Auditing in nursing and its importance for quality care

To analyze scientific publications on the importance of auditing in nursing and its benefits for the patient in terms of improving the quality of and satisfaction in care. This is an integrative review, carried out by searching the databases: Database in Nursing – Brazilian Bibliography (BDENF), Latin American and Caribbean Literature in Health Sciences (LILACS) and Online System of Search and Analysis of Medical Literature (MEDLINE/PUBMED). Crossing the descriptors, using the Boolean operator "and" was implemented as follows: nursing audit AND Nursing Assistance AND nursing notes, using complete articles from the last 5 years, after selection 21 articles were chosen for this revision. It was possible that when there is a follow-up of the audit in the verification of the medical records, there is a correlation between the notes and the assistance provided, but often what is on paper was not performed on the patient, this is a negative aspect, in the positive aspect when what is on paper was performed on the patient and is meticulously recorded, there was an efficient and coherent communication between the team. Auditing in nursing is very important for health institutions, as it has an educating role in care, improving customer service and thus making the institution more recognized by the community it serves.


Introduction
Auditing was introduced in the health area in the 20th century as a tool for the quality of care, and the first records of auditing in nursing were published in the 50s. later the medical and nursing audit (Rodrigues et al., 2020).
The nursing audit has been acquiring new dimensions and, consequently, its importance within hospitals and health plan operators because they aim to search for quality and, in a way, seek to standardize efficient care. The nursing team's notes have been used as a means of communication and information about the patient's condition and the care provided. It constitutes a valuable document and is also a source for an evaluation of the efficiency and effectiveness of the assistance provided.
However, for this to occur, clarity is needed regarding the form and content of these notes so that the understanding and legibility of the information can be guaranteed .
The systematic evaluation of the quality of the assistance provided is often verified by the audit itself and not only by the quality sector. This investigation is carried out by the notes made in the patient's chart. The audit is not only linked to issues of more efficient hospital costs of the service provided but it is also intended to assist in the control of costs and billings sent to service providers (health plans), carefully analyzing the procedures performed, routine visits, crossing the information received with that contained in the medical record (Silva & Taveira, 2021).
Everything inherent to the assistance provided and directly favours the care of the patient/client during the period of hospitalization is in these notes and expresses the nature of each procedure performed by a multidisciplinary team that assisted this patient, therefore, it must be performed in a clearly, objectively and always following the ethical and moral principles of the profession, offering, in turn, alternatives for the solution of identified problems, as is the case of the systematization of nursing care, directing the planning of interventions and, later, evaluating the results (Alves & Banaszeski, 2020).
Considering the importance of the information contained in the medical record, the audit can and should evaluate them and, in turn, support the team through guidance on them and how they should be done, showing the importance of appropriate records and nursing actions. be adequately described, thus avoiding erroneous records, which in turn are susceptible to mistakes in team communication (Jesus, et al., 2020).
The notes made by the nursing staff are an important instrument to prove the quality and that the professional's practice was carried out with excellence. There is an estimate that about 50% of information related to patient care is provided by nursing, which makes it essential to have adequate and frequent records (Furukawa, et al., 2018).
And yet, in the form of written communication, it is extremely relevant to the patient and their care, when written in a way that portrays the reality to be documented, it can be related to several purposes: auditing, research, planning, legal processes, among others (Meira, et al., 2020).
Therefore, the analysis of scientific publications that address the contributions of auditing in nursing for the benefit of the patient as well as the improvement in the quality of care and satisfaction with care is the objective of this work. The descriptors were crossed using the Boolean operator "and", as follows: nursing audit AND nursing care AND nursing notes. The selection of the articles used was carried out in May 2022. The guiding research question of the study was:

Methodology
What is the impact caused by the audit on nursing notes concerning quality care?
Inclusion criteria were: studies available online, with free access, text available in full, in English, Portuguese and Spanish, which were published in the last 6 years (2017-2022), related to the proposed topic and that answered guiding question. Theses, dissertations, congress abstracts, proceedings, incomplete articles, duplicate articles and articles not available in full were excluded.

Results and Discussion
The search in the databases resulted in 169 articles, of which 98 were excluded because they had been published for more than 5 years and 71 were selected. Of these, 46 were chosen by reading the title, excluding articles not available in full and with other methodologies, 25 were selected by reading the abstract, of which 04 were excluded because they were duplicates, and 21 were read in full and included in this review.
Of these articles, 15 were selected to set up a sample campus, their sampling was distributed as follows: one (6.6%) was published in 2017, two (13.3%) in 2018, five (33.3%) %) published in 2020, five (33.3%) in 2021, and in 2022 two articles (13.3%) were published. The most productive years on the subject are 2020 and 2021, as shown in Table 1. Research, Society and Development, v. 11, n. 12, e226111234401, 2022 (CC BY 4. The authors highlighted the need to improve the records in the patient's medical records, as well as the use of systematized methods to control care practices and the impacts on patient safety.
Nursing audit on quality and patient care COSTA et al., 2021.
Regarding hospital glosses, the most related items are 12% of materials, 2% of medicines, 2% of medical fees and 5% of OPME and in the external audit they are 22% of materials, 7% of medicines, 17% of fees doctors and 49% of OPME and it is again noticeable that to achieve the quality of care, analyzing the medical records is of paramount importance.
The impact of nursing records on health care and its relationship with hospitals glosses GONÇALVES et al, 2020. It was found that when the nursing notes were performed incorrectly, in addition to causing disallowances, it is also not possible to measure whether the assistance was provided correctly. It is the role of the nurse auditor to verify and instruct the team to avoid these glosses and ensure that the records are complete and objective and evidence the quality of the care provided.

Audit of health accounts: analysis of glosses and their justifications in Home Care
SILVA et al, 2020.
The health audit comes to seek, contribute and improve the management equation optimizing a better allocation of financial resources in health.
Nursing record in a hospital environment: contributions of the nurse