Clinical Audit of Procedures and Quality in Pressure Injury Care

This report details a clinical audit conducted to assess the effectiveness and quality of pressure injury care within a healthcare setting, specifically referencing the National Safety and Quality Health Service (NSQHS) standard one: Clinical Governance. The audit, performed by a graduate registered nurse, utilized the Ward Audit tool from the Queensland Department of Health to evaluate clinical safety, quality, and the knowledge of nurses in a general medical ward. The report outlines the background of pressure injuries, the methodology including location, duration, recruitment, ethical considerations, measurement tools, data collection, and analysis. The audit aimed to evaluate nurses' knowledge, assess the quality of care, and recommend improvements. The report includes data analysis, recommendations, and potential dissemination of results, offering a comprehensive overview of the clinical audit process and its implications for enhancing patient care related to pressure injuries.

Running head: CLINICAL AUDIT
CLINICAL AUDIT OF PROCEDURES AND QUALITY IN
PRESSURE INJURY AGAINST NSQHS STANDARD ONE:
CLINICAL GOVERNANCE
Name of the Student
Name of the University
Author Note

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CLINICAL AUDIT
Table of Contents
1.0 Introduction................................................................................................................................2
2.0 Background................................................................................................................................2
3.0 Aim and Objective.....................................................................................................................4
4.0 National Standards.....................................................................................................................4
5.0 Audit Methodology....................................................................................................................5
5.1 Location and Duration...........................................................................................................5
5.2 Recruitment Process, Sample size and Inclusion/ Exclusion Criteria...................................5
5.3 Ethical Considerations and Consent of Participants..............................................................6
5.4 Measurement Tools...............................................................................................................6
5.5 Data Collection......................................................................................................................7
5.6 Data Management..................................................................................................................7
6.0 Data Analysis.............................................................................................................................7
7.0 Dissemination of Results...........................................................................................................8
8.0 Recommendations......................................................................................................................9
References......................................................................................................................................10
Appendix........................................................................................................................................12

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CLINICAL AUDIT
1.0 Introduction
Pressure injury is the factor of health care which can be stated as one of the most crucial
aspect for the care procedure of the immobile patients. The quality of this procedure should be
effectively dependent on the knowledge and the understanding of the care providers. This factor
of care should be done with the consideration of the National Safety and Quality Health Service
(NSQHS) standard one that is the Clinical Governance standard (Safetyandquality.gov.au, 2017).
The audit has been conducted by the graduate registered nurse with the help of the Ward Audit
tool of Queensland Department of Health (Clinical Excellence Queensland, 2018). The audit
helps in the identification of the clinical safety, clinical quality and also the factor of the clinical
knowledge of the nurses in the ward.
2.0 Background
Immobility and the prolonged pressure on a certain area of the skin can cause the
development of the pressure injury or pressure ulcer. The classification of the pressure ulcer is
dependent on the severity of the condition of the injury and the condition of the tissues
underlying the skin layer as well. According to Edsberg et al. (2016), there is a staging system
developed in order to classify the different types of the pressure injuries. Based on the
assessment of the authors it can be stated that the pressure injury can be prevented among the
patient by the proper diagnosis and utilizing different strategies including the mobility and also
the position changing of the patient along with providing proper support to the patient as well.
Roberts et al. (2016), highlighted that the nurses have a primary role in the pressure ulcer
prevention process and they also stated that the factor of the pressure ulcer care is dependent on
the knowledge and the strategies developed by the nurses. However, they also stated that the
factor of the pressure ulcer care would be dependent on the proper patient participation and also

