WELCOME….
INTRODUCTION
The concept of audit rooted as early as
during the Crimean war of 1853 to 1855
under taken by Florence Nightingale
First report of nursing audit of the hospital
was published in 1955.
Audit
An audit is a process by which someone looks at the
result of an activity and makes a judgment about
whether done to the level expected as out by preset
rules ,guidelines or standards
Clinical audit
The clinical audit is multi professional, patient
focused check, leading to cost effective, high quality
care delivery in clinical teams
Badstone and Edwards
The clinical audit is the systematic and critical
analysis of the procedure used for diagnosis , care
and treatment associated use of resources and the
effect care has on the outcome and quality of life for
the patient
Department of health, London 1993
Nursing audit
The nursing audit is the examination of a patient
record to determine the degree to which nursing
case was satisfactory according to prescribe
standards and to collect data as a base for
corrective action
Donovan
Objectives of Audit
To evaluate and try to improve the expected quality of
nursing
To measure the level of quality of patient care again
standard
To minimize the cost of rendering nursing care
To have a basis for detecting nursing negligence
To take remedial measure towards the cost effective
To prevent shortcoming from reoccurring
To improve knowledge and skill by learning from
mistakes
Importance of nursing audit
It serves as a valuable indicator to measure quality care
It focuses on case provided and not on the case
provider
It helps in improving the quality of nursing
It facilitate to attain more efficient use of healthcare
resources
It assist in maintaining the quality and accuracy of
nursing records
Advantages of nursing audit
It's utilization as a method of measurement is in
all areas of nursing
It may be a useful tool as a part of the quality
assurance program in documentation
It is a process to understand its outcomes
Disadvantages of nursing
audit
Since many of the components overlap that makes
analysis difficulty
It is time consuming
It requires a team of trained auditors
It deals with information
Bases of nursing audit
Debit items
Credit items
Nursing auditors
Quality
Nursing standards
Defined activities
Resources
Debit items
These are items that gives discredit to institute
These variables are against the quality of care and hence
referred as debit items
Example:
Several deaths , complications of disease ,Hospital
infections ,Errors in treatment ,patient left against medical
advice
Credit items
It gives credit to the care rendered
Example,
Several recovered discharge patient ,expansion in patient
knowledge a shorter day of patients.
Quality
It is a degree of excellence that needs to define and pre
determine based on the nursing audit.
Nursing auditors
These are the personnel trained as auditors.
They are both internal and external
Internal auditor work within an organization and
responsible for internal auditing
External auditors are external parties
Nursing standards
Thenursing standards are valid and explicit statements
about the quality of facts of nursing care
structure process outcome
standard standard standard
Structure standard:
It is characteristic of Healthcare institution,
men, money, material, methods required for the
nursing organization
Process standard:
It is performance of nursing care delivered by
the care providers.
Outcome standard:
It indicate result about objectives of the nursing
organization and that of the Healthcare
Institution
Defined activities
These are the goal oriented transaction required to
carry out for auditing.
Resources:
Resource include human and material required for
auditing and desired Healthcare
Types of nursing audit
Retrospective audit
It is a type of inspection conducted after an event take
place.
It means looking back at what has happened in the past.
It carries out after the discharge of patients, usually
through observations and analyzing patient record, nursing
care plans, questionnaires, interviews and surveys of the
patients administrative and other documents.
Retrospective audit
Advantages
It relies on records and it is easy to gather information and
analyze data.
It need less time as compared to concurrent audit
It is less costly than a parallel review and at one time total
data can be gathered.
Retrospective audit
Disadvantages
It may not get accurate and up to data information if
documentation not done properly.
The records may not be error free
This type of audit will not reveal actual case received by the
client
Chance of having manipulative data.
Concurrent audit
Concurrent means where happening at the same
time
It is a method of evaluating on going nursing care
rendered by nurses to the individual patient.
The information gathered simultaneously with the
nursing care given to the patient by the car e giver
or through observing patients directly during on
going nursing care or interviewing for the care
Concurrent audit
Advantages
1) it is easy to pinpoint deficiencies in the caring
patient in the actual situation.
2) it provides a mechanism to identify meeting client
needs and communicating with the client.
