COMMUNITY HEALTH AUDIT AND SANCTIONS

PRESENTED BY REENA YADAV

LECTURER PUSHPANJALI COLLEGE OF NURSING,

AGRA

DEFINITION OF AUDIT

Nursing audit is a review of the patient record designed to identify, examine, or verify the performance of certain specified aspects of nursing care by using established criteria.

DEFINITION OF AUDIT

Nursing audit is the process of collecting information from nursing reports and other documented evidence about patient care and assessing the quality of care by the use of quality assurance programmes.

SanctionAuthoritative permission or approval that makes a course of action valid or permission.

Support or encouragement, as from public opinion or established custom.

A consideration, influence, or principle that dictates an ethical choice. 

Auditing for community health services in India

It is also the evaluation of health services. The general steps are:

Determine what is to be evaluatedEstablish standards and criteriaPlan the methodology to be appliedGather information Analyze the resultsTake actionRe-evaluate

Importance of auditingFor community health serviceErrors are locatedFrauds are discoveredAdvice about weaknessHigh moral valuesEfficiency improvesDispute is settledPlanning becomes possibleImprovement of the internal control

For governmentBetter performanceProgress of economy

AuditorsExternal auditorsIt is an independent public accounting

firm engaged by the client subject to the audit, to express an opinion of whether the companies financial statements are free of material misstatement, whether due to fraud or error.

External auditors are regarded as independent auditors. They are also called as statutory auditors.

Internal auditors

internal auditors are not considered independent of the company they perform audit procedures for,

internal auditors of publically traded companies are required to report directly to the board of directors or a sub-committee of the board of directors, or not to management, so to reduce the risk that internal auditors will be pressured to produce favorable assessments.

Purpose of community health services audits:

monitor the progress of national health programs. modify the deficiency of certain programs. assess the performance of physicians, nurses, and

other paramedical.Record auditing: to see the records whether they

are properly maintained and updated or not.Financial auditing.Auditing of vaccines preventable diseases and

other communicable diseases and non communicable diseases.

Audits of stocks and inventory.

Audit process it consist of 6 stepsStep 1: Identify the problem or

issueThis stage involves the selection of a

topic or issue to be audited, and is likely to involve measuring adherence to healthcare processes that have been shown to produce best outcomes for patients.

Step 2: Define criteria & standards

Decisions regarding the overall purpose of the audit, either as what should happen as a result of the audit,

what question you want the audit to answer. criteria are explicit statements that define

what is being measured and represent elements of care that can be measured objectively.

The standards define the aspect of care to be measured,

based on the best available evidence.

Step 3: Data collectionTo ensure that the data collected are

precise, and that only essential information is collected, certain details of what is to be audited must be established from the outset.

Data to be collected may be available in a computerized information system, or in other cases it may be appropriate to collect data manually or electronically using data capture solutions.

Step 4: Compare performance with criteria and standards

This is the analysis stage.the results of the data collection are

compared with criteria and standards. The end stage of analysis is concluding

how well the standards were met and, if applicable, identifying reasons why the standards weren't met in all cases.

These reasons might be agreed to be acceptable,

Step 5: Implementing changeOnce the results of the audit have been

published and discussed, an agreement must be reached about the recommendations for change.

Using an action plan to record these recommendations is good practice; this should include who has agreed to do what why and when.

Each point needs to be well defined, with an individual named as responsible for it, and an agreed timescale for its completion.

Step 6: Re-audit: Sustaining Improvements

After an agreed period, the audit should be repeated.

The same strategies for identifying the sample, methods and data analysis should be used to ensure comparability with the original audit.

The re-audit should demonstrate that the changes have been implemented and that improvements have been made. Further changes may then be required, leading to additional re-audits.

This stage is critical to the successful outcome of an audit process - as it verifies whether the changes implemented have had an effect and to see if further improvements are required to achieve the standards of healthcare delivery identified in stage 2.

Types of audit

Internal auditing Internal auditing is a control

technique performed by an external auditors who is not a employee of the organization. He makes an independent appraisal of the policies, plan and the points deficits in the policies or plans and give suggestion for eliminating deficits.

External auditing It is an independent appraisal of the

organizations, finances, accounts and statements. The external auditors is the qualified persons who has to certify the annual profits and accounts and prepare a balance sheet after careful examinations of the relevant books, accounts and documents.

Types of internal audit

Retrospective audit:

It evaluates the quality of care through appraisal of nursing process after the client’s discharge from the health care system.

This refers to an in-depth assessment of quality after the patient has been discharged, and uses the patient’s chart as the source of data.

Retrospective audit:

AdvantagesLess time consuming

and less expensive.For companies of

actual practical findings

For analysis of actual practical findings

A total picture of care given.

Encourages accurate recording.

Disadvantages Focus of evaluation

is directed away from ongoing care

Corrective action can only be used to improve the care of future clients

Care giver may chart care activities without giving care to client

Types of internal audit

Concurrent audit :It is the method of evaluating the quality of

ongoing care through appraisal of nursing process.

This refers to the evaluations conducted on behalf of patients who are still undergoing care. It includes assessment the patient at bedside in relation to pre-determined criteria, interviewing the staff responsible for his care and reviewing the patient record and care plan.

concurrent auditAdvantages Identification of problems

at the time of care givenProvision of mechanism

for identifying & meeting client’s needs during care

Implementation of measures to fulfill professional responsibilities

Provision of mechanism for communicating on behalf of the client

Disadvantages Time consumingMore costly to

implement than retrospective

Does not present the total picture of care that client will ultimately receive

Peer review peer review nurses functioning in same capacity that is

peer appraise the quality of care or practice performed by others equally qualified nurses. The peer review is based on pre established standards or criteria.