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the acceptance of the patients in these processes of the prevention of this condition. According to
the International Council of Nurses (ICN) the documentation of the nurses play a key role in the
planning and also the management of the nursing care, analysis of patient outcomes and also the
policy development process for the pressure injury care (Icn.ch, 2013).
On the other hand study of Usher et al. (2018), highlighted that the factor of the
knowledge of the pressure ulcer care is very low among the nursing professionals and also the
nursing students. The approximate statistical figure for the amount of who actually know the
factors of the pressure ulcer treatment is 51 percent. Whether the aspects of the attitude towards
the process are high that is 78 percent. Thus on the basis of this result it can be stated that the
factor of the knowledge for the pressure ulcer prevention is low among the nurses. According to
the NSQHS standards the clinicians would be responsible for the partnering with the health care
service and also making decision for service planning, care model development and also
evaluation of the system of care (Safetyandquality.gov.au, 2012). Based on the views of Latimer,
Gillespie and Chaboyer (2017), there are lacking details about the condition of the pressure
injury care in the Australian context. Thus the authors conducted a study on this aspect and
found that the knowledge of the nurses on this context is not satisfactory. On the other hand the
process of the care for the pressure injury is not satisfactory as well as the knowledge is not
adequate among the care professionals. Moreover, it can be seen that the factor of the attitude for
the development of the knowledge and also providing the proper care to the patients with
immobility and pressure ulcer are effectively positive among the nursing students and also the
registered nurses in the country.

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3.0 Aim and Objective
Aim of this audit is to develop the idea about the effectiveness and also the proper quality
of care provided in cases of pressure injury among the Australian context. On the other hand it
will also significant for the recommended change outlining based on the quality of care audit.
 To evaluate the knowledge of the nurses in the process of the pressure injury care.
 To analyse the quality of care in the hospital facilities of Australia.
 To recommend the proper ways to handle the patients with pressure injury and provide
the care properly to the patients as well.
4.0 National Standards
Based on the National Safety and Quality Health Service (NSQHS) standard one that is
the Clinical Governance standard it can be stated that the leaders of the care facility should focus
on the development and improvement of the care facility continuously. On this context it can
also be seen that the process of the quality improvement would be dependent on the patient
centered care and also the factor of the care would be continuous. Moreover, the care facility
should be safe and effective for the patients as well. Thus it can be stated that the process of the
care should be dependent on the continuous advocacy of the patient and also the effective
communication with the patient should be implemented as well. On the context of the pressure
injury the process of the care should also be provided with the consideration of the mobility,
safety of the patient, posture of the patient and also the providence of the facility with the proper
clinical governance. The governance should be considering of the NMBA standards along with
the NSQHS standards. Thus it can be stated that the factor of the audit would be dependent on
this contexts as well.

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5.0 Audit Methodology
Clinical audit is the process that helps in the proper assessment of the care facility and
finding the quality improvement points as well. On this context it can be stated that the factor of
the audit should be done on the basis of the National standards of care. This audit would be a
qualitative data collection and descriptive process. This audit will be done with the help of the
proper observation and analyzing with the help of the Ward Audit tool developed by the
Queensland Department of Health.
5.1 Location and Duration
The audit would be conducted in the general medical ward of Charleville Hospital facility
of Queensland (South West Hospital and Health Service, 2019). The audit would be done with
the help of the observation of the care process utilized by the nurses and also the condition of the
ward in accordance with the admission of the patients and also the quality of the ward as well.
The facility would be assessed with the help of the Ward unit questionnaire tool. The audit
would be done for four weeks. The first week will be comprised of the permission taking process
and also the recruiting the nurses for helping the data collection process along with the
recruitment of the sample population. The second and the third week will be comprised of the
data collection and observation of the ward. The fourth week will be needed for the data analysis
process and the final result development as well.
5.2 Recruitment Process, Sample size and Inclusion/ Exclusion Criteria
Convenient sampling would be the process for the sample recruitment and sample
selection (Etikan, Musa & Alkassim, 2016). The recruitment process is prospective as the sample
population would be selected for the audit process which will be an observation and also the
assessment of the care facility for the pressure injury in the hospital.

