Audit of Nursing Care Quality at Dr. Slamet Hospital

Rohmah Susanto

, Ati Surya Mediawati

, and Kurniawan Yudianto

Department of Nursing, Faculty of Health Science, University of Muhammadiyah Malang, Jalan Bendungan Sutami No

188A, Malang, Indonesia

Faculty of Nursing, Padjdjaran University, Jalan Raya Bandung-Sumedang KM 21, Bandung, Indonesia

Keywords: In house training, audit, quality, care, nursing.

Abstract: Audit of nursing is the assessment of clinical nursing quality evaluation which is a professional effort for the

quality of nursing service records held by the nursing and the nursing profession. Based on PMK No. 49 of

2013, that the quality audit of Nursing Care and Midwifery Care is carried out by the Nursing Committee

through the Professional Quality Sub Committee. This study aims to determine the effectiveness of In-

House Training audit of nursing care quality at RSUD Dr. Slamet Garut. The study is a cross sectional study

with descriptive design, the variable in this study was nurses' knowledge of the audit of nursing care quality,

a sample of 35 nurses using a purposive sampling technique. The instrument used a questionnaire to

determine the level of nurses' knowledge about auditing the quality of nursing care. Assessment of pretest

and posttest performed before and after the implementation of In-House Training. Technique data analysis

using t-test to determine the effect tifitas before and after activities. The results showed an increase in

knowledge about the audit of nursing care nurse from a mean value of 38.71 to 74 .33 statistical test p value

= 0.00 (p <a), the conclusion of an increase in knowledge of nurses about the quality of nursing care after an

audit carried out In House Training. This was also shown by the mean post test scores which were higher

than the mean pretest scores.

1 INTRODUCTION

Health development in the field of hospital services,

aims to improve the quality and efficiency of the

implementation of integrated health referrals and to

improve and strengthen the management of health

services which includes planning, implementing,

monitoring, controlling and evaluating activities.

The development of socio-cultural changes in

society and the development of science and

technology, as well as increasing public knowledge

about health followed by community demands for

better health services requires health care facilities to

improve continuously in line with developments in

the community. Development is carried out in stages

in order to improve the quality of health services in

hospitals. If the hospital does not prepare itself in an

effort to improve the quality of services, the facility

will be shunned by the community and the

community will seek better health facilities.

Hospitals must improve their appearance in a

planned manner in accordance with the needs and

demands of the community in order to continue to

grow.

One effort to improve the order of each service

facility in hospitals is to improve the quality of

service in all service units, both in medical service

units, medical support services, nursing services or

in administrative and management service units

through a quality assurance program. These quality

improvement activities can be carried out with

various approaches or quality activities, including by

developing Quality Control Groups, Integrated

Quality Control, Compilation/ Application of service

standards or service provision in hospitals.

Hospital Service Quality is the degree of perfection

of Hospital services to meet the needs of the

community/ consumers for health services in

accordance with professional standards and

professional service standards by using the potential

resources available in hospitals in a reasonable,

efficient and effective manner and provided safely

and satisfactorily according to norms, ethics, law

and socio-culture, taking into account the limitations

and the ability of the government and society as

consumers.

Susanto, R., Mediawati, A. and Yudianto, K.

Audit of Nursing Care Quality at Dr. Slamet Hospital.

DOI: 10.5220/0009125101330136

In Proceedings of the 2nd Health Science Inter national Conference (HSIC 2019), pages 133-136

ISBN: 978-989-758-462-6

133

In order to improve the quality of hospital services,

it is arranged in the form of comprehensive and

integrative activities concerning the systematic and

continuous structure, process and output / outcome ,

monitoring and assessing the quality and fairness of

services to patients, using opportunities to improve

patient services and solve problems that occur so

that the services provided at the hospital are efficient

and effective. Efforts to improve quality in hospitals

aim to provide care or the best service to patients.

One effort to guarantee the quality of health

services is the concept of clinical governance.

Activities to implement the basic concept of clinical

governance consist of clinical audit activities,

providing clinical data of good quality, outcome

measurement, evidence based clinical risk

management, poor clinical performance

management, and mechanisms for monitoring

service outcomes. Clinical audits include medical

audits and nursing audits, the implementation of

medical and nursing audits is now increasingly

important not only in terms of benefits but also

medical and nursing audits as one of the hospital's

accreditation instruments. A clinical audit is carried

out to maintain and improve the quality of clinical

services continuously to patients.

According to Elison, the nursing audit

specifically refers to the assessment of the quality of

clinical nursing which is a professional evaluation of

the quality of nursing services provided to patients,

using nursing records and carried out by the nursing

profession. Internal nursing audits are carried out by

professional organizations within institutions where

nursing practice is conducted, external nursing

audits are carried out by professional organizations

outside the institution.

Based on PMK No. 49 of 2013 concerning the

Hospital Nursing Committee, that the quality audit

of Nursing and Midwifery Care is carried out by the

Nursing Committee through the Professional Quality

Sub Committee, which includes case audits (nursing

incidents; based on events that occur during the

nursing care service process), and clinical audits

nursing (carried out periodically and planned) .

