Nursing Audit | CHAPTER 10 | Leadership And Management

Nursing Audit – This book covers the entire syllabus of “Leadership & Management” prescribed by the BNMC for Diploma in Nursing Science & Midwifery Students.

We tried to accommodate latest information and topics. This book is an examination setup according to the teachers’ lectures and examination questions. At the end of the book previous university questions are given. We hope in touch with the pook students’ knowledge will be upgraded and flourished. The unique way of presentation may make your reading of the book a pleasurable experience.

Nursing Audit

Audit is an instrument facilitating quality assurance, which was developed in the 19th century. The nursing audit is similar to an audit performed by accounting departments. It is a process that offers a health agency nursing personnel the opportunity to create and implement standards of nursing care and to examine their own practice in a systemic manner.

(Ref by- I. Clement/Management of Nursing services and Education/24/91)

Definition of Audit:

Audit is an independent appraisal activity within an organization for the review of accounting, financial and other operations as a basis of services to the management.

Or,

An audit is, an objective examination and evaluation of the financial statements of an organization to make sure that the records are a fair and accurate representation of the transactions they claim to represent. It can be done internally by employees of the organization, or externally by an outside firm.

(Ref by- BT Basavanthappa/Nursing Administration/2/317)

Types of Audit:

There are mainly 7 types of audit:

1. Financial Audits

2. Operational Audits

3. Department Audit

4. Information Systems Audits

5. Integrated Audits

6. Investigative Audits or Reviews

7. Follow-up Audits

Definition of Nursing Audit

According to Elison

“Nursing audit refers to assessment of the quality of clinical nursing”.

According to Goster Walfer:

“Nursing audit is an exercise to find out whether good nursing practices are followed”

“The audit is a means by which nurses can define standards from their point of view and describe the actual practice of nursing”.

Or,

“Nursing audit is the systemic, critical analysis of the quality of clinical/community care. It is an official examination of nursing records for the purpose of evaluation, verification and betterment of nursing care”.

Or,

“Nursing audit is a systemic, formal and written appraisal of the quality of the content, and process of nursing service from care records for discharged patients”.

(Ref by- 1. Clement/Management of Nursing services and Education/24/91)

Methods of Nursing Audit

There are two methods:

♦ Retrospective view: This refers to an in depth assessment of the quality after the patient has been discharged, have the patient chart to the source of data.

♦ 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 beside in relation to predetermined criteria, interviewing the staff responsible for his care and reviewing the patients record and care plan.

(Ref by- BT Basavanthappa/Nursing Administration/24/717)

Advantages of Nursing Audit

• Useful method of measuring and assessing in all areas of nursing.
• All functions are easily understood.
• Simple scoring system.
• No difficulty in understanding result.
• Help in determining the work of people involved in recording care.
• A useful tool in a quality assurance program in areas where accurate records of care are kept.

Disadvantage of Nursing Audit

• Not so useful in areas where the nursing process has not been implemented as it assesses only the outcomes of a nursing process.
• Analysis becomes difficult because of overlap in components.
• Demands more time.
• Only trained auditors can handle this
• Detailed information is required.
• Useful for evaluating record keeping and improving documentation process. Does not help in nursing care.

(Ref by- I. Clement/Management of Nursing services and Education/24/91)

Types of Nursing Audit:

1. Nursing management audit: This types is more structure oriented, focusing on administrative aspects of the nurses responsibilities and checking that the health facilities are suitably equipped to provide care.

2. Retrospective audit: This is the evaluation of nursing care by examining the records and charts of discharged patients.

3. Concurrent audit: It is the evaluation of nursing care by the observation and retrospective method during the delivery of care.

(Ref by- I. Clement/Management of Nursing services and Education/2/92)

Purposes of Nursing Audit

• To evaluate the nursing care that is being given
• To achieve deserved and feasible quality of nursing care.
• To lead the keeping of better records
• To focus on care provided and not on the care provider.
• To contribute to research.
• To study the degree of quality patient care against defined criteria.
• To take remedial action towards cost effectiveness.