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CLINICAL AUDIT
The inclusion criteria for this audit are the registered nurses and the nursing students of
the hospital and the patients over the age of 50. Thus the patients with pressure injury and also
immobility would be the criteria for the inclusion in the population. On the other hand the
exclusion criteria would be patient with mobility and. Based on this inclusion and exclusion
criteria of the sample size would be 50. On the other hand the registered nurse, enrolled nurse
and also the nursing students practicing in the ward would be considered for the sampling as
well.
5.3 Ethical Considerations and Consent of Participants
Before the audit process starting the permission of Research ethics department of
Queensland Health will be taken for the ethical consent of the research project. Moreover, a
consent form will be developed for the consideration of the consent of the nurses and also the
patients before the questioning process. On this context it can be stated that the ethical
consideration would be comprised of the autonomy maintenance of the participants of the audit
program as the personal data should not be spread without the consent of the participants. Other
than this the consent of the participants would be required for proceeding with the audit process
(Roberts, 2015).
5.4 Measurement Tools
The audit would be done with the help of the Ward audit tool questionnaire developed by
the Queensland Department of Health. The audit would be done with the help of the 14 questions
of this questionnaire. The audit team will observe the actions in the ward and based on the
observation the answers of the questionnaires would be developed and the answers would only
be “yes” or “no”. However, there is a descriptive question and also three questions which would
be answered with numerical denominator based on the quality of the ward care facility. Thus this

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questionnaire would be answered with the observation process and also the answers of the
participants as well which will also add some of the qualitative open ended questions in the
questionnaire about the expectation and feelings of the participants.
5.5 Data Collection
The data collection process would be dependent on the observation process in the clinical
ward for the care process of the nurses for the pressure injury. On the other hand the Ward audit
tool questionnaire will be used for the interview of the patients and also the nurses of the ward.
The responses of the nurses would be taken into account as the data collection method. The data
would be collected by the investigators and the helping nurses in the process.
5.6 Data Management
The data collected from the audit tool and also by the observation would be kept
confidentially. The anonymity of the participants would be considered and also maintained. The
data will be kept in separate data storage and the access will only be in the hand of the research
analyst till the publication of the result of the study.
6.0 Data Analysis
The data analysis process will be done with the help of the MS excel software. The data
collected would be segmented in accordance of the gender, age and the objective completed
weekly in this audit procedure. The data analysis process would be the statistical data analysis by
MS excels software. The segmented data will be imported to the MS excel software and the
software will develop different graphical and statistical outcome from the data provided (Metsalu
& Vilo, 2015). Based on the result the recommendation and the conclusion will be developed.

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14%
86%
Gender
Male Female
Figure 1: Gender based sample size percentage
21-30 31-40 41-50 51-60 61-75
0
2
4
6
8
10
12
14
16
Age of Prticipants
Number of Prticipants
Age Range
Number of Participants
Figure 2: Age range of Participants
7.0 Dissemination of Results
After the data analysis process will be done at the end of fourth week of this audit
program the result will be discussed on the basis of the segments of the data collected and also
the observation results. The results will be disseminated among the nurses of the ward for the
better understanding of their flaws and the improvements can be achieved by them as well. The

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final outcome of the result will be assessed with the knowledge development of the nurses in this
process.
8.0 Recommendations
Based on the data and also the literature review it has been found that the issue of the
knowledge and the attitude towards the pressure injury care are not adequate among the nurses.
Hence, based on this assessment two recommendations are as follows:
First recommendation would be the training for the nurses in order to deliver adequate
care to the patients with proper quality. The empowerment or the education for the better clinical
governance development among the nurses would be required with the highest priority. On this
context it can be seen in a study that the nurses have very low amount of knowledge for the
pressure ulcer care and clinical governance that is approximately 51 percent (Usher et al., 2018).
Thus it can be stated that the education for the pressure ulcer care should be provided to the
nurses.
Second recommendation would be the use of the observation record management sheet
for nurses in order to record all the changes among the patients with time. This record sheet will
be helpful in the proper identification of the changes and also the required care for the patients. It
will also help in the proper identification of the specific patient needs as well (Roberts et al.,
2016)

