Authors (including presenting author) :
CHIU, PL(1), LI, MN(1), CHAN, PH(1), NG, YSE(1), LEUNG, PMQ(1)
Affiliation :
(1) Nursing Services Division, New Territories West Cluster
Keyword 1: :
Cyclic Nursing Audit
Keyword 2: :
Clinical Governance
Keyword 3: :
Continuous Quality Improvement
Keyword 4: :
Patient Safety
Keyword 5: :
Nursing Standards
Keyword 6: :
Clinical Risk Management
Introduction :
In 2024, the Nursing Services Division (NSD) of NTWC fortified its clinical governance by instituting a structured Cyclic Nursing Audit (CNA) framework. Designed to synergize with the Hospital Authority’s annual nursing audits, this paradigm shift moves from singular, cross-sectional evaluations to a continuous monitoring model. This approach facilitates the pre-emptive identification of clinical risks and ensures robust adherence to evidence-based practices across acute, sub-acute, rehabilitation, and extended care settings.
Objectives :
The primary objective of the CNA is to systematically appraise compliance with Basic Nursing Standards and clinical guidelines on a cyclic basis. The initiative aspires to minimize practice variability, elevate patient safety, and cultivate a culture of professional accountability. Crucially, it aims to generate high-resolution, longitudinal data to propel Continuous Quality Improvement (CQI) initiatives, thereby transcending the limitations of annual benchmarking.
Methodology :
The framework operationalizes an 18-month cycle encompassing over ten distinct clinical domains, executed at six-week intervals. To ensure statistical rigor, the audit design targets a sample size representing approximately 25% of qualified nursing staff. A Core Audit Team—chaired by Cluster General Manager (Nursing) and led by NSD—employs standardised instruments and explanatory notes endorsed by either Coordinating Committee (Nursing) or the Cluster Nursing Management Committee. The audit team comprises Nurse Consultants, Associate Nurse Consultants, NSD officers, Nursing School teaching staff, and Clinical Preceptors. Data analysis prioritizes criterion-wise compliance and the detection of critical failures, utilizing inferential statistics to examine subgroup variations across hospitals and specialties.
Result & Outcome :
Interim analysis of Cycle 1 reveals consistently high adherence to standards. "Medication Administration: Intravenous Infusion" achieved a 99.3% compliance rate (n=483), while "Pressure Injury Prevention" reached 99.9% (n=462). Compliance with "Fall Prevention" standards significantly improved to 99.1% (n=497) relative to historical annual audits. Notably, "Suicidal Risk Assessment" attained 100% (n=475) compliance subsequent to the alignment with updated monitoring instruments. "Oxygen Therapy and Transfer" approached 100% (n=491), with only very minor variances noted in fire safety and infection control practices. Conversely, "Nasogastric Tube Feeding" maintained a 99.0% (n=446) compliance rate, elucidating specific deficits in hand hygiene and tube securement. To facilitate knowledge translation, results were disseminated via nursing and related governance meetings and Safety Café, and further reinforced through the circulation of concise one-page summary posters. These findings have successfully catalysed targeted Plan-Do-Check-Act-driven interventions, corroborating the cyclic model's efficacy in detecting subtle practice nuances often obscured by sporadic auditing.
