Nursing Audit
Concepts of Nursing Audits
• According to OH (1987) ; Nursing audits
is a process of analyzing data about the
nursing process or patient outcome to
evaluate the effeteness of nursing
intervention.
• Nursing Audit refers to assessment of the
quality of clinical nursing. (Elison)
• Nursing Audits 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
standard and criteria.(RANF 1985)
Nursing Standard and Nursing Audits
• Nursing standard is a descriptive
statement of desired level of performance
against which the quality of structure,
process or outcomes can be judged.
• Standards are norms or criteria against
which performance is to be judged.
• Standards are statements that describe a
desired level of performance.
Nursing care standard:
• A nursing care standard is a descriptive
statement of desired quality against which to
evaluate nursing care. Standards are
professionally agreed levels of performance,
which are relevant, attainable, observable
and measurable.
ii) It is a descriptive statement of desired
quality against which to evaluate
nursing care given to a patient.
• Standards of care are preplanned,
preprinted directions for care, developed by
nurses groups of clients rather than
individuals.
• The standards identify the nursing
diagnosis and collaborative problems that
occur in a defined situation.
Nursing standing order:
• Standing order is a written document
containing rules, policies, procedures,
regulations and orders the conduct of
patient's care in various clinical situation.
(Rules and regulations, which remain in
force until discontinued by the proper
authority.
Purposes of Standards:
• To monitor and improve the quality of
nursing care. (Quality assurance)
• To decrease the cost of nursing care by
eliminating nonessential nursing activities.
• To be used as a framework or basis for
determining nursing negligence.
• To motivate nurses to achieve excellence
(Especially not to loosen in their practice of
giving nursing care.) by insisting or
enforcing them to carry out standard
Nursing practice on an ongoing basis.
• To increase objectivity in evaluation of
the performance by reducing subjectivity
and biases.
• To communicate clearly what level of
services or the performance is expected
• To achieve optimal patient outcomes and
satisfaction by providing quality nursing
care as expected by the pts
• To establish the nursing as a profession
or increase professionalism.
• To give direction and provide guidelines
for performance of nursing staff
• It may help to determine the degree to
which standard of nursing care maintained
and take corrective action in time if
necessary.
Classification of Nursing Standard:
1. Structure Standards: Structural are
group or thing oriented. They are the
policies that define conditions and
mechanisms that facilitate desired staff
functioning, systems operation and
patient care delivery.
• Structural standards are used in the
structure evaluation of a health care facility.
This type of evaluation focuses on assessing
the systems by which nursing care is
delivered.
• Structure evaluation examines the
physical facilities, resources, equipment,
staffing patterns, procedure manuals,
organizational patterns, safety measures, job
descriptions, orientation programs etc.
2) Process Standards:
• Process standards are action oriented.
They describe the specific methods used for
nursing care delivery and specify expected
nursing activities and behaviors.
• Process standards come in a large
variety. eg. Protocol and performance
standards. These standards determine
whether nursing care was adequate,
appropriate, effective and efficient. Process
standards are used to determine the nurse's
ability to establish an environment that
promotes the client's health.
• 3) Outcome standards:
• These are standards relating to outcomes.
They are oriented. Outcome evaluation is
the process of comparing the client's current
status with the expected outcomes.
• This type of evaluation examines all
direct care activities that affect the client's
health status. Outcome evaluation focuses
on changes in the client's health status
Maintain an Auditing System (Nursing)
• Nursing audit is the process of evaluating
appropriateness and effectiveness of nursing
services.
• It is an administrative tool for evaluating
the quality of nursing care .
• Objectives
— To improve the quality of nursing care
— To motivate employee/performance
— To decrease the cost of nursing care
— Determine the basis for evaluating
nursing
• Methods
— Formal methods (planned)
— Informal method (unplanned)
• Use of tools
— Performs
— Checklist
— Rating scale
Types of Nursing Audit
Concurrent audit:
Ongoing care through the appraisal of the
nursing process.
Retrospective audit: Evaluation quality
of care through appraisal of process after
the patient discharge from health care
system.
• Internal audit:
Audit within the department — appointed
staff, check stock, verifies records etc.
• External Audit:
Legally appointed auditors to verify and
certifies the written documents of nursing
care provided by nursing personnel.
Purpose of Nursing Audit
• It provides a means of judging the
quality of nursing care that is actually
delivered to the patient.
• It is a systematic evaluation tool, which
keeps determining individuals’ patient
needs, resources, required to meet them.
• To determine from patient individuals
record the adequacy of nursing care under
the legality of form of the chart
• Evaluating nursing care
• Achieves deserved and feasible quality
of nursing care.
• Stimulate to better records
• Focuses on care provided
• Contributes to research
Advantage of Nursing Audit
It provides for analysis of actual
findings.
It can be use as a method of
measurement in all areas of nursing.
Assess the work of all those involved in
recording area.
Identification of deficiencies at the time
of care given
Improve knowledge and proficiency of
care.
• It also helps to revise job description or
job specification.
• Enable to assess performance. In terms
of time, cost, quantity and quality.
• Aids in locating errors, omission
negligence of care.
Disadvantage
Time consuming
Too costly
Clients problems cannot be identify
during hospitalization
Requires a team of trained auditors.
Deal with large amount of information at
a time
Who Will Perform Nursing Audit
• Nursing Staff
• Doctors
• Cleric from the Medical record section
• Have ability to work in-group.
• Have clinical competency in her subject
matter.
• Members should be at least five in the
audit committee.
Steps of nursing audit
• Select: Objectives/Topics/Areas
• Set criteria/guidelines
• Prepare tool/protocol
• Decide target group
• Method of data collection — decide
• Time required — decide
• Implement
• Prepare report
• Submit /action
Areas of Nursing Audit
• Quality patient care
• Work performance
• Assignment methods
• Physical facilities
• Safety & security
• Recording reporting
• — Equipment & supplies
— Inter & intra department relation
— Communication system
— Public relation
