Outcomes are the end result of care: the
changes in the patient’s health status and can
be attributed to the delivery of health care
services. Outcome audits determine what
results if any occurred as result of specific
nursing intervention for clients. These audits
assume the outcome accurately and
demonstrate the quality of care that was
provided.
15. PROCEDURE FOR NURSING AUDIT
Formulate
committee
Meeting of
committee
Assigning
format
Filling and
compiling
Submission
of report
16. procedure of audit is continuous cyclic process
Set
standards
Observe
practice
changes
Compare
with
standard
Implement
changes
AUDIT
CYCLE
17. METHOD TO DEVELOP CRITERIA FOR AUDITING
1. Define patient population,
2. Identify a time framework for measuring
outcomes of care,
3. Identify commonly recurring nursing problems
presented by defined patient population.
4. State patient outcome criteria.
5. State acceptable degree of goal achievement
6. Specify the source of information.
18. 7.Design and type of tool.
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
assurance activities.
D. Roles and responsibilities must be delivered.
E. Nurses must be informed about the process and the
result of the programme .
F. Data must be reliable.
G. Adequate orientation of data collection is essential.
H. Quality data should be analyzed and used by nursing
personnel at all levels.
19. ADVANTAGES OF NURSING AUDIT
• Can be used as a method of measurement in all
areas of nursing.
• Scoring system is fairly simple.
• Result 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.
• Patient is assured of good service.
20. Cont…………….
• It develops openness to change
• It provide assurance, by meeting
evidence based practice.
• It increases understanding of client’s
expectations.
• It minimizes error or harm to patients.
• It reduce complain or claim.
21. DISADVANTAGES OF THE NURSING AUDIT
–Appraises the outcomes of the nursing
process, so it is not so useful in areas
where the nursing process has not been
implemented.
–Many of the components overlap
making analysis difficult.
–It is time consuming.
22. Cont………….
–Requires a team of trained auditors.
–Deals with large amount of information.
–Only evaluates record keeping. It only
serves to improve documentation, not
nursing care.
–It may be considered as a punishment to
professional group.
23. CONCLUSION
• Nursing audit programme is useful to evaluate
the nursing care rendered. It enables the
nursed administrator to uncover inefficient
care and save the nursing staff from the
problem of medico-legal implication due to
incomplete records. The programme audit
acts as a control device to improve standard of
performance by nursing personnel.
