a judgment of what constitutes good or bad Audit a systematic and critical examination to examine or verify

(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

“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.

Brief history 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.

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

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

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

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.

The nursing audits are mainly of 3 types  Concurrent audit  Retrospective audit  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:  Indications of problems at the time of caring  Provision of a mechanism for identifying and meeting clients’ needs during care  Implementation of measures to fulfill professional responsibilities.  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

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

(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.

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

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

1. Planning audit sessions and scheduling 2. Arrange for medical records to pull charts for 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.

- Lack of resources - Personnel problems - 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

- 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.

- 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