Here is a clear, organized explanation of Nursing Audit based on the textbook pages you've shared (Chapter 43, Safety Protocol, Unit 5):
Nursing Audit
Definition
A nursing audit is the process of analyzing data about the nursing process of a patient's outcome in terms of health, in order to evaluate the effectiveness of nursing intervention.
- Elison defines it as: "Nursing audit refers to assessment of the quality of clinical nursing."
- It is also described as a means by which nurses themselves can define standards from their point of view and describe actual nursing practice.
Purposes of Nursing Audit
- Helps in evaluating nursing care given by nurses using standardized audit forms.
- Motivates and stimulates nurses to understand the importance of meticulous documentation, leading to better maintenance of nursing records and reports.
- Was designed to measure quality care and identify where improvement is needed in nursing practice.
- Gives an opportunity to evaluate nursing care against set standards.
- Contributes to nursing research by evaluating trends in care through systematic collection of facts - allowing new strategies to improve nursing care.
Types of Audit
There are two main types:
1. Concurrent Audit
- Evaluates ongoing/active care through appraisal of the nursing process.
- Benefits:
- Identifies and meets client needs during the care process.
- Helps implement measures for fulfillment of professional responsibilities.
- Provides a mechanism for communicating on behalf of the client.
- Limitations:
- More time-consuming and costly than retrospective audit.
- Does not present the total picture of care the client will receive.
2. Retrospective Audit
- Evaluates the entire nursing care of the patient through records after discharge from the healthcare system.
- Benefits:
- Compares actual practice to standards of care.
- Gives a total picture of care provided.
- Renders data for making future improvements.
- Limitations:
- Evaluation is directed away from ongoing care.
- Problems are identified only after discharge - no room for improvement during care.
- Can only help picture clients after the fact.
The Audit Process
Audit is conducted by an audit committee comprised of experts from clinical and education fields. The committee:
- Sets criteria for audit.
- Assesses nursing care in selective clients.
- Meets once a month to audit records (retrospective audit).
- The chairperson assigns number of charts to each member.
- A confidential report is compiled and submitted to authorities.
Six Steps (Lancaster, 1988):
| Step | Action |
|---|
| 1 | Selection of a topic for audit |
| 2 | Explicit criteria selected for quality care |
| 3 | Review of records |
| 4 | Peer review of all cases that do not meet criteria for quality care |
| 5 | Recommendations to correct deficiencies |
| 6 | Follow up of problems |
(See Flowchart 43.1 in your textbook for the visual diagram of this cycle.)
Classification of Audit
Audits are classified based on what is being measured:
| Type | What It Measures |
|---|
| Structure Audit | Physical facilities, equipment, and supplies against set standards |
| Process Audit | The care provided by the nurse |
| Outcome Audit | Results of specific nursing interventions |
Audits can also be classified by who performs them:
- External audit - done by an outside agency.
- Internal audit - done by the health agency itself.
Summary
In a nutshell, nursing audit measures the quality of nursing care actually given to patients. Appraisal is done through records after the patient is discharged. Audit findings suggest improvements in care, and nurses can take initiative to develop and modify the system of care according to set standards.