Nursing Audit

Quality
a judgment of what constitutes good or bad

Audit
a systematic and critical examination to

examine or verify

Nursing audit
(a) it is the assessment of the quality of

nursing care
(b) uses a record as an aid in evaluating
the quality of patient care

Medical audit
the systematic, critical analysis of the

quality of medical care, including the

procedures for diagnosis and treatment,
the use of resources, and the resulting
outcome and quality of life for the patient

Elison

Nursing audit refers to assessment of the quality

of clinical nursing.

Goster Walfer
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.

Purposes of Nursing Audit

1. Necessitating adequate documentation
of nursing care provided to the client
through the entire nursing process.
2. Directing attention to the design and
utility of the charting record.
3. Encouraging the use of the problem
oriented nursing system.

4. Supporting and becoming an integral part

of nursing by objective program
5. Facilitating the co-operative planning and
delivery of client care by physicians and
nursing employees
6. Increasing the priority for a results
oriented performance evaluation program
for nursing service employees.
7. Enriching and providing direction to in
service education effects.

8. Providing a specific management

technique in carrying out evaluation
and control function.
9. Identifying ways to improve patient
care.
10. Providing a meaningful ways for
nursing staff members to participate
and achieve career growth.

TYPES OF AUDITORS:
Auditing whether general as nursing can be
conducted by two types of auditors.
1. Internal auditors
2. External auditors

Internal Auditors:
In nursing auditing, internal auditors are the
nursing experts as specialists in the hospital
appointed by the hospital management
eg : Nurse Manager, Director

External Auditors:
The experts from the external statutory
agencies to the auditing process
eg : inspectors from TNAI, KNC etc.

Nursing Audit has become mandatory for 3

basic reasons.
1. The increasing cost of the care.
2. The need to improve the quality of care.
3. The need for the proof of the quality of care
actually delivered, proof for the
a) Nurse, b) Agency, c) Client

STEPS OF NURSING AUDIT PROCESS:

(Logufo and Brook (1984))
1. Selection of a topic for study
2. Selection of explicit criteria for quality care
3. Review of records to determine whether
criteria are met.
4. Peer review of all cases that do not meet
criteria.
5. Specific recommendations to correct problem
6. Fallow-up to determine whether problems
have been eliminated.

AUDIT CYCLE:

The nursing audits are mainly of 3 types

1.Concurrent audit
2. Retrospective audit
3.Prospective audits

Concurrent Audit
The concurrent audit has also been called as the
open chart audit because it is done while the
patient is receiving care. It is a process audit
that evaluates the quality of ongoing care
being perceived by clients by looking at the
nursing process.
Purpose: To assess the past and present care
given to a client.
Components:
1. Assessing the client
2. Interviewing the nursing staff
3. Reviewing the clients record and care plan.

Advantages of Concurrent Audit:

1.Indications of problems at the time of caring
2. Provision of a mechanism for identifying and

meeting clients needs during care

3.Implementation of measures to fulfill

professional responsibilities.
4. Provision of a mechanism for communicating

on behalf of the client.

Disadvantages of Concurrent Audit:

1. Concurrent audit is a time consuming
procedure
2. It is costly to implement than the
retrospective audit
3. Does present the total picture of care that
the client ultimately well receive
4. Rosenthal effect: changing results at
expectations of care gives

Retrospective Audit
Refers to an in-depth assessment of the quality,
after the client has been discharged, having
the client chart as a source of data.
Focuses in 2 factors Discharge status and
complications the 3 components of discharge
status are:
Health - Activity - Knowledge

Advantages:
1.Comparison of actual practice to standards of
care
2.Analysis of actual practice findings
3. A total picture of care given
4. More accurate data for planning corrective
action
Disadvantages:
1.The focus of evaluation is directed away from
ongoing care
2.The clients problems are identified after
discharge

OTHER TYPES OF NURSING

AUDITS
(i) Structure audit:
The inspection of the management process as carried
out and documented by the nurse manager.
(ii) Process audit:
In this type of audit inspection of the nursing process,
as carried out and documented by staff nurses to
evaluate competence with established standards of
nursing care.
(iii) Outcome audit:
It mainly identifies client outcomes (satisfactory and
unsatisfactory and the patterns of nursing care that
appears to be responsible.

NURSING AUDIT
COMMITTEE
Membership
-

Client care coordinators

Supervisors
Head nurses
Clinical specialists
Nurse clinicians
Licensed practical nurses
Nursing assistants
Other client care personnel
Medical records administrator

FUNCTIONS OF THE AUDIT

COMMITTEE
Development of purposes and objectives
Establishing standards and criteria
Establishing guidelines for conducting

audits
Deciding upon auditing forces (JCAH forms)
Initiating the auditing process
Keeping up brief, pertinent minutes

RESPONSIBILITIES OF
NURSING
1. Planning auditAUDIT
sessions and scheduling
2. Arrange for medical records to pull charts for
COMMITTEE:
retrospective audits and retrieve data.
3. Evaluating audit results in committee.
4. Conducting process audits
5. Preparing summaries of all audits
6. Teaching professional nursing personnel the
auditing process
7. Assisting nursing staff in using audits results
8. Making recommendations
9. Keeping brief pertinent minutes of audit
committee meetings.

FACTORS AFFECTING
AUDITING
PROCESS IN
- Lack of resources
- Personnel problems
NURSING:
- Unreasonable clients and attendants
-

Improper maintenance
Absence of well-informed population
Absence of accreditation laws
Legal restore
Lack of incident review procedure
Lack of good hospital information system
Absence of survey condition routine
Lack of nursing case records
Miscellaneous factors

ADVANTAGES OF NURSING
AUDIT:
-Easy Method of measurement
- Functions are easily understood
- Scoring system is fairly simple
- Results are easily understood
- Assess the work of all those involved in
recording case.
- May be useful tool as part of a quality
assurance program in area where accurate
records of case are kept.

DISADVANDAGES
- It is not so useful in areas where the nursing
process has not been implemented.
- Many components overlap making analysis
difficult
- It is time consuming
- Requires a team of trained auditors.
- Deals with a large amount of information.
- Only evaluates record keeping