GOVERNMENT COLLEGE OF NURSING

RAJNANDGAON (C.G.)

SUBJECT -NURSING MANAGEMENT

SEMINAR ON NURSING AUDIT

GUIDED BY
Ms. Neelam Chaturvedani
Asst.Professor
Child Health Nursing
Govt.College Of Nursing
Rajnandgoan
 INTRODUCTION
Increase in the cost of medical treatment and public
awareness of their rights under the consumers act
necessity that the nurses become accountable for their
practice they have public account lity in addition to their
personal accountability audit has become a
mechanism of assessing and improving the quality of a
work and identifying the way of improving the efficacy
of care.
 conti.....
nursing Audit one of the control tool responsible for
controlling the activity of the nurses that focus on
providing the best possible nursing care the HR
nursing rented is compared with the standards this is
mainly refer to clinical nursing audit the nursing
management audit is in evaluation of the nursing
management as a whole its an critical examination
and the entire nursing management process
 DEFINITION
According to Ekson
“Nursing audit refers to the assessment of the quality of clinicas nursing”
According to Goster Walfer
“Nursing audit is the means by which nurses themselves can define
standards from there point of view and describes the actual practice of
nursing"
According to phaneuf (1976)
A method for evaluating quality of care through of aursing appraisal of
nursing process as it i reflected in the patient care palients records for
discharged patient.
 PURPOSE
1. Evaluate Nursing care given.
2. Achieves describe and feasible qualIity of nursing care.
3. Stimulate to better record.
4. Focuses in care provided and not in care provider
5. Contributes to research.
6. Necessitating adequate documentation of nursing care provided to the
client though the center nursing process.
7. Directing attention to the design andatility of the charting record,
8. Encouraging the use of the problem oriented nursing system.
9. Suppeeting and becoming an instegral part of nursing by objective
programme
 CHARACTERISTICS
• The improve the quality of nursing
• It compares actual practice with agreed standards of practice
• It involves pees review
• It requires the identificación of Variations between practice
and standard followed by the analysis of causes of such
variations.
• It provide feedback for those whose record are audited.
• It includes follow-up or repeated or repeated an audit
sometimes later to find out if the practice is fulfilling the
agreed standards.
 METHODS
NURSING AUDIT
 A) RETROSPECTIVE VIEW
• This refers to an in-depth assessment of the quality after the patient has been
discharged, have the patients chart to the source of data.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 looks through the patient’s records and asks :-
a. Was the problem solving process used in planning nursing care?
b. Whether patient data collected in a systematic manner?
c. Was a description of patient’s pre-hospital routines included?
d. Laboratory test results used in planning care?
e. Did the nurse perform physical assessment? How was information used?
f. Were nursing diagnosis stated?
g. Did nurse write nursing orders? And so on.
 B. THE CONCURRENT REVIEW
This refers to 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 and reviewing the
patients record and care plan.
Method to Develop Criteria :
• 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-
 TOOLS ARE
• a. Quality assurance must be a priority,
• b. Those responsible must implement a programme not
only a tool,
• c. A co-ordinator should develop and evaluate quality
assurance activities,
• d. Roles and responsibilities must be delivered,
• e. Nurses must be informed about the process and the
results of the programme,
• f. Data must be reliable,
• g. Adequate orientation of data collection is
essential,
• h. Quality data should be annualized and used by
nursing personnel at all levels.
 CONTI......
OTHER TYPES
• Audit can be categorised as per the auditors appointed for auditing these
are internal and external audit .
1.Internal audit:-
Review of a work is done by pears or nursing personal continuously the
internal auditors abstract and classify clinical records and evaluate the quality
of nursing care.

2.External Audit :-
The external audit is carried out by the outside agency usually periodically
test completeness and accuracy of internal audit is done review is done by
non nursing administrator.
• EXAMPLE :- MCI and INC,SNC
 AUDIT COMMITTEE

Before carrying out an audit, an audit committee should be

formed, comprising of a minimum of five members 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
and 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, then an auditor may
select 10 per cent of discharges.
 LIST OF AUDIT COMMITTEE
• 1.HOD of surgical oncology chairperson
• 2. surgical oncologist
• 3. Anaesthetics
• 4. radiation oncologist
• 5.medical oncologist
 CONTI....
• 6.PET and Nuclear medicine HOD
• 7.radiology department HOD
• 8. pathology department HOD
• 9.nursing department HOD
• 10.manager quality department
• 11. executive medical service secretary
 PROCEDURE FOR NURSING AUDIT
i) Formulation of nursing audit committee consisting of Chairman
(e.g. senior nurses) and 3-4 members (supervisors/head nurses)
ii) Committee should meet once a month to audit records of
patients discharge during that time.
iii) Chairman would assign the number of charts each member will
audit. Steps out lined for evaluation/auditing are:
 Visit the unit to complete the evaluation form compile the score
for each patient
 Meet the committee to discuss the finding.
VI) Member should be very honest and impartial in
their judgment. Aconfidential note should be sent to
the individual if something very outstanding has been
recorded.
v) Review of audit is done by the members of the
committee, compiled and submitted to the authorities
with recommendations for future action.
 TRAINING FOR AUDITORS SHOULD
INCLUDE THE FOLLOWING
• a. A detailed discussion of the seven components.
• b. A group discussion to see how the group rates t he care
received using the notes of a patient who has been
discharged, these should be anonymous and should reflect
a total period of care not exceeding two weeks in length.
• c. Each individual auditor should then undertake the same
exercise as above. This is followed by a meeting of the
whole committee who compare and discuss its findings,
and finally reach a consensus of opinion on each of the
components.
AUDIT CYCLE
AUDIT CYCLE
 STEPS OF AUDIT CYCLE ARE
Step 1 define the standards
• standards comprise two elements that define the contest for
care and a third which show how care is delivered.
• structure environment and elements required to delivered
care that is policy procedure clinical setting equipments
record keeping systems etc
• process professional elements required to deliver the care
that is ksfin GN guidance
• outcome measurable elements demonstrating result of care
that is leg ulcer healing time breastfeeding duration
Step 2 to measure current practice with in the selected
topic a baseline enquiry is carried out to identify
problems require a solution to improve the quality of a
patient care

