NURSING AUDIT

Introduction
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 terms

Quality
A judgment of what constitute good or bad

Audit
A systematic and critical examination to examine or verify

Nursing audit
1) It is the assessment of the quality of nursing care
2) Uses a record as an aid in evaluating the quality of patient care
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 audit
Audit 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 audit
1) Internal auditing
Internal auditing is a control technique performed by an external auditor who is an employee of the organization. He makes an independent appraisal the policies, plans and points the deficits in the policies or plans and give suggestion for eliminating deficits
2) external auditing
it is an independent appraisal of the organizations financial account and statements. The external auditor is a qualifed person who has to certify the annual pprofit and loss account and prepare a balance street after carefull examination of the relevant books of accounts and documents
evalution of nursing audit
There are 3 types of evaluation of nursing audit:

1) retrospective evaluation
2) concurrent evaluation
3) peer review


I. 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 acridities body initially required hospitals to conduct certain number of per year.
II. 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.
III. 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 audit
1) evaluating nursing care given
2) achieves deserved and feasible quality of nursing care
3) stimulant to better records
4) Focuses on care provided and on care provider
5) Contributes to research
Methods of nursing audit
1) define patient population
2) identify a time framework for measuring outcomes of care
3) identify commonly recurring nursing problems presented by the defined patient population
4) state patient outcome criteria
5) state acceptable degree of goal achievement
6) specify the source of information
7) design and type of tool
a) quality assurance must be priority
b) those responsible must implement a programmer not only a tool
c) a coordinator should develop and evaluate quality assurance activity
d) roles and responsibilities must be delivered
e) nurses must be informed about the process and the result of the programmed
f) data must be reliable
g) adequate orientation of a data collection is essential
h) quality data should be analyzed and used by nursing personnel at all levels
Audit cycle
Set standards




Implementation change observe practice




Compare with standard



Nursing standards
Defines a strandard as the desirable and achievable level of performance against which actual practice is compared. The standards must meet the needs of the patient
Advantage of nursing audit
1) Can be used as a method of measured in all areas of nursing
2) Seven function are easily understood
3) Scoring system is fairly simple
4) Results easily understood
5) Assess the work of all those involved in recording care
6) May be usefull tool as part of a quality assurance programme in areas where accurate records of care are kept
Disadvantage of nursing audit
1) Appraises the outcomes of the nursing process , so it is not so usefull in areas where the nursing process has not been implemented
2) Many of the components overlap making analysis difficult
3) Is time consuming
4) Requires a team of trained auditors
5) Deals with a large amount of information
6) Only evaluates record keeping. It only serves to improve documentation not nursing care
Audit committee
Before carring out an audit committee should be informed comparising 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
Training for auditors should evaluate the following
a) A detailed discussion of the seven components
b) A group discussion to see how the group rates the care recived using the notes of a patient who has been discharge these should be anonymous and should reflect a total period of care not exceeding two weeks in length
c) Each individual auditor should then under take same exercise as above this is followed by a meeting of the whole committee who compare and discuss its finding and finally reach a components
Steps to problem solving process in planning care
a) Collects a patient data in a systematic manner
1) Inculdes description of patients pre hospital routines
2) Has informed about the severity of illness
3) Has information regarding lab tests
4) Ha information regarding vital signs
5) Has information regarding physical assessment
b) States nurses diagnosis
c) Write nursing orders
d) Suggests immediate and long term goal
e) Implement the nursing care plan
f) Plans health teaching for patients
g) Evaluates the plan of care
Retrospective audit is a method for evaluating the quality of nursing care as it is reflected in the patient care records for discaharge patients. In this type of audit specific behaviors are described then they looks for answers in the record
For ex the examiner looks throught the patient’s records and asks ;
a) Was the problem solving process used in planning nursing care
b) Whether patient data collected in a systematic manner
c) Was a description of patients pre- hospital routine included
d) Laboratory test results used in planning care
e) Did the nurses perform physical assessment? How was information used?
f) Were nursing diagnosis stated?
g) Did nurse write nursing orders? And so on
Summary
Nursing audit is an evaluation of nursing service. Purpose of nursing audit is evaluating nursing care plan methods of nursing audit are retrospective, concurrent and peer review methods ofnursing audit methods to develop criteria, audit cycle nursing standards advantages of nursing audit
Disadvantage of nursing audit is audit committee steps to problem solving process in planning care are collects a patient data in a systematic manner states nursing diagnosis plans health teaching for patients evaluates the plan of care
Conclusion
A professional concrns for the quality of its service constitute the heart of its responsibity 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
Bibliography
1) B.T.Basavantappa. “NURSING ADMINISTRATION” 1st edition, Jaypee brothers publication, 2003. page. no 161-164, 435-438
2) Carol Taylor “FUNDAMENTAL OF NURSING THE ART AND SCIENCE OF NURSING CARE” 5th edition Lippincott Williams, Wilkms publication 2005, page no 331
3) Kozier Barbar. “ FUNDAMENTAL OF NURSING CONCEPTS, PROCESS AND PRACTISE” 7th edition Darling Kindersley publication 2006. page no 361
4) Potter and Perry “ FUNDAMENTAL OF NURSING” 6th edition, Mosby publication,2005, page no. 481
5) Sr Nancy “ PRINCIPLES AND PRACTICE OF NURSING” 2nd volume, 4th edition, N.R.Brother’s publication, 2005, page no 570
Web site
http://www.atcpr.gov/audit