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•With the implementation of CPA professional

accountability to an enlightened public can no longer


be ignored by nursing staff.
^QuaIity nursing care” has become essential on
day to day functioning.
•Nursing audit is a way of ensuring quality nursing
care.
Nursing audit is a detailed review and evaluation
of selected clinical records by qualified
professional personnel to identify, examine, or ".
verify the performance of certain specified aspects -
of nursing care by using established criteria.
One of first ever clinical audits was undertaken by Florence
Nightingale during the Crimean war of 1853-1855.
On arrival at the medical barracks hospital in Scutari in
1854, Florence was pained by the unsanitary conditions and
high mortality rates among injured or ill soldiers.
She and her team of 38 nurses applied strict sanitary
routines and standards of hygiene to the hospital and
equipment,
Florence's gift of statistic kept meticulous records of
the mortality rates among the hospital patients.

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1 Before 1955 very little was known about the
concept of nursing audit.
1 First report of Nursing audit of the hospital
published in 1955.
1 For the next 15 years, nursing audit is reported from
study or record on the last decade.
1 The program is reviewed from record nursing plan,
nurses notes, patient condition, nursing care.
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
not on care provider,
5. Contributes to research.
CONCURRENT
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 añer carefull examination of the
relevant books of accounts and documents -
.
•RETROSPECTIVE EVALUATION : Retrospective audit is a
method for evaluating the quality of nursing care by examining
the nursing care as it is reflected in the patient care records for
discharged patients.
•in this type of audit specific behaviors are described then they
are converted into questions and the examiner looks for answers
in the record.
For example the examiner Iook9 through the patient's record9
and a9ks :
a. Was the problem solving process used in planning nursing care?
II. CONCURRENT AUDIT : It is performed during ongoing
nursing care.
The evaluations conducted on behalf of patients who are still
undergoing care.
It includes assessing the patient at the bedside in relation to
pre-determined criteria,
Interviewing the staff responsible for this care .
Reviewing the patients record and care plan.
Ill. 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
I Outcomes are the end results of care;
The changes in the patients health status and can be
attributed to delivery of health care services.
Outcome audits determine what results if any
occurred as
2. PROCESS AUDIT:
Process audits are used to measure the process of care or how
the care was carried out.
Process audit is task oriented and focus on whether or not
practice standards are being fulfilled.
These audits assumed that a relationship exists between the
quality of the nurse and quality of care provided.
3. STRUCTURE AUDIT:
Structure audit monitors the structure or setting in which patient
care is provided.
•Such as the finances, nursing service, medical records and
environment.
AUDIT IS A CYCLIC PROCESS
3‘Before carrying out an audit, an audit committee
should be formed, comprising of a minimum of five
members 3‘ 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.
\‘That the auditor should have the ability to carry out
an audit in about 15 minutes.
\‘ If there are less than 50 discharges per month,
then
all the records may be audited,
\‘If there are large number of records to be audited,
a. A detailed discussion of the seven components of
criteria.
b.A group discussion to see how the group rates the
care received using the notes of a patient who has
been discharged,
c. These should be anonymous and should reflect a
total period of care not exceeding two weeks in
length
d. Each individual auditor should then undertake the
same exercise as above.
e.This is followed by a meeting of the whole
commiVee who compare and discuss its findings, and
finally reach a consensus of opinion on each of the
components.
a. Collects patient data in a systematic manner,
•includes description of patients pre-
hospital routines,
• has information about the severity of illness,
• has information regarding lab tests,
• has information regarding vital signs,
• Has information from physical assessment etc.
b. State nurses diagnosis,
c. Writes nursing orders,
d. Suggests immediate and long term care,
e. Implements the nursing care plan,
f. Plans health teaching for patients and students,
g. Evaluates the plan of care at own level,
-starting point
-careful thought and planning

a rare condition, with an insignificant


outcome
•InvoIve ALL the people concern.
• Fix time and Plan resources
•Access the evidence/data
•MethodoIogy to be followed
•PiIot study
•Report for Action
•Re-audit
All activities should be documented.
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
Points to be remembered:
a. Quality assurance must
be a priority,
b. Those responsible must
implement a programme
not only a tool,
•The data co)Iected are to be precise
•Essential data
•CompIeted data
•Adequate data
•User group to be included
Example:
Immunisation status of
pregnant women
•Do not try and collect too
many items, keep it simple
and
short.
IDENTIFYING BARRIERS TO CHANGE:
- Fear
- Lack of understanding
- Low morale
- Poor communication
- Individual Culture
- Doubt of outcome
-Consensus not gained
SYSTEMATIC APPROACH:
MONITORING AND EVALUATION:
systematic approach to changing professional practice
should include plans to:
•monitor and evaluate the change
•maintain and reinforce the change
REINFORCING IMPROVEMENT:
•reinforcing or motivating factors by
the management .
•integration of audit
•strong leadership
6. RE-AUDIT:
-Review evidence
ADVANTAGE DISADVANTAGE

• Can be used as a method • appraisea the outcomes of the


of mea9urement in all nursing procese, 9o it is not so
nuraing.
area9 of useful in areas where the
• Seven function9 are easily nursing proce9s has not been
understood, implemented,
1A profession dedicated for
the quality of its service to
patients constitutes the heart of
its responsibility to the public.
1 An audit helps to ensure that the
quality of nursing care desired
and feasible is achieved.
1 This concept is often referred to
as
quality assurance.
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