Conducting Clinical AUDITS: The GOOD, the BAD, and the UGLY
An AUDIT is a means of gathering information and/or substantiating that an existing intervention in place for patient care, is being utilized effectively. Thorough auditing can help us provide good quality of care and avoid deficiencies from the State. An auditing tool is a template used to outline key areas to look at, to ensure proper care is being provided to the patients.
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Now for the good, the bad, and the ugly.
THE GOOD: Identifying Issues Before Survey
When the supervisor pays attention and conducts a thorough audit, you reap the rewards by having minimal deficiency or no deficiencies in the audited areas. As a result, promoting and improving the quality of patient care.
THE BAD: Scheduled Audits
Some people like to schedule dates and times when to conduct audits. (i.e. conducting Foley Catheter audits every Wednesday on 11-7 shifts). How effective do you think the audit will be? Your 11-7 staff is already aware when you plan to conduct the audit. As a result, they will make sure that everything is in place prior to you coming to the unit on that day to conduct the audit. So, naturally you will have better outcomes. But what happens when State comes for a surprise visit not on said audit day? 😩
Conducting random audits (to be done any day, any shift once per week or month) is the best use of auditing. Staff have no idea when the audit will be done, the same way that they have no idea when the state will arrive at the front door for their annual or complaint survey. That way you can more accurately gage if they are properly following the resident’s plan of care to meet compliance.
THE UGLY: Falsified Audits
Sometimes an audit is done on the same day that State comes into your facility. Yet surprisingly you receive a deficiency for the same concern as said completed audit (yikes). Many times this occurs when supervisors sit in the office and complete audits, without actually setting their eyes on the resident. Sometimes this is done by just making up information, using past information, or more innocently by just placing a phone call to the unit and gathering information, without actually checking its validity. This is unacceptable and inaccurate auditing. For example, let's say in the past two months a splint audit indicated that the resident has been wearing a splint as scheduled. One day, during your rounds you ask the CNA how the resident is doing with the splint use. The CNA responds that they have not seen the splint for over a month, and has been telling the nurses about it. You go back to your office to make sure that the splint audit you saw two days ago was for the same resident you was discussing with the CNA. Lo and behold, it was the same resident. Surprise!
That being said, it is very important that you audit the auditor to avoid such surprises and ensure compliance. Whether you are the Supervisor/Unit Manager auditing the Nurses, or the Assistant Director of Nursing auditing the Supervisor/Unit Manager, or the Director of Nursing auditing the ADNS. Someone must audit the auditor to ensure that the audit is properly being done. Because, auditing is a great tool to keep your facility deficiency free.
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