Concurrent audit
Disadvantage
It is costly and needs prior preparation as
compared to retrospective audit
It is time consuming and required well trained
auditors there are changes of introducing the
hollow effect
Mixed method audit
These are both retrospective and
concurrent both method used for auditing
patient care observation interviewing
questionnaire and record analysis are the
techniques used for the purpose.
According to agency:
Internal audit
The peers of nursing personal contact internal
audit continuously .
They are the employees of an organization and
appointed by the authority in the audit committee
The internal auditors abstract and classify clinical
records and evaluate the quality of nursing care
Internal auditing is desirable
These are norms and standards for auditing.
External Audit
The outside agency contact the external audit .
Usually periodically test completeness and
accurate of internal audit are done by external
auditor annually sometime non professional
administrator conduct an audit.
AUDIT PROCESS
Sustaining Planning
improvement phase phase
Improvement
phase preparation phase
Analysis
and Implementing
finding phase
gap phase
PLANNING PHASE
Identify subjects
Constitute audit
committee
Set criteria for
standards
Develop an audit
protocol
Develop an audit protocol
Audit objectives
The target group
Selection of audit sample
Method of data collection
Development of tools
Data collection procedure
Plan for analysis
Preparation phase
Define criteria
and prepare
audit tools
Seek ethical
approval Develop an
action plan
Preparation phase
Define criteria and prepare audit tools
Select criteria
Define criteria
Prepare a rough draft of audit tools
Check content validity of tools
Check reliability of devices
Check reliability of electronic audit tools.
Develop an action plan
Who is going to gather information.
The period of gathering information.
The size of the target group at one time.
Seek ethical approval:
Seek clearance from the ethical committee of the
institution for nursing audit.
Get permission from the subjects per criteria laid
down.
Implementation phase:
Gather data
Collect the audit data per the developed action
plan and protocol.
Use tools and audit forms carefully.
Be transparent and honest in gathering
information.
Analysis and finding gap
phase:
Analyze data
Compare data
Identify gaps and make an audit summary.
IMPROVEMENT PHASE
Development of a revised action plan.
Implementation of the revised action plan.
Re auditing
SUSTAINING IMPROVEMENT
PHASE
This phase describes the ways of continuing
improvement in nursing practice.
It needs the development of guidelines, standards,
policies and monitoring.
Role of nurse manager in
nursing audit
Appoint an audit committee with approval from an
appropriate authority.
Constitute audit committee, select members.
Conduct regular meetings with members
Have a grand round with audit committee
members.
Make a priority list of problems and issues.
Role of nurse manager in nursing audit
Follow all steps of the audit process.
Plan and conduct an orientation program for auditors.
Make sure that auditors are honest in data gathering and
sensitive to attitude and fellings of subjects.
Make realistic recommendations for improvement if
required.
Be ready with action plan
Implement change if required and monitor the progress.
Make audit a continuous process by implementing and re
auditing.
Use the guiding approach rather than fault finding.
Keep a record of all information and remedial action taken.
SUMMARY
Conclusion:
An audit has become a mechanism for assessing
and improving the quality of work and identifying
ways of improving the efficiency of care.
assignment
Preparea plan for Nursing Audit in Emergency
department.
JOURNAL REFERENCE
“Nursing audit as a method for developing nursing care and ensuring patient
Safet”.
Minna Mykkänen, MHSc, RN1, Kaija Saranto, PhD, RN2,, Merja Miettinen, PhD, RN1 Kuopio university
hospital, Kuopio, Finland; 2University of Eastern Finland, Kuopio, Finland
Abstract
Nursing documentation is crucial to high quality, good and safe nursing care. According to earlier studies nursing
documentation varies and the nursing classifications used in electronic patient records (EPR) is not yet stable
internationally nor nationally. Legislation on patient records varies between countries, but they should contain
accurate, high quality information for assessing, planning and delivering care. A unified national model for
documenting patient care would improve information flow, management between multidisciplinary care teams
and
patient safety. Nursing documentation quality, accuracy and development needs can be monitored through an
auditing instrument developed for the national documentation model. The results of the auditing process in one
university hospital suggest that the national nursing documentation model fulfills nurses’ expectations of
electronic
tools, facilitating their important documentation duty. This paper discusses the importance of auditing nursing
documentation and especially of giving feedback after the implementation of a new means of documentation, to
monitor the progress of documentation and further improve nursing documentation.
THEORY APPLICATION
