Nursing Audit in Nursing Management- Simplified.

I. INTRODUCTION

• Audit – is a systematic and critical evaluation to examine or
verify the standards or quality assurance.

• Nursing audit is a way of ensuring quality nursing care.

II. Definition

“ Nursing audit refers to assessment of the quality of clinical nursing”. (Elisen)

• “A Nursing audit is a systematic review and structured evaluation of nursing care processes, and outcomes to assess the quality of care delivered to patients”.

III. PURPOSES OF NURSING AUDIT

1. Evaluate Nursing care given.
2. Achieves Quality nursing care. (QA)
3. Stimulate to better health records.
4. Focuses on Care provided not on care provider.
5. Contributes to research.

IV. Objectives of Nursing Audit
1. Assess the Quality of Nursing Care
2. Identify Areas for Improvement
3. Ensure Compliance
4. Enhance Patient Safety
5. Promote Professional Accountability
6. Facilitate Evidence-Based Practice

V. Types of Nursing Audit
1. Retrospective Audit
2. Concurrent Audit
3. Prospective Audit
4. Peer Review
5. Patient-Centered Audit
6. Criterion-Based Audit
7. Internal Audit
8. External Audit
9. Structure, Process, and Outcome Audit
10. Others
a. Statistical Review
b. Thematic Audit
c. Root Cause Analysis (RCA)

1. Concurrent Audit
a. Definition:
An audit conducted while care is being delivered (During) , often in real time.

2. Prospective Audit
a. Definition:
This approach evaluates care before it is delivered.
3. Retrospective Audit
a. Definition:
• Involves reviewing patient records and documentation after the care has been delivered.
4. Peer Review
a. Definition:
• Nurses review the performance and care provided by their peers.

5. Patient-Centered Audit
a. Definition:
Focuses on the patient’s experience and outcomes.
6. Criterion-Based Audit
a. Definition:
Measures nursing care against pre-established criteria or standards.
7. Internal Audit
a. Definition:
• Conducted by the nursing staff or the healthcare facility itself.

8. External Audit
a. Definition:
• Performed by external agencies or accrediting bodies.

9. Structural, Process, and Outcome Audit
a. Structural Audit:
• Evaluates the resources, equipment, and staffing available for providing nursing care.
b. Process Audit:
• Focuses on the methods and procedures used in delivering care.
c. Outcome Audit:
• Assesses the results of the nursing care provided, such as patient outcomes, recovery rates, and complications.

NURSING AUDIT CYCLE

1. Select or Identify the area of topic / problem / issue
2. Set Criteria & Standards
3. Observe the practice / performance
4. Compare performance with set Criteria & standards
5. Implementing change


VII. Steps in Nursing Audit


Steps in a Nursing Audit:
1. Planning
2. Data Collection
3. Data Analysis
4. Reporting
5. Action Plan
6. Follow-up


1. Planning:
a. Define the Purpose and Scope
b. Establish Criteria and Standards
c. Identify the Sample
2. Data collection
a. Gather relevant Information.
b. Use a Standardized data collection tool or check- list
3. Data Analysis
a. Compare the collected data with established standards or benchmarks.
b. Identify deviations from expected care practices, as well as any instances of best practices.

4. Reporting
a. Prepare a Report that highlights the findings of the audit.
b. Include areas where the standards were met or exceeded, as well as
areas that need improvement.
c. Offer recommendations to address any deficiencies or gaps in care.

5. Action plan
a. Develop a plan to implement the recommendations from the audit.
This may involve revising policies, providing additional training to staff, or implementing new procedures.

7. Follow up
Conduct follow-up audits or evaluations to assess whether the changes have been implemented and have led to improvements in care.

VIII. Benefits / Advantages of Nursing Audit
1. Improves Patient Care
2. Ensures Compliance
3. Encourages Continuous Improvement
4. Increases Efficiency
5. Promotes Professional Development
6. Others

IX. DISADVANTAGES OF NURSING AUDIT
1) Not so useful in areas where the nursing process has not been implemented
2) Many of the components overlap making analysis difficult
3) It Is time consuming
4) Requires a team of trained auditors
5) Only evaluates record keeping.
6) It only serves to improve documentation not nursing care.
7) Others

X. Problems or Issues in Nursing Audit
1. Lack of resources.
2. Personnel problems
3. Lack of nursing care records.
4. Improper maintenance of records
5. Absence of well informed population.
6. Absence of accreditation laws
7. Lack of Incident Review Procedure
8. Lack of good Hospital Information System (HIS)
9. Absence of routine Patient satisfaction survey
10. Others

XI. Challenges in Nursing Audits
1. Resistance to Change
2. Time-Consuming
3. Data Accuracy