There are two types of nurses review

Individual peer review - Focuses on the performance of an individual nurses.

Nursing audit – focus on evaluating the nursing care through the records.

 

Quality audits

are performed to verify conformance to standards through review of objectives evidence.

quality audits may verify the effectiveness of a quality management system.

This is a part of certification such as ISO. Quality audits are essentials to verify the

existence of objective evidence showing conformation to required process, to assess how successfully processes have been implemented, for judging the effectiveness of achieving any defined target levels,

OUTCOME PROCESS STRUCTURE

The audits most frequently used in quality control include

outcome, process and structure audits

Outcome audit It is the end result of care. The changes in the patients health

status and can be attributed to delivery of health care services.

It determines the results of specific nursing intervention.

Process audit It is used to measure the process of care

or how the care was carried out. This audit is task oriented and focuses

on whether or not practice standards are being fulfilled.

Structure audit This type of audit monitors the structure

or setting in which the patient care occurs.

The audit is done for assessing the physical facilities, equipments and supplies describe whether they fulfill the set standards or not.

Energy auditsAn energy audit is an inspection,

survey and analysis of energy flows for energy conservation in a building, process or system to reduce the amount of energy into the system without negatively affecting the outputs.

Instruments of community health services audit

Numerous audit instruments can be found.

Two valid and reliable tools are phaneuf nursing are the slater nursing competencies rating scale and the quality patient care scale.

phaneuf nursing audit. This 50 item instrument measures

seven functions of professional nursing as they relate to nursing process.

his instrument is the example of retrospective audit instrument

The slater nursing competencies scale is an 84 item scale intended to rate nurses performance in the clinical setting after direct observation of an identified number of nurses and client encounters.

The quality of patient care scale is a 68item scale intended to measure the quality of care received by a client either through direct nurse client encounters or interventions with others on behalf of the client.

Other nursing audits instruments areRush- Presbyterian – st. luke’s

medical centre medicus methodology for monitoring quality patient care.

The professional practitioner’s performance rating scale.

The CASH nursing care evaluation instrument.

The critical incident performance appraisal system.

Regular health check audits

Regulatory auditsThe aim of regulatory audit is to verify

that a project is compliant with regulations and standards.

Record auditA commonly used method for collecting

performance data in community health services is the record audit. Both concurrent and retrospective record auditing is carried out.

The audit committee is a committee of the board of community

health services. Its primarily function is to assist the board in fulfilling its oversight responsibility by reviewing the independent audit report as to the system of internal controls.

The committee experts advised of:The financial information provided to the

governmental regulatory bodies.The status of examinations/ audits

conducted by other government states or regulatory bodies.

Responsibilities of audit committee

It provides an open avenue of communication between the board, management and the independent auditors.

It also provides insight with regard to the manner in which the financial reporting of the department of community health services.

The audit committee is appointed annually by the board of community health services.

The audit committee consists of at least three members of whom at least one should have background in financial reporting, accounting, and auditing.

There is chairperson in audit committee. It is the responsibility of the chairperson to schedule the meeting of the committee and to suggest agenda items for the committee’s consideration.

The audit committee meets as often as it determines necessary, but not less frequently than 4 times per calendar year. The audit committee meets the management and independent auditors in separate executive sessions.

Responsibilities and duties of audit

Review and reassess the adequacy of the charter annually and recommended any proposed changes to the board for approval.

Maintain other records of meetings and activities.

Review management’s independent audit procurement process and confirm the selection of independent auditors.

Review reports from independent auditors regarding their independent audit . At the committee’s discretion, discuss such reports with the auditors and if appropriate, recommend that the board take action to satisfy itself or the independent auditor.

Review of department’s periodic report of major financial risk exposure includes:

Fraud and other misconduct. Change in accounting to policies

and procedure.

Review the annual audited financial statements with management including:

Major accounting issues and changes to accounting principles and auditing standards.

Adequacy of internal controls that could significantly affects the department’s financial statements

Meet with the independent auditors as necessary to monitor the progress of the annual financial and single audit. Evaluate the results of annual audits including, but not limited to:

The audited financial statementsThe adequacy of the system of internal controls.The adequacy of the department’s accounting

policies and procedures, including the level of compliance with governmental regulations

Discuss with the independent auditor the matters required by AICPA professional standards.

8. Establish guidelines in accordance with applicable laws and government auditing standards.

9. Review a current list of examinations and/ or audit of DCH in process or recently completed conducted by:

Governmental or other authorities.Internal audit staff.

1o. Periodically review and evaluate the adequacy of department’s monitoring of compliance with reporting requirements of governmental agencies and other organization.

11. Initiate investigation of other matters the committee deems appropriate and relevant to the committee’s purpose.

What need to be done in health sector in india

The audit has benefitted in the implementation of the program and increasing transparent accountability.

It become an important tool for effective program implement awareness generation, program monitoring and evaluation, reducing the chances of corrupt and grievance redressal, and follow up on corrective actions.

What need to be done in health sector in india

As of now, there are only a few examples of use of audits in health sectors in india,

however, it is expected that with the time will increase. The use of this approach in maternal death audits and infant mortality audit a long way in achieving millennium development goals.

Thank you