ppt nursing audit - role of nurse manager

nursing audit

1. S.QUEENMARY
M.Sc(N),
Global kasturbacollege of Nursing,
Hyderabad

3. MEANING
Quality-ajudgmentofwhatconstitutesgoodorbad.
Audit-a systematic and critical examination to
examine or verify.

4. DEFINITION
Nursing audit-
(a)Itistheassessmentofthequalityofnursingcare.
(b)Usesarecordasanaidinevaluatingthequality
ofpatientcare.

5. CONT…….
According to Elison
"Nursing audit refers to assessment of the
quality of clinical nursing".
According to Goster Walfer
a.NursingAuditisanexercisetofindout
whethergoodnursingpracticesarefollowed.

6. PURPOSES OF NURSING AUDIT
*ToEvaluatenursingcaregiven.
*Achievesdeservedandfeasiblequalityofnursingcare
*Verification.
*FocusesoncareprovidedandNotoncareprovider
*Contributestoresearch
*Reviewofprofessionalwork.

7. CONT………
*Itencouragesfollowerstobeactivelyinvolvedinthe
qualitycontrolprocessandbetterrecords.
*Itclearlycommunicatesstandardsofcareto
subordinates.
*Facilitatesmoreefficientuseofhealthresources.
*Helpsindesigningresponseorientationandin-service
educationprogramme.

8. TYPES OF AUDIT
1INTERNALAUDITING
2.EXTERNALAUDITING
3. FINANCIAL AUDIT
4. OPERATIONAL AUDIT

9. CONT………
5. Department Review
6. Integrated Audit
7. Investigative Audit
8. Follow- up Audit

10. Methods of Nursing Audit
There are three methods:
a.Retrospective review
b.The concurrent review
c. Peer review

11. CONT………
1.Retrospectivereview-thisreferstoanin-depth
assessmentofthequalityafterthepatienthasbeen
discharged,havethepatientscharttothesourceofdata.

12. CONT………
2.Theconcurrentreview-thisreferstothe
evaluationsconductedonbehalfofpatientswhoare
stillundergoingcare.Itincludesassessingthepatientat
thebedsideinrelationtopre-determinedcriteria,
interviewingthestaffresponsibleforthiscareand
reviewingthepatientsrecordandcareplan.

13. CONT………
3. Peer review
 Innursepeerreviewnursesfunctioninginthesame
capacitythatispeer’sappraisethequalityofcareorpractice
performedbyothersequallyqualifiednurses.Thepeerreviewis
basedonpre-establishedstandardsorcriteria.
Therearetwotypesofpeerreviews.Individualandnursingaudit
a)Individualpeerreview:focusesontheperformanceof
anindividualnurse
b)Nursingaudit:focusesonevaluatingnursingcare
throughthereviewofrecords.

14. PROCESS OF NURSING
AUDIT
A)Setthekeycriteria(item)
B)PrepareAuditProtocol
C)DesignTheTypeOfTool

15. CONT…………
D) Plan and implement the tool:
E) Recording/ Analysis, concluding
F) Using Results

16. The Audit Cycle
THE AUDIT
CYCLE
1. DEFINE THE STANDARDS
5. REVIEW
STANDARDS
2. MEASURE CURRENT
PRACTICE
3. IDENTIFY GAPS
4. DECIDE AND
IMPLEMENT ACTION

17. AUDIT CYCLE
Step1:DefinetheStandard
1.Structure–environmentalelementsrequiredtodeliver
care.E.g.policy,procedures,clinicsetting,equipment,
recordkeepingsystemetc.
2.Process–professionalelementsrequiredtodeliver
care.

18. CONT…………
3.Outcome–measurableelementsdemonstratingresults
ofcare.E.g.Legulcerhealingtime,breastfeeding
duration,immunizationlevels,smokingcessation,
dyingathome,asthma/diabeticstability,pressureulcer
prevalenceetc.
Theelementscontaincriteria,whichshouldbeReliable,
Understandable,Measurable,Behaviourableand
Acceptable

19. CONT…………
Step2:Measurecurrentpracticewithintheselected
topic
Abaselineenquiryiscarriedouttoidentify
problemsrequiringasolutiontoimprovethequality
ofpatientcare.
Step3:Identifygapsinserviceprovision

20. CONT…………
Step4:DecideandImplementaction
•Thisisthehardestareatoaddressand
involvestheinputfromthewholeteam.
*Anactionplanneedstobedeveloped.

