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
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

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