Nursing audit in management of nursing service

1. NURSING AUDIT

2. DEFINITION
• Nursing audit is a detailed review and evaluation of
selected clinical records by qualified professional
personnel for evaluating quality of nursing care
• Nursing audit refers to assessment of the quality of
clinical nursing
-Elison

3. PURPOSES
• Evaluating nursing care given
• Achieves deserved and feasible quality of nursing care
• Stimulant to better records
• Focuses on care provided and not on care provider
• Contributes to research

4. METHODS OF NURSING AUDIT
1. Retrospective View
• Refers to an induct assessment of the quality after
the patient has been discharged with patient’s
chart as the source of data

5. 2. Concurrent review
• Refers to evaluations conducted on behalf of patients who are
still undergoing care
• It includes assessing the patients at the bedside in relation to
predetermined criteria,interviewing the staff responsible for the
care and interviewing the patients record and care plan

6. AUDIT CYCLE
Step 1
• Define the standards
Standard comprise two elements that defined the contest for care
and how care is delivered
• Structure: environmental elements required to deliver care.

7. E.g. policy, procedures, clinic setting, equipment, record keeping
system etc.
• Process : professional elements required to deliver care.
• Outcome : measurable elements demonstrating results of care. E.g.
Leg ulcer healing time,breast feeding duration, immunization levels,
smoking cessation, dying at home, asthma diabetic stability, pressure
ulcer prevalence etc. The elements contain criteria, which should be
Reliable, Understandable, Measurable, Behaviourable and Acceptable.

8. Step 2:
• Measure current practice within the selected topic
A baseline enquiry is carried out to identify problems requiring a solution to
improve the quality of patient care.
Step 3:
• Identify gaps in service provision
Step 4:
Decide and Implement action. This is the hardest area to address and involves
the input from the whole team. An action plan needs to be developed.

9. Step 5
Review standards.
• If the standard is easily met, does it need to be raised?
• Is the standard too high?
• What are the future needs?

10. AUDIT CYCLE

11. ADVANTAGES OF NURSING AUDIT
 Can be used as a method of measurement in all areas of nursing
Scoring system is fairly simple.
Results easily understood.
 Assesses the work of all those involved in recording care
May be a useful tool as a part of a quality assurance Programin
areas where accurate records of care are kept.

12.  It gives a biographical index of quality of nursing each patient has
achieved.
 Patient is assured of good services.
It will give valuable and pertinent information for the staff,
improvement in quality of nursing as well as strengths and
weaknesses in nursing service are revealed.

13. It will lead to better cooperation and communication among the
nurses and health team members as a result of improved quality of
nursing notes.
It will help each professional nurse for her self evaluation.
It helps the administration-better planning can be done through
nursing audit.

14. • It enables the nurse administrator to uncover the inefficient service
and point the ways to elevation of standards.
• It will reduce the incidence of medico-legal complications arising
out of incomplete or inaccurate records maintained by nurses.
• It will broaden and strengthen nursing service in the hospital.

15. 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.
Is time consuming
Requires a team of trained auditors.

16. Deals with a large amount of information.
Only evaluates record keeping.
It is considered as source of punishment by the
professional group.
It is only served to improve the documentation not the
nursing care.

17. UTILIZATION OF RESULTS OF NURSING
AUDIT FOR NURSING CARE SERVICES
1.For nursing care services
• Modifying nursing care plans and the nursing care process,
including discharge planning, for selected patient population.
• Implementing a program for improving documentation of
nursing care through improved charting policies, methodologies
and forms.

18. • Focusing supervisory attention upon areas of weakness identified,
such as one particular nursing unit or specific employee.
• Focusing of nursing rounds and team conferences.
• Designing responsible orientation and in-service education
programs.
• Gaining administrative support for making changes in resources
including personnel.
• Using the evaluation based on nursing audit criteria to focus staff
attention on individual patient outcome.

19. FOR SUPERVISOR AND HEAD NURSE
• Identify the areas of needed patient care improvement.
Provide basis for planning in-service education
program
• Identify teaching/supervision needs of staff members
who give direct care to patients.

20. FOR NURSING ADMINISTRATORS
• Provide evaluations of particular program such as orientation of
personnel or establishment of patient teaching program.
• Support requests for accreditation or for financing of a particular
program.
• Serve as a basis for planning new programs or program changes

21. • Serve to identify areas of strength and weakness in the
total nursing programs, in specific areas of the program,
and in various settings in which a program exists.
• Determine the influence of varied staffing patterns.
• It may be used as data in cost-effectiveness status. For
example, studies comparing the quality of care received
by patients in varied situations in which costs of staffing
vary.

22. FOR STAFF NURSE
• Provide self-examination of care in their specific nursing unit or settings.
• Identify particular types of care in which practice may be improved
merely by increased attention and consciousness
• Identify types of care in which improvement will depend on the staff's
acquiring additional knowledge and skill

23. AUDIT AS A TOOL FOR QUALITY
CONTROL
• An audit is a systematic and official examination of a record,
process or account to evaluate performance.
• Auditing in health care organization provide managers with a
means of applying
control process to determine the quality of service rendered.
• The audits most frequently used in quality control include outcome,
process and structure audits.

24. 1. Outcome audit:
• Outcomes are the end results of care; the changes in the patients health
status and can be attributed to delivery of health care services.
• These audits assume the outcome accurately and demonstrate the
quality of care that was provided.
• Example of outcomes traditionally used to measure quality of hospital
care include mortality, its morbidity, and length of hospital stay.

25. 2. 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 focus on whether or not
practice standards are being fulfilled.
• These audits assumed that a relationship exists between the
quality of the nurse and quality of care provided.

26. 3. Structure audit:
• Structure audit monitors 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.