 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
The nursing audits are mainly of 3 types
1. Concurrent audit
Retrospective audit
3. Prospective audits
2.
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
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
(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