NURSING AUDIT

jayadeepa J

NURSING AUDIT 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 termsQuality

A judgment of what constitute good or bad

AuditA systematic and critical examination to examine or verify

Nursing audit1) It is the assessment of the quality of nursing care2) Uses a record as an aid in evaluating the quality of patient care

Nursing standardsDefines a standard as the desirable and achievable level of performance against which actual practice is compared. The standards must meet the needs of the patient

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 auditAudit 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 audit1) Internal auditing

Internal auditing is a control technique performed by an external auditor who is an employee of the organization. Makes an independent appraisal the policies, plans and points the deficits in the policies or plans and give suggestion for eliminating deficits

2) External auditingIt is an independent appraisal of the organizations financial account and statements. The external auditor is a qualified person who has to certify the annual profit and loss account and prepare a balance street after careful examination of the relevant books of accounts and documents

Evaluation of nursing audit

• There are 3 types of evaluation of nursing audit:

1) Retrospective evaluation2) Concurrent evaluation3)Peer review

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

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.

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 audit1) Evaluating nursing care given2) Achieves deserved and feasible quality of

nursing care3) Stimulant to better records4) Focuses on care provided and on care

provider5) Contributes to research

Methods of nursing audit 1) define patient population

2) identify a time framework for measuring outcomes of care3) identify commonly recurring nursing problems presented by the defined patient population4) state patient outcome criteria5) state acceptable degree of goal achievement6) specify the source of information

7) design and type of toola) quality assurance must be priorityb) those responsible must implement a programmer not only a toolc) a coordinator should develop and evaluate quality assurance activityd) roles and responsibilities must be deliverede) nurses must be informed about the process and the result of the programmedf) data must be reliableg) adequate orientation of a data collection is essentialh) quality data should be analyzed and used by nursing personnel at all levels

Audit cycle

Set standards

Implementation change observe

practice

Compare with standard

Advantage of nursing audit1) Can be used as a method of measured in all areas of

nursing2) Seven function are easily understood3) Scoring system is fairly simple4) Results easily understood5) Assess the work of all those involved in recording

care6) May be useful tool as part of a quality assurance

program in areas where accurate records of care are kept

Disadvantage of nursing audit1) Appraises the outcomes of the nursing

process , so it is not so useful in areas where the nursing process has not been implemented

2) Many of the components overlap making analysis difficult

3) Is time consuming4) Requires a team of trained auditors5) Deals with a large amount of information6) Only evaluates record keeping. It only serves

to improve documentation not nursing care

Audit committee

Before carrying out an audit committee should be informed comprising 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

ConclusionA professional concerns for the quality of its

service constitute the heart of its responsibility 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.

Thank you

By , Jayadeepa J