Characteristics of Nursing Audit:

• Audit looks at the entire process of care including administration and not just at clinical management.
• It compares the care which is actually given with the standard procedures that have been laid down on the care that should be given
• It concentrates on finding solution for the problems identify.

(Ref by- I. Clement/Management of Nursing services and Education/24/92)

Process of Audit for Quality Control of an Organization:

There are six specific steps in the audit process that should be followed to ensure a successful audit.

♦ Requesting Documents

• After notifying the organization of the upcoming audit, the auditor typically requests documents listed on an audit preliminary checklist.
• These documents may include a copy of the previous audit report, original bank statements, receipts and ledgers.
• In addition, the auditor may request organizational charts, along with copies of board and committee minutes and copies of bylaws and standing rules.

♦ Preparing an Audit Plan

• The auditor looks over the information contained in the documents and plans out how the audit will be conducted.

♦ Scheduling an Open Meeting

• Senior management and key administrative staff are then invited to an open meeting during which the scope of the audit is presented by the auditor.
• A time frame for the audit is determined, and any timing issues such as scheduled vacations are discussed and handled.
• Department heads may be asked to to inform staff of possible interviews with the auditor.

♦ Conducting Fieldwork

• The auditor takes information gathered from the open meeting and uses it to finalize the audit plan
• Fieldwork is then conducted by speaking to staff members and reviewing procedures and processes:
• The auditor tests for compliance with policies and procedures. Internal controls are evaluated to make sure they’re adequate.
• The auditor may discuss problems as they arise to give the organization an opportunity to respond.

♦ Drafting a Report

• The auditor prepares a report detailing the findings of the audit. Included in the report are mathematical errors, posting problems, payments authorized but not paid and other discrepancies; other audit concerns are also listed.

♦ Setting Up a Closing Meeting

• The auditor solicits a response from management that indicates whether it agrees or disagrees with problems in the report, a description of management’s action plan to address the problem and a projected completion date.
• At the closing meeting, all parties involved discuss the report and management responses. If there are any remaining issues, they’re resolved at this point.

Benefits/Importance of Nursing Audit

A. Patient: The fundamental principles behind nursing care audit to everyone involved is care.

B. Nursing staff: For nurses, it offers the opportunity to concentrate on areas of care where their skills and efforts can have positive outcomes, a greater sense of achievement, autonomy and responsibility, and it provides a means for self-improvement.

C. Community: The new purchases provide an environment in a hospital which requires practitioner to qualify the work they do. Nursing care audit allows nurses to measure the more intangible aspects of their work, in particular the quality care given to the community.

Ref by- I. Clement/Management of Nursing services and Education/24/92

Definition of Quality Audit:

A quality audit entails a systematic evaluation of a representative sample of the activities and drawing inference on the quality system as a whole. Quality audit is always performed against a documented system.

Types of Quality Audit:

There are three types of quality audits, namely, first party (internal), second party (external) and third party (extrinsic) audits. Let us understand each of these in details.

♦ First party quality audit (Internal audit): when an organization conducts an audit on its own quality system using its own staff/external consultants, the audit is known as first part quality audit or internal quality audit. Important points are: auditing staff must be trained for conducting this exercise and should not bias against the functional department being audited.

♦ Second party quality audit (external quality audit); The second party quality audit is performed by the purchasing organization upon the supplier organization.

The idea here is to have an assessment of the supplier’s processes in order to have confidence that the supplier would be able to supply goods or services of an agreed quality level on a sustained basis. Important point is these audits can be performed by the trained personnel of the purchasing organization or an outside agency hired by them.

♦ Third party quality audit (extrinsic audit); this audit is performed by the certification bodies (ISO registered bodies) on the applicant organization seeking such certification. If these, auditors, after conducting the quality audit on the organization with respect to a standard, find the organization to be worthy enough, the certification is granted to the organization.

Third party audits normally results in the disruption of day-to-day activities of the organization being audited during the duration of the audit. Apart from the registered certification bodies, the third part audit may also be conducted by some government departments dealing with environment and pollution, health and safety, atomic energy etc.

Read more:

• Leadership And Management | Diploma in Nursing Science and Midwifery