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References
Clinical Excellence Queensland. (2018). Audit tools for National Safety and Quality Health
Service Standards. Retrieved 27 August 2019, from
https://clinicalexcellence.qld.gov.au/resources/audit-tools-national-safety-and-quality-
health-service-standards
Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016).
Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System.
Journal of Wound, Ostomy and Continence Nursing, 43(6), 585–597.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and
purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
Icn.ch. (2013). Pressure Ulcer Prevention. Retrieved 27 August 2019, from
https://www.icn.ch/sites/default/files/inline-files/Pressure_Ulcer_Prevention.pdf
Latimer, S., Gillespie, B. M., & Chaboyer, W. (2017). Predictors of pressure injury prevention
strategies in at-risk medical patients: An Australian multi-centre study. Collegian, 24(2),
155-163.
Metsalu, T., & Vilo, J. (2015). ClustVis: a web tool for visualizing clustering of multivariate data
using Principal Component Analysis and heatmap. Nucleic acids research, 43(W1),
W566-W570.
Roberts, L. D. (2015). Ethical issues in conducting qualitative research in online communities.
Qualitative Research in Psychology, 12(3), 314-325.
Roberts, S., McInnes, E., Wallis, M., Bucknall, T., Banks, M., & Chaboyer, W. (2016). Nurses’
perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study.
BMC nursing, 15(1), 64.

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Safetyandquality.gov.au. (2012). Retrieved 27 August 2019, from
https://www.safetyandquality.gov.au/sites/default/files/migrated/Standard8_Oct_2012_W
EB.pdf
Safetyandquality.gov.au. (2017). Retrieved 27 August 2019, from
https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Safety-and-
Quality-Health-Service-Standards-second-edition.pdf
South West Hospital and Health Service. (2019). Charleville Hospital - South West Hospital and
Health Service. Retrieved 30 August 2019, from
https://www.southwest.health.qld.gov.au/healthcare-facilities/hospitals/charleville-
hospital/
Usher, K., Woods, C., Brown, J., Power, T., Lea, J., Hutchinson, M., ... & Zhao, L. (2018).
Australian nursing students’ knowledge and attitudes towards pressure injury prevention:
A cross-sectional study. International journal of nursing studies, 81, 14-20.

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Appendix
Ward/Unit questions Responses
1.0 Is there evidence that the ward/unit evaluates safety and
quality data (including data from the risk management
system) in order to identify the areas/gaps that need
improvement?
1.1 Is there documented evidence that the ward/unit has a
quality improvement plan that details the improvement
actions taken, based on the gaps identified?
1.2 If Yes: Provide details of the examples of improvement
activities that have been implemented and when.
1.3 If examples of improvement activities: Is there evidence
that they have been evaluated post implementation to
identify an improvement?
1.4 If yes to 1.1: Is there evidence that the workforce knows
of the types of improvement activities that have been
undertaken i.e. have these been communicated and
celebrated?
2.0 Is there evidence that the ward/unit uses clinical
guidelines and pathways that reflect best practice?
2.1 If yes: Is there evidence:
 that audits of patient clinical records related to the use
of clinical guidelines and/or pathways are undertaken
i.e. to demonstrate the guideline/pathway is followed
in patient care?
2.2
That audits of compliance with available clinical
guidelines and/or pathways are undertaken i.e. to
demonstrate the ward/unit uses the suggested
guideline/pathway?
If yes to 2.0: Provide details of the guidelines / pathways
that the ward/unit uses and the audits undertaken to
demonstrate compliance / adherence to them.
3.0 Is there evidence that the ward/unit has mechanisms in
place to identify patients at increased risk of harm?
3.1 If yes: Is there evidence:
 that patient clinical records demonstrate that risk
assessments are completed on admission and during
an episode of care?

• of a management plan that includes an evaluation of
risks and methods of eliminating or reducing identifiable
risks?
• that action plans are implemented for patients
identified at increased risk of harm?
3.2 If yes to 3.1: Provide details on the risk assessments,
action plans and management plan that has been
implemented and when.
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

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Collation of audited patients (This section is only
needed to be used if the data was collected at the
patient level. Enables ward/unit reporting.)
Count of
No. of
patients
who meet
criteria
Count of
Total No. of
patients who
are included
in the
denominator
and audited
Calculate
the %
Numerator
(N)
Denominator
(D)
(N/D*100)
4.0 What is the number of patients who have an Advance
Health Directive that is contained within the patient’s
medical record (if appropriate)? (Gov_Patient_Q1.0 &
Q1.1)
5.0 What is the number of patients/carers who reported
receiving information on how to feedback comments and
concerns to staff? (Gov_Patient_2.0)
6.0 What is the number of patients/carers who reported
receiving information about the Australian Charter of
Health Care Rights? (Gov_Patient_3.0)