BY Mrs. .Prema BaluPrincipal Navodaya college of nursing RAICHUR

Nursing Audit

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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 AuditNursing 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 …CriteriaStatements defining what you want to measure.

Standard

Describe thequality or level you should achieve!

To make the criteria (statement) useful

the Standard needs to be

defined.

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?

To improve aspects of care in a wide variety of topics.

Used in association with changes in systems of care.

To confirm that current practice meets the respected level of performance.

Principle

To improve the nursing practice

Purposes Evaluating nursing care givenAchieves deserved and feasible

quality of nursing careStimulant to better recordsFocuses on care provided and on

care provider Contributes to research

Methods of Nursing AuditRetrospective

Refers to an in

depth assessment of the quality

after the patient has

been discharged .

Concurrent

Refers to the valuations conducted on behalf of patients who are still undergoing

care.

Nursing Audit cycle

1.Identify problem or issue Select a topic that is important or

significantThis 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 PrioritiesIs the topic concerned of high cost,

volume or risk to staff or users Is there evidence of a serious quality

problem e.g. patient complaint or high complication risk

Is good evidence available to inform standards e.g. Systematic review or national clinical guidance.

Verbs useful in defining the aims of an auditTo improveTo enhance To ensure To changeTo increase

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

For each criterion you will need to set targets for something you should always do (100%) and / or something that should never happen (0%).

Standards – Setting Targets

Criteria

To make the criteria

(statement) useful the Standard

needs to be defined

Standards Setting Targets

Doing things in an ideal

world.Item of care

Level of care

Remember to be valid follow

S• Specific ,Standards should relate

to a specific area of care and should give specific boundaries. They should be unambiguous.

M

• Measurable, If standards are vague and woolly how can you compare your practice against them. You need to be able to physically measure aspects of the standard to allow comparison.

A• Achievable, There is no point

writing standards that are not achievable either due to resource or clinical limitations.

R • Research Based, Peer reviewed research evidence will have shown the best available treatment / method for your topic area.

T •Timely, Standards should reflect current practice not what you thought you did two years ago.

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 auditorDeals with a large amount of informationOnly 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 evaluates the use of current treatments

Involves comparators between new treatments and placebos

Involves review of records by those entitled to access them

Requires access by those not normally entitled to 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.’