BY

Mrs. .Prema Balu

Principal
Navodaya college of
nursing
RAICHUR

 Nursing Audit

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 ? QUESTIONS ?
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Nursing Audit

A powerful tool for quality improvement

LEARNING OBJECTIVES
The student is able to


understand the language of Audit

define Nursing Audit
list the purposes of nursing Audit
state the importance of nursing Audit cycle
List down the benefits and disadvantages of
nursing audit



What is Audit ?


 Audit compares actual practice to a standard

of practice.


 A systematic and critical examination to

examine or verify.

What is nursing Audit
Nursing Audit is the process of collecting
and analyzing data to evaluate the
effectiveness of nursing intervention.


 Cont……….
What is Nursing Audit ?
 “is a quality improvement process that seeks
to improve care and outcomes through
systematic review of care against explicit
criteria and the implementation of change”


 explicit criteria standards


 Cont…
 Criteria
Criteria …
Statements defining what you want

To make the criteria (statement) useful the Standard needs to be defined.

Describe the
Standard quality or level you should
For example:

Criterion: All patients on lithium therapy

should have a record of lithium levels in
the therapeutic range (normally 0.4 – 1.0
mmol/l) within the previous 6 months.


Standard: 90%

 Why Nursing Audit?
ØTo improve aspects of care in a wide variety of
topics.
ØUsed in association with changes in systems of
care.
ØTo confirm that current practice meets the
respected level of performance.
Principle


 To improve the nursing practice

Purposes
Evaluating nursing care given
Achieves deserved and feasible
quality of nursing care
Stimulant to better records
Focuses on care provided and on
care provider
Contributes to research
Methods of Nursing Audit
Retrospective Concurrent
 

 Refers to an in Refers to the

depth  valuations
assessment of  conducted
the quality
 after the
 on behalf of
 patients who
 patient has

 been
 are still
 discharged .
 undergoing
care.
Nursing Audit cycle
1.Identify problem or issue
Select a topic that is important or
significant
This may come from personal experience.
A problem may be identified from every
day practice or
A feeling that something could or should
have been done better.
Cont…..
Problems can be identified in 3 basic areas of Practice work:



 Structure - what you need.
 This refers to the resources required, for example, the number
of staff and the skills they require, space and equipment.


 Process - what you do.

 This refers to actions and decisions taken by practitioners, such
as communication, assessment, education, investigations,
prescribing, interventions, evaluation and documentation.


 Outcome - what you expect.

 This refers to the outcome of interventions such as health
levels, patient knowledge or satisfaction
Problem Priorities
ØIs the topic concerned of high cost,
volume or risk to staff or users
ØIs there evidence of a serious quality
problem e.g. patient complaint or high
complication risk
ØIs good evidence available to inform
standards e.g. Systematic review or
national clinical guidance.
Ø
Verbs useful in defining the aims of
an audit
ØTo improve
ØTo enhance
ØTo ensure
ØTo change
ØTo increase
Ø
Example
1.To improve blood transfusion process
2.To increase the proportion of patients with
hypertension whose B.P is controlled
3.To enhance that every infant has access to
immunization
2.Set criteria and
standards
A criterion is an item of care or an aspect
of practice that can be used to assess
quality.
This is where you can say what should be
happening.
The criterion is written as a statement
defining what you want to measure.
Criteria are the way you should be doing
things in an ideal world

Cont…
To make the criteria (statement) useful the
Standard needs to be defined.


 Standards – Setting Targets


Standards – Setting Targets
 For each criterion you will need to set
targets for something you should always do
(100%) and / or something that should
never happen (0%).
 Criteria Doing things in an ideal world .
Item of care

the criteria (statement) useful the Standard needs t

Level of care

Standards Setting Targets

Remember to be valid
follow
Cont….
 Who should write Criteria and Standards?
Recent government publications state that health
professionals will be expected to develop
standards that measure a wide range of features
of quality in healthcare
 What if no standards are available?
 You will need to develop and write your own in
conjuction with the clinical team.
 Who needs to be involved?
 You can write standards alone, but if you are going
to use them to measure practice other than your
own, you must involve the relevant people
3.Collecting data on
performance


Identify what data needs to be collected,

how and in what form it needs to be
collected, and who is going to collect it.
Remember only collect information that is
absolutely essential.

4.Assess performance
against criteria and
standards


With the information collected analysis is

possible, and identification of any area of
care below the predetermined standard of
the criteria can be made. The results can
then be used to develop an action plan ie
what needs to be done, how it needs to be
done, who is going to do it and when is it
going to be done.

5. Identify need for
change/Implementing
change


The audit cycle is now almost complete,

but without re-evaluating the care the
practice is giving it is impossible to see if
recommendations have been implemented
and the level of care improved.

Example
Diagnosis
Criterion 1 Stool microbiological investigations should be
performed if:
septicaemia is suspected or

there is blood and/or mucus in the stool or

the child is immunocompromised

Exceptions None

Standard 100%

Definitions None
Criterion 1 Percentage of women offered evidence-based information about:
their pregnancy

the care they should be offered, including being made aware of the

‘Understanding guidance’ booklet (available from www.nice.org.uk/CG062)

the service providing their care.

Exceptions None
Settings All
Standard 100%
Definitions Women should be offered information to help them make informed decisions about their
healthcare. This should cover the pregnancy, maternity care and the health service
providing care. Information should be available in formats appropriate to the individual
woman, taking into account language, age, and physical, sensory or learning
disabilities.
Criterion 2 Percentage of partners or relevant family members offered evidence-based
information about:
the woman’s pregnancy

the care the woman should be offered, including being made aware of the

‘Understanding guidance’ booklet (available from www.nice.org.uk/CG062)

the service providing the woman’s care.

Exceptions Where there is no partner or relevant family members involved



Where sharing information may compromise the woman’s confidentiality or wishes



Settings All
Standard 100%
Definitions Partners and relevant family members should have the opportunity to be involved in
decisions about the woman’s care, unless the woman specifically excludes them.
What are the benefits of nursing
audit?
Improvements in practice: creating real
benefits in patient care and service delivery;
Develops openness to change;
Provide assurance: meeting evidence-based
best practice;
Listening to patients, understanding their
expectations;
Development of local guidelines or protocols;
Minimise error or harm to patients;
Reduce incidents/complaints/claims.

What are the disadvantages
of nursing audit?
Many of the components overlap making
analysis difficult
Is time consuming
Requires a team of trained auditor
Deals with a large amount of information
Only evaluates record keeping. It only
serves to improve documentation not
nursing care
Audit vs Research : A View
Audit Research

Is not randomised May be randomised

Compares actual performance against standards Identifies the best approach, and thus the sets the
standards

Conducted by those providing the service Not necessarily provided by those providing the service

Usually led by service providers Usually initiated by researchers

Does not involve investigation of new treatments, but Involves comparators between new treatments and
evaluates the use of current treatments placebos

Involves review of records by those entitled to access Requires access by those not normally entitled to
them access them

Ethical consent not normally required Must have ethical consent

Results usually not transferable Results may be generalisable

Hypothesis used to generate the standard Testable hypothesis generated

Compares performance against the standard Presents clear conclusions

So ….
 Research discovers the
 right thing to do;


 Audit ensures
 it is done right’.
Conclusion

 Nursing audit is ‘a quality improvement process

that seeks to improve patient care and
outcomes through systematic review of care
against explicit criteria and the
implementation of change. Aspects of the
structure, processes and outcomes of care are
selected and systematically evaluated against
explicit criteria. Where indicated, changes
are implemented at an individual, team, or
service level and further monitoring is used to
confirm improvement in healthcare delivery.’
