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Nursing Audits
Business
problem
Nurses audit medical records in every inpatient unit to ensure high-quality
patient care and compliance with accreditation standards. We needed
a tool to capture audit results for reporting and to ensure that
the correct audits were done in each unit in the correct timeframe.
What
it does
The nursing audit tracking tool provides:
-
overview of an inpatient unit's audit status for the current period
- forms
to create or edit a patient audit
- forms
to create or edit a hand hygiene audit
- tools
to manage the lists of units to audit and the audit schedule
Unit
status
To determine which audits remain to be completed for any unit, a nurse
selects the unit from the list of all inpatient units. An overview
of all required audits for that unit during that period is displayed,
with any audits due highlighted in red (shown below).
[Click
the image above to see the full size image]
Selecting
any link in the form brings the nurse to the patient
selection form for that unit (the same form used when
adding a new audit). A specific patient may be selected by inputting
name or medical record number, or by searching with no criteria,
which displays a list of all current patients (shown below).
[Click
the image above to see the full size image]
Selecting
a patient from the list (above) opens the
audit tool with the selected audit already exposed (shown
below).
| Note:
if the maximum number of audits for any category has already
been performed, that category cannot be selected. |
[Click
the image above to see the full size image]
- Answering
"Yes" for any category completes that audit.
-
Answering "No" for the category exposes
any additional items to be audited (shown below).
[Click
the image above to see the full size image]
Most
categories have a simple list of items to be audited (shown below).
[Click
the image above to see the full size image]
Certain
categories have multiple sub-categories
(shown below)
[Click
the image above to see the full size image]
Selecting
a sub-category
exposes the choices for that sub-category (shown below).
Modifying
an audit
Completed audits for the current month may be modified by searching
the database of audits. Any combination of criteria may be used;
simply selecting a start date will list all completed audits for
the unit (shown below).
[Click
the image above to see the full size image]
Observational
audits
Other types of audits are being added to the tracking tool. The
first was a hand hygiene audit (shown below).
Audit
schedule
Application administrators control the audit process by selecting
the months when each type of audit must be performed (shown below).
[Click
the image above to see the full size image]
Unit
configuration
Application administrators also control the audit form used for
each unit, selecting from a list of available forms (shown below).
[Click
the image above to see the full size image]
Permissions
Application administrators also control access levels for each unit.
- "User"
permissions are granted for specific units by the manager of that
unit; users may submit an audit for that unit.
- "Manager"
may submit audits, assign other managers/users, and receives monthly
unit status report. Responsible manager is automatically assigned
by automated process.
- "Superuser"
holds user privileges AND may enter/view observational audits.
- "Admin"
holds superuser privileges AND maintains quarterly audits and
assigns permissions.
Reminders
Unit managers receive an automated e-mail reminder one week prior
to the end of each month if there are any missing audits for that
unit (shown below).
Reports
Monthly reports are automatically produced and published on the
intranet for each audit category. A sample of one report is reproduced
below.
[Click
the image above to see the full size image]
Outcomes
- Nursing
audits are completed with the least possible effort and on a timely
basis.
- Excellent
results from a recent Joint Commission accreditation survey.
Lessons
learned
- The
operating department(s) must devote adequate resources to implement
a new process. It took two tries to successfully implement nursing
audits. A major reason for the failure of the first attempt was
that adequate nursing resources were not assigned to auditing.
- A
significant amount of application development rework should be
expected when a new process is designed and automated simultaneously.
Changes in the underlying process are inevitable, and these will
trigger revisions in the automated process. In the real world
this cannot be avoided when the new process must be brought on
line as quickly as possible.
Posted 26 November 2008
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