INTRODUCTION TO SUSTAINABLE DEVELOPMENT GOALS

For nearly 15 years, the Millennium Development Goals (MDGs) have been a guiding force on many issues affecting the lives of children, young people and their families.  Much progress has been made in reducing preventable child deaths, getting more children into schools (including girls), reducing extreme poverty and in ensuring more people have access to safe water


The Millennium Development Goals (MDGs) – which have proved highly successful in rallying public, private and political support for global poverty reduction and provided an effective tool to stimulate the production of new poverty-related data and additional aid commitments – are set to expire at the end of 2015. Consequently, the international community and stakeholders around the world are currently engaged in a process to negotiate a new global framework to eradicate poverty - the Post-2015 Development Agenda.
 With the MDGs era coming to an end this year the world has a historic opportunity to set a course for the next era of human development that is transformational for both people and planet.  Already millions have been involved in crafting what this new sustainable development agenda will look like: governments, civil society, the private sector, academia, the UN system, concerned individuals and others.
This new agenda will define a vision of how the world should look in 2030; a bold, courageous narrative of an integrated sustainable future where no one is left behind. The framework will also include a new set of global goals, targets and indicators to incentivise and measure progress – the sustainable development goals (SDGs).
 While the MDGs prioritised the social dimension of development, the aim is for the SDGs to embody a comprehensive and integrated approach to development, and to seek to balance sustained socioeconomic growth with the sustainable use of natural resources. In addition, the SDGs will apply to all countries, unlike the MDGs, which served as goals for developing nations only. Building upon the successes and lessons learned from the MDGs, the SDGs are expected to become an important tool for national priority-setting, mobilisation of resources, and the achievement of specific development gains.
  

AUDIT AS A TOOL FOR QUALITY CARE

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

AUDIT AS A TOOL FOR QUALITY CARE

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

PREREQUISITES OF NURSING AUDIT

• 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

ADVANTAGES OF NURSING AUDIT

• 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

DISADVANTAGES OF NURSING AUDIT

• 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.

ROLES 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 determining 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.

FUNCTIONS

• 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.

NURSING AUDIT

Nursing audit- definition, history, purposes, methods, characteristics, process

Nursing services are necessary for every client seeking care of any type, including health promotion, diagnosis and treatment. With the changing trends in the health care delivery, the role of the nurse manager is becoming largely devoted to the holistic care of client which can only achieved through the careful appraisal of the services in order to make further reforms.

Audit

A systematic and critical examination to examine or verify.

Systematic review and evaluation of records and other data to determine the quality of the services or products provided in a given situation.

Nursing Audit

Nursing audit is defined as the evaluation of nursing care in retrospect through analysis of nursing records. It is a systemic format and written appraisal by nurses of the quality of content and the process of nursing service from the nursing records of the discharged patient.

Definition

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. Often a nursing audit and a medical audit are performed collaboratively, resulting in a joint audit

(Mosby’s Medical Dictionary, 8th edition. © 2009, Elsevier)

“Nursing audit refers to assessment of the quality of clinical nursing”   Elison

“Nursing audit is an exercise to find out whether good nursing practices are followed”  Goster Walfer

The audit is a means by which nurses can define standards from their point of view and describe the actual practice of nursing.

Nursing audit is also defined as

.....part of the cycle of quality assurance. It  incorporates the systematic and critical analysis by nurses,midwives in conjunction with other staff , of the planning,delivery and evaluation of nursing ang midwifery care,in terms of their use of resources and the outcome for patients and clients, and introduces appropriate change in response to that analysis                 

BRIEF HISTORY OF NURSING AUDIT

Before 1915- very little was known about the concept.

1918- industrial concern introduced for the beginning of medical audit.

George Groword- introduced the term physician for the first time medical audit.

Ten years later Thomas R Pondon MD established a method of medical audit based on procedures used by financial account. He evaluated the medical care by reviewing the medical records.

1955- First report of nursing audit of the hospital published

Next 15 years, nursing audit is reported from study or record.

The program is reviewed for record nursing plan, nurses’ notes, patient condition, nursing care.

PURPOSES OF NURSING AUDIT

• Evaluation: Evaluating the nursing care given. Achieve deserved and feasible quality of nursing care.
• Verification: Stimulant to better records. Focuses on care provided and not on care provider.
• Contributes to research. Review of professional work or in other words the quality of nursing care i.e. we try to see how far the nurses have confirmed to the norms and standards of nursing practice while taking care of patients.
• It encourages followers to be actively involved in the quality control process and better records.
• It clearly communicates standards of care to subordinates.
• Facilitates more efficient use of health resources.
• Helps in designing response orientation and in-service education programme.

METHODS OF NURSING AUDIT

There are two methods:

• Retrospective View: This refers to an in-depth assessment of quality after the patient has been discharged, and uses the patient’s chart as the source of data.
• Concurrent Review: This refers to the evaluations conducted on behalf of patients who are still undergoing care. It includes assessment the patient at bedside in relation to pre-determined criteria, interviewing the staff responsible for his care and reviewing the patient record and care plan.

ESSENTIAL CHARACTERISTICS OF NURSING AUDIT

There should be:

• Written standards of care against which to evaluate nursing care
• Evidence that actual practice was measured against such standards, sharing a percent conformance rate.
• Examination & analysis of findings.
• Evidence of corrective action being taken.
• Evidence of effectiveness of corrective action.
• Appropriate reporting of the audit programme.

PROCESS OF NURSING AUDIT   

                                         

1. Set the key criteria (item): It should be measurable against identified values, set standard & in terms of desired patient outcome.

Methods to develop criteria are:

• Define patient population.
• Identify a time framework for measuring outcomes of care.
• Identify commonly recurring problems presented by the defined patient population.
• State patient outcome criteria.
• State acceptable degree of goal achievement.
• Specify the source of information

2. Prepare Audit Protocol keeping in mind Audit Objectives, Target groups, Method of information gathering (by asking, observing, checking records), Criterion you are measuring, identify the time framework for measuring outcome of care, identify commonly recurring nursing problems, State acceptable of goal achievement.
3. Design the type of tool: Quality assurance must be a priority. Those responsible must implement a program not only a tool. A co-coordinator should develop and evaluate quality assurance activities. Roles and responsibilities must be delivered. Nurses must be informed about the process and the results of the program. Data must be reliable. Adequate orientation of data collection is essential. Quality data should be analyzed and used by nursing personnel at all levels.
4. Plan and implement the tool: What is to be evaluated? Who is going to collect the information? How many sample in the target group? Time period
5. Recording/Analysis, Concluding: Record the information, Analyze the information, Make a summary, Compare with set standard, Conclusion.
6. Using results : The results aid to modify nursing care plans & the nursing care process, including discharge planning, for selected patient outcome, implementing a program for improving documentation of nursing care through improved charting policies, methodologies & forms, focusing of nursing rounds & team conferences. Focusing supervisory attention upon areas of weakness identified, such as one particular nursing unit or specific employees. Designing responsive orientation & in-service education programs. Gaining administrative support for making changes in resources, including personnel.