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Audit as a Quality Control Tool

Reported By: Jenno Ray Senal

An audit is a systematic and official examination of a rec process or account to evaluate performance. Auditing health care organization provide managers with a me of applying control process to determine the quality o service rendered.

Nursing audit is the process of analyzing data about the nursing process of patient outcomes to evaluate the effectiveness of nursing interventions. The audits mo frequently used in quality control include:

1. Outcome audit - are the end results of care; the chang the patients health status and can be attributed to delivery of health care services.

2. Process audit - are used to measure the process of ca how the care was carried out.

3. Structure audit - monitors the structure or setting in w patient care occurs, such as the finances, nursing servic medical records and environment.

These above audits can occur retrospectively, concurren and prospectively.

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.

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.

According to Elison: "Nursing audit refers to assessment of the quality of clinical nursing". According to Goster Walfer:

a. Nursing Audit is an exercise to find out whether good nursing practices are followed. b. The audit is a means by which nurses themselves ca define standards from their point of view and describ the actual practice of nursing.

Nursing audit is defined as: .part of the cycle of quality assurance. It incorporates the systematic and critical analysis by nurses, midwives and health visitors, in conjunction with other staff, of the planning, delivery and evaluation of nursing and midwifery care, in terms of their use of resources and the outcomes for patients/clients, and introduces appropriate change in response to that analysis

(NHS ME, 1991 Framework for Audit for Nursing

Purposes of Nursing Audit:

1. Evaluating Nursing care given, 2. Achieves deserved and feasible quality of nursing care, 3. Stimulant to better records, 4. Focuses on care provided and not on care provider, 5. Contributes to research.

Methods of Nursing Audit

There are two methods:

a. Retrospective view

This refers to an in-depth assessment of the quality aft the patient has been discharged, have the patients cha 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.

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.

c. Peer Review

In nurse peer review nurses functioning in the same ca that is peers 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 peer reviews:

Individual peer review focuses on the performance an individual nurse. Nursing audit focuses on evaluating nursing care through the review of records.

Advantages of Nursing Audit :

1. Can be used as a method of measurement in all area nursing. 2. Seven functions are easily understood, 3. Scoring system is fairly simple, 4. Results easily understood, 5. Assesses the work of all those involved in recording 6. May be a useful tool as part of a quality assurance programme in areas where accurate records of care kept.

Disadvantages of the Nursing Audit:

1. Appraises the outcomes of the nursing process, so it is not so useful in areas where the nursing process has not been implemented, 2. Many of the components overlap making analysis difficult, 3. Is time consuming, 4. Requires a team of trained auditors, 5. Deals with a large amount of information, 6. Only evaluates record keeping. It only serves to

Role And Functions Of Nurse Manager For Effective Quality Care:

ROLES: Encourages followers to be actively involved in the quality control Process. Clearly communicates standards of care to subordinates. Encourages the setting of high standards to maximize quality instead of setting minimum safety standards. Implement quality control proactively instead reactively. Uses control as a method of detraining why goals were not met. Is positively active in communicating quality control finding.

FUNCTIONS: In conjunctions with other personnel in the organization establishes clear cut, measurable standards of care and determines the most appropriate methods for measuring if those standards have been met. Selects and uses process, outcome and structure audits appropriately as quality control tools. Assesses appropriate sources of information in data gathering for quality control tools Determines discrepancies between care provided and unit standards and seeks further information regarding why standards were not met. Uses quality control findings as a measure of employee

Why do audit?
1. It is compulsory for Stimulative Assessment.

2. It improves quality of care as both an outcome and b the process of performing the audit. 3. It is an aid to continuing medical education. 4. There is a sense of personal and professional achievement.

The educational benefit from audit:

Audit allows a critical review of current information (keeping up to date). Audit highlights the need for specific knowledge/ information, the acquisition of new skills and the development of existing ones. Audit improves communication skills and enables attitudes to be modified when working with other members of the Primary Care Team. Audit enables 'self evaluation'. Audit promotes learning by answering questions.