Based on preliminary studies through interviews

with the nursing committee team, that the audit of

nursing care has not been carried out optimally at

Dr. Slamet Hospital, this is related to human

resource constraints. Interest in this research is to

know P: What Knowledge Q nurses on Audit

Quality Nursing Care in Dr. Slamet Hospital.

According to the National Academic Institute of

Medicine (IOM) the quality of health services is the

degree to which health services for individuals and

populations increase the probability of desired health

outcomes and are consistent with current

professional knowledge. This definition highlights

several aspects of quality. First, high-quality health

services must achieve the desired health outcomes

for individuals who are in accordance with diverse

choices. Second, health services must achieve the

desired health outcomes for the population in

accordance with applicable regulations on the

efficiency of policy makers and third-party payers.

Finally, health services must conform to professional

standards and scientific evidence, consistent with the

effectiveness of clinical focus and health care

providers.

According to The Centre of Clinical Governance

Research in Health (2009) audit instruments can be

in the form of checklists, reviews of nursing care,

and computer software programs that have been

developed to improve quality, accuracy, and make

time effective.

The scope of the nursing audit includes audit

structures that focus on facilities, equipment,

officers, organization, procedures and reporting

records. The audit process is an assessment of the

implementation of nursing care whether carried out

according to standards. The audit process uses a

retrospective approach by measuring the quality of

nursing care after the patient returns or after several

patients are treated (Swansbrug, 1990). Audit results

done Concurrent or Retrospective which is based on

the concept of Henderson so that nursing care will

be given to produce data patient’s needs are met,

patient have the knowledge to meet their needs,

patient have the skills and abilities, motivated.

Ability that must be possessed to conduct audits,

among others: Selecting and establishing audits, as

well as establishing criteria and standards, selecting

populations, samples, and collecting data,

Conducting descriptive analysis of nursing audit

results, Planning changes and improvements in

nursing audits, Planning reaudits nursing, a simple

statistical test.

2 METHODS

This research is a quantitative research with a

descriptive design where the variables in this study

are nurses' knowledge about nursing care audits. The

population in this study were nurses in charge of

conducting audits of the quality of nursing care in

each treatment room of Dr. Slamet Hospital as many

as 50 people, the sample in this study were 35 nurses

with purposive sampling technique. The instrument

HSIC 2019 - The Health Science International Conference

134

used a questionnaire of 30 questions to determine

the level of nurses' knowledge about nursing care

audits related to: selecting and establishing audits, as

well as determining criteria and standards, selecting

populations, samples, and data collection, carrying

out descriptive analyses of nursing audit results,

planning changes and improvements in nursing

audits, planning nursing re-audits. Observation sheet

to see the ability of nurses in data processing

applications in Microsoft Excel. Assessment of pre-

test and post-test performed before and after the

implementation of the In-House Training held for 3

days, with lectures, discussions, direct practice of

nursing care quality audit on the status of patients

who have already gone home. Data analysis

techniques used t-test to determine the effect before

and after holding In House Training.

3 RESULTS AND DISCUSSION

Characteristics of respondents by Education level

and Gender can be found in table 1 below.

Table 1: Demographic characteristic of nurse.

Characteristic

N (%)

Level of education

- Diploma

- Bachelor

20 (57)

15 (43)

Gender

- Male

- Female

11 (31)

24 (69)

Figure 1: Nurses' knowledges about auditing the

quality of nursing care.

The results showed that most of nurse gained

diploma for their education and most of nurse are

female nurse. Also, nursing ability in a data

processing application using Microsoft Excel

accounted 10 people from 35 nurses. The average

pre-test value of 35 nurses is 38.71 with a mean of

12,650, while the post-test mean value is 74.33 with

a mean of 11,800. In addition, the statistical test

results obtained p value = 0.00 (p <a), so it can be

concluded that there is an increase in nurses'

knowledge about the audit of nursing care quality

after stabilization in the form of In-House Training.

It is also shown by the average post-test value which

is higher than the average pre-test value.

This shows that In House Training activities are

effective in increasing nurses' knowledge and

abilities in conducting audits of nursing care quality,

so that these activities are expected to continue and

be followed up in order to increase nurses

knowledge and abilities, so as to produce accurate

audit data in order to make improvements

improvement of nursing care services which in turn

can improve the quality of nursing services at Dr.

Slamet hospital.

4 CONCLUSIONS

Based on the research it can be concluded that there

is an increase in nurses' knowledge in conducting

audits of the quality of nursing care, which is

indicated by the average post-test scores higher than

the average pre-test scores. The suggestion for the

hospital is to make a routine agenda of In-House

Training activities in increasing the knowledge and

abilities of nurses, especially about auditing nursing

care, because there are many other nursing audit

topics.

ACKNOWLEDGEMENTS

The author would like to thank those who have

helped a lot in the preparation of this scientific work

Ladies and Gentlemen at the Faculty of Health

Sciences of UMM and Faculty of Nursing

Padjadjaran University.

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