21. CONT…………
Step5:Reviewstandards
*Ifthestandardiseasilymet,doesitneedtoberaised?
*Isthestandardtoohigh?
*Whatarethefutureneeds?

22. PREREQUISITES OF
NURSING AUDIT
:Audit Committee
*seniornursesasmemberstodonursingaudit.
•minimumoffivemember
-
Client care coordinators
-Supervisors
-Head nurses
-Clinical specialists
-Nurse clinicians
-Licensed practical nurses
-Nursing assistants
-Other client care personnel
-Medical records administrator
visors
-Head nurses
-Clinical specialists
l

23. Audit as a Tool for Quality Control
1.Outcomeaudit
Outcomesaretheendresultsofcare;thechangesin
thepatientshealthstatusandcanbeattributedto
deliveryofhealthcareservices.Outcomeaudits
determinewhatresultsifanyoccurredasresultof
specificnursinginterventionforclients.Theseaudits
assumetheoutcomeaccuratelyanddemonstratethe
qualityofcarethatwasprovided. Exampleofoutcomes
traditionallyusedtomeasurequalityofhospitalcare
includemortality,itsmorbidity,andlengthofhospital
stay.

24. CONT………
2.Processaudit
Processauditsareusedtomeasuretheprocessofcare
orhowthecarewascarriedout.Processauditistask
orientedandfocusonwhetherornotpracticestandards
arebeingfulfilled.Theseauditsassumethata
relationshipexistsbetweenthequalityofthenurse
andqualityofcareprovided.

25. CONT………
3.Structureaudit
Structureauditmonitorsthestructureorsettingin
whichpatientcareoccurs,suchasthefinances,
nursingservice,medicalrecordsandenvironment.
Thisauditassumesthatarelationshipexistsbetween
qualitycareandappropriatestructure.
Theseaboveauditscanoccurretrospectively,
concurrentlyandprospectively.

26. ADVANTAGE OF NURSING AUDIT
1.methodtomeasureallareasofnursing
2.Scoringsystemisfairlysimple
3.Resultseasilyunderstood
4.Assesstheworkofallthoseinvolvedinrecordingcare
5.usefultoolinqualityassuranceprogrammeinareas
whereaccuraterecordsofcarearekept

27. CONT………
6)Enablestheprofessionalgrouptohighlightthe
deficienciesandhowgoodtheyareingivingcare.
7)Betterplanningcanbedone.
8)Helpsinreallocationofresources.
9)Administratorsarealsosurethatpatientsaregetting
qualitycare.

28. DISADVANTAGES OF NURSING AUDIT
1)Appraisestheoutcomesofthenursingprocess,soitis
notsousefulinareaswherethenursingprocesshas
notbeenimplemented
2)Manyofthecomponentsoverlapmakinganalysis
difficult
3)Istimeconsuming
4)Requiresateamoftrainedauditors

29. CONT………
5)Dealswithalargeamountofinformation.
6)Onlyevaluatesrecordkeeping. Itonlyservesto
improvedocumentationnotnursingcare.
7)Medicallegalimportance.
8)Theprofessionalsfeelthattheywillbeusedincourtof
lawasanydocumentcanbecalledforincourtoflaw.

30. ROLE AND FUNCTIONS OF NURSE MANAGER
FOR EFFECTIVEQUALITY CARE:
RolesofNurseManager
1.Encouragesfollowers..
2.Clearlycommunicatesstandardsofcareto
subordinates.
3.Encouragesthesettingofhighstandards.4..Implementqualitycontrolproactively.

31. CONT………
5.Usescontrol.
6.Positivelyactiveincommunicatingqualitycontrol
finding.
7.Actsasarolemodel.

32. CONT……
FunctionsofNursemanager:
1.Inconjunctionswithotherpersonnelinthe
organizationestablishesclearcut,measurable
standardsofcareanddeterminesthemostappropriate
methodsformeasuringifthosestandardshavebeen
met.
2.Selectsandusesprocess,outcomeandstructureaudits
appropriatelyasqualitycontroltools.

33. CONT……
3.Assessesappropriatesourcesofinformationindata
gatheringforqualitycontroltools.
4.Determinesdiscrepanciesbetweencareprovidedand
unitstandardsandseeksfurtherinformationregarding
whystandardswerenotmet.
5.Usesqualitycontrolfindingsasameasureof
employeeperformanceandrewards,coaches,counsels
ordisciplinesemployeesaccordingly.
6.Keepsabreastofcurrentgovernmentandlicensing
regulationsthataffectqualitycontrol.