How to carry out an Audit: The Audit cycle

Define Criteria and Standards Identif Data y Collection Chang es Assess Performance against Criteria and Standards

The four main features of the audit cycle can be analyse to a greater depth.

1. Identify the need for change This may come from personal experience. A problem m be identified from every day practice, and following thi there is a feeling that something could or should have been done better. Problems can be identified in 3 basic areas of Practice work:

Structure: This refers to the input of care such as manpower, premises and facilities. Process: This refers to the provision of care (looking at what is done and how it is done) Outcome: This refers to the result of clinical intervention.

2. Setting criteria and standards A Criterion is an item of care or some aspect of care that can be used to assess quality. The criterion is written as a statement. Below are three criteria one relating to an audit in structure, one an audit in process and one an audit in outcome.

This is where you can say what should be happening

S: All patients requesting an urgent appointment will be seen that day. P: All patients with epilepsy should be seen at least once a year. O: All patients on Warfarin should have their INR within the recommended limits.

To make the criteria (statement) useful the Standard needs to be defined. A Standard describes the level of care to b achieved for any particular criteria. Standards must be set. The level of standard can often be controversial. There are basically 3 options:

A minimum standard. This describes the lowest accepta standard of performance. An ideal standard describes the care it should be possib to give under ideal conditions, with no constraints. An optimum standard lies between the minimum and the idea. Optimum standards represent the standard of care most likely to be achieved under normal conditions of practice.

3. Collecting data on performance Identify what data needs to be collected, how and in wh 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 predetermin 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.

Audit Quality Control Procedures

Checklist Create a checklist for each audit. The checklist can be any format, including a simple "Yes/No" form. Begin by asking a question about current tracking activities. Timing One of the most important aspects of any QMS is the ability to adhere to a schedule. Check to see a schedul in place. Create a way to monitor staff and review meetings.

Process Changes Ask questions about the process for making changes t process. Review procedures and meeting notes or tables of content for past meetings.

Who should be involved in Quality Control

1. Ideally, everyone in the organization should participate in the quality control, because each individual is a recipient of the benefits. 2. Quality control gives employees feedback about their current quality of care and how the care they provide can be improved. 3. Although that it is impractical to expect full staff involvement throughout the quality control

4. Quality control requires evaluating the performance of all members of the multidisciplinary team.

5. All professionals (in the health care team) contribute t patient outcomes and must therefore be considered in th audit process.
6. Patients should also be actively involved in the determination of the organizations quality of care.

7. However, it is important to remember that the quality o care does not always equate with patient satisfaction.

Who Will Be Audited?

Absolutely Everyone whose job affects quality is subj the audit. Which is to say Everyone!

And the farther up the corporate tree you go, the more difficult the audit is. This is because as you go up the tr job duties and responsibilities increase.

Things Everyone Must Know

Know what documentation affects YOU! You must know what documentation applies to your job and know how to check to make sure what you are using. This should have been explained to you when you were trained to do the job.

Know what Training you have had. If you do not know, ASK YOUR SUPERVISOR NOW! Dont wait until the audit

You must follow all documentation that applies to you. says you do something a certain way, you must do it tha way.

General Things To Know and Do

Auditors are NOT trying to test your memory. If you have to look something up in your documentation, tell the auditor. The auditor will then tell you whether to Only answer the auditors question. Do NOT volunteer look up information. Do NOT try to help the auditor with the information or not. additional information.

Answer with the shortest, simplest answer you can th of. If you can answer with a Yes or No, thats all you should do.

Dont try to explain things unless the auditor asks you to. The auditor will ask questions to help him/her understand. Your job is to only answer questions aske Do not tell stories or speculate what may happen.

If there is any documentation which you are using that think or know is not correct, contact your supervisor immediately! Before the audit!