NURSING AUDIT

Introduction

The world trend of professional accountability to an enlightened public can no longer be ignored

by nursing. We nurses easily use the worlds “quality nursing” but have we defined what we

mean by quality? Do you know our deficiencies? Are we ready to admit our deficiency to our

peers? Are we taking steps to remedy them? Only by such self regulation we can relate our

identity with the 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 terms

Quality

A judgment of what constitute good or bad

Audit

A systematic and critical examination to examine or verify

Nursing 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

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 nursing

3) 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 care

Medical 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 audit

1) Internal auditing

Internal auditing is a control technique performed by an external auditor who is an employee of

the organization. He makes an independent appraisal the policies, plans and points the deficits in

the policies or plans and give suggestion for eliminating deficits

2) external auditing

it is an independent appraisal of the organizations financial account and statements. The external

auditor is a qualifed person who has to certify the annual pprofit and loss account and prepare a

balance street after carefull examination of the relevant books of accounts and documents

evalution of nursing audit

There are 3 types of evaluation of nursing audit:

1) retrospective evaluation

2) concurrent evaluation

3) peer review

I. 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

acridities body initially required hospitals to conduct certain number of per year.

II. 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.

III. 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 audit

1) evaluating nursing care given

2) achieves deserved and feasible quality of nursing care

3) stimulant to better records

4) Focuses on care provided and on care provider

5) Contributes to research

Methods of nursing audit

1) define patient population

2) identify a time framework for measuring outcomes of care

3) identify commonly recurring nursing problems presented by the defined patient population

4) state patient outcome criteria

5) state acceptable degree of goal achievement

6) 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 cycle

Set standards

Implementation change observe practice

Compare with standard

Nursing standards

Defines a strandard as the desirable and achievable level of performance against which actual

practice is compared. The standards must meet the needs of the patient

Advantage of nursing audit

1) Can be used as a method of measured in all areas of nursing

2) Seven function are easily understood

3) Scoring system is fairly simple

4) Results easily understood

5) Assess the work of all those involved in recording care

6) May be usefull tool as part of a quality assurance programme in areas where accurate records

of care are kept

Disadvantage of nursing audit

1) Appraises the outcomes of the nursing process , so it is not so usefull in areas where the

nursing process has not been implemented

2) Many of the components overlap making analysis difficult

3) Is time consuming

4) Requires a team of trained auditors

5) Deals with a large amount of information

6) Only evaluates record keeping. It only serves to improve documentation not nursing care

Audit committee

Before carring out an audit committee should be informed comparising 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

Training for auditors should evaluate the following

a) A detailed discussion of the seven components

b) A group discussion to see how the group rates the care recived using the notes of a patient

who has been discharge these should be anonymous and should reflect a total period of care not

exceeding two weeks in length

c) Each individual auditor should then under take same exercise as above this is followed by a

meeting of the whole committee who compare and discuss its finding and finally reach a

components

Steps to problem solving process in planning care

a) Collects a patient data in a systematic manner

1) Inculdes description of patients pre hospital routines

2) Has informed about the severity of illness

3) Has information regarding lab tests

4) Ha information regarding vital signs

5) Has information regarding physical assessment

b) States nurses diagnosis

c) Write nursing orders

d) Suggests immediate and long term goal

e) Implement the nursing care plan

f) Plans health teaching for patients

g) Evaluates the plan of care

Retrospective audit is a method for evaluating the quality of nursing care as it is reflected in the

patient care records for discaharge patients. In this type of audit specific behaviors are described

then they looks for answers in the record

For ex the examiner looks throught the patient’s records and asks ;

a) Was the problem solving process used in planning nursing care

b) Whether patient data collected in a systematic manner

c) Was a description of patients pre- hospital routine included

d) Laboratory test results used in planning care

e) Did the nurses perform physical assessment? How was information used?

f) Were nursing diagnosis stated?

g) Did nurse write nursing orders? And so on

Summary

Nursing audit is an evaluation of nursing service. Purpose of nursing audit is evaluating nursing

care plan methods of nursing audit are retrospective, concurrent and peer review methods

ofnursing audit methods to develop criteria, audit cycle nursing standards advantages of nursing

audit

Disadvantage of nursing audit is audit committee steps to problem solving process in planning

care are collects a patient data in a systematic manner states nursing diagnosis plans health

teaching for patients evaluates the plan of care

Conclusion

A professional concrns for the quality of its service constitute the heart of its responsibity 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

Bibliography

1) B.T.Basavantappa. “NURSING ADMINISTRATION” 1st edition, Jaypee brothers

publication, 2003. page. no 161-164, 435-438

2) Carol Taylor “FUNDAMENTAL OF NURSING THE ART AND SCIENCE OF NURSING

CARE” 5th edition Lippincott Williams, Wilkms publication 2005, page no 331

3) Kozier Barbar. “ FUNDAMENTAL OF NURSING CONCEPTS, PROCESS AND

PRACTISE” 7th edition Darling Kindersley publication 2006. page no 361

4) Potter and Perry “ FUNDAMENTAL OF NURSING” 6th edition, Mosby publication,2005,

page no. 481

5) Sr Nancy “ PRINCIPLES AND PRACTICE OF NURSING” 2nd volume, 4th edition,

N.R.Brother’s publication, 2005, page no 570