Step 3 identify gaps in a service provision

• Step for decide an implement action this is the
hardest area to address the involvement the input
from the whole team and action plan needs to be
developed
STEPS 5 REVIEW STANDARDS
• If the standards is easily met ,does it need to be
raised?
• Is the standard too high?
• What are the future need
 USES OF NURSING AUDIT
For Nursing Care Services
• It helps in modifying nursing care plans and nursing care pro-cess; implementing a programme
for improving docu-mentation of nursing care through improved charting policies; focusing
attention, weak-nesses identified; nursing round and term conferences, and designing
responsible orientationand in-service educationprogramme.
For Nursing Administrator:
• Providing evaluation of particular programme, such as orientation of personnel or
establishment of a patient teachingprogramme; support for financing a particular
programme;serving as basis for planning new programmes; identification of areas of strength
and weakness in various settings;determining the influence of varied staffing patterns.
For Supervisors and Head Nurses:
• Identifying areas of needed patient care improvement; providing basis for in-ser-vice
education programme, and identifying needs of staff members who gives direct care to patient.
For Staff Nurses:
• It provides a self examination of care; identi-fies a particular type of care in which practice
may be improved merely by increased attention and identifies types ofcare on which
improvement will depend.
SCOPE OF AUDIT
 SCOPE ARE
The Agency is expected to support in the performance of the following broad
functions;
1.MEDICAL AUDIT
Scope
A. The scope of medical audit under the Scheme shall focus on ensuring
comprehensiveness of medical records and shall include but not be limited to:
1. Completeness of the medical records file.
2. Evidence of patient history and current illness.
3. Operation (OT) Notes (if surgery is done).
4. Patient progress notes from admission to discharge.
5. Pathology and radiology reports.
• B.If at any point in time the SNA issues Standard
Treatment Guidelines for all or some of the medical/
surgical procedures, assessing compliance to Standard
Treatment Guidelines shall be within the scope of the
medical audit. Standard Treatment Guidelines in
reference to package is available at AB PMJAY official
site.
 2.HOSPITAL AUDIT
a. The ISA will conduct hospital audit for every single private EHCP at
least four times (or more in hospitals with high inflow of claims 6 visit
for hospitals with no. of claims per month (State Nodal Agency will
share as per no. of claims later as it is dynamic in nature) in a year.
b. Hospital audit shall be conducted as per the format given by the
state.
c. Hospital audit will focus on compliance to EHCP’s obligations for
empanelment like operational help desk, appropriate signage of the
Scheme prominently displayed, etc. details of which are captured in
audit format by State Nodal Agency
3. REGULAR ANALYSIS OF CLAIMS (DATA-BASED)

• Monthly analysis of claims data is to be carried out and

different report preparation i.e hospital wise cases,
mortality rate etc. This is to be done by shifting through
claims data, flagging such service providers and
subjecting them to audits with a view to correcting past
shortcomings and ensuring course-corrections for future.
This report must be the part of the online portal which will
be created by the selected agency.
 4. FIELD SURVEY FOR USERS'
EXPERIENCE
• To conduct in-depth interviews and field surveys of the
beneficiaries (home visit) who have availed treatment under the
scheme. The underlying objective of this questionnaire-driven
audit is to not only ascertain the nature of treatment received by
them but also to highlight deficient services or malpractices, if
any. The tool for the survey and sampling method will be
mutually agreed upon between the department and the chosen
organizations. 3% of total claims of previous month cases will
be given by SNA for this purpose. (maximum of one claim per
beneficiary). Format will be provided by State Nodal Agency
 5. DEATH AUDIT
• The ISA will do in-depth audits of 100% mortality cases
under the schemes and submit a report to the State Nodal
Agency. The death cases will be given through
Transaction Management System AB PMJAY, the death
audit must be completed within the specified TAT.
 RESEARCH STUDY
I study was conducted to analyse current audit practice and identify improvement
for incorporation in the newscast clinical audit tool kits for mental health published
material relating to the central Nottinghamshire Psychiatric nursing audit like a
psychiatric nursing monitor standard for a care and practice achievable standard of
care quartz and quest are used the result show that 5 of the symptoms fail to
specify some important elements of the audit process consulting the six system can
be divided into the two main types is instruments like a system design along the
psychiatric lines and which emphasize the distance between the two subject of the
audit and the operation operators of the systems and “tool like” a symptoms which
of the exploit opportunities for care setting staff to engage in the audit process the
third type of systems in the locally developed system which is offered to a wider
audience but which does not make the same level of plane to universal applicability