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Nursing audit- advantages, disadvantages, prerequisites, tool for quality care, role-functions of nurse manager


The audits most frequently used in quality control include outcome process and structure audits.

Outcome Audit

Outcomes are the end results of care; the changes in the patient’s health status and can be attributed to the delivery of health care services. Outcome audits determine what results if any occurred as result of specific nursing intervention for the clients.

Examples of outcomes traditionally used to measure quality of hospital care include mortality, its morbidity, and length to hospital stay.

Process Audit

Process audits are used to measure the process of care or how the care was carried out. Process audit it task oriented and focuses on whether or not practice standards are being fulfilled. These audits assume that a relationship exists between the quality of the nurse and quality of care provided.

Structure Audit

Monitors the structure or setting in which patient care occurs, such as the finances, nursing service, medical records and environment,. This audit assumes that a relationship exists between quality care and appropriate structure. These above audits can occur retrospectively, concurrently and prospectively


  • Audit Committee: Before carrying out an audit, an audit committee should be formed which consists of fair and impartial members including senior nurses as members to do nursing audit. This committee should comprise of minimum five members who are interested in quality assurance, are clinically competent and able to work together in a group.
  • It is recommended that each member should review not more than 10 patients each month and that the auditor should have the ability to carry out an audit in about 15 minutes.

If there are less than 50 discharges per month, all the records may be audited. If there are large numbers of records to be audited, an auditor may select 10 per cent of discharges. The impetus must come from the nursing staff themselves, realizing the benefits to the patients and themselves. A good system of nursing record keeping


  • Can be used as a method of measurement in all areas of nursing.
  • Seven functions are easily understood.
  • Scoring system is fairly simple.
  • Results easily understood.
  • Assesses the work of all those involved in recording care.
  • May be a useful tool as part of a quality assurance programmed in areas where accurate records of care are kept.
  • Enables the professional group to highlight the deficiencies and how good they are in giving care.
  • Better planning can be done.
  • Helps in re-allocation of resources.
  • Administrators are also sure that patients are getting quality care


  • Appraises the outcomes of the nursing process, so it is not so useful in areas where the nursing process has not been implemented.
  • Many of the components overlap making analysis difficult.
  • It time consuming.
  • Requires a team of trained auditors.
  • Only evaluates record keeping.
  • It only serves to improve documentation, not nursing care.\ Medical legal importance. The professionals feel that they will be used in court of law as any document can be called for in court of law.
  • Deals with a large amount of information.



  • 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.
  • Acts as a role model for followers in accepting responsibility and accountability for nursing actions.


  • In conjunctions with other personnel in the organization establishes clear cut, measurable standards of care and determines the most appropriate method 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 performance and rewards, coaches, counsels, or disciplines employees accordingly.
  • Keeps abreast of current government and licensing regulations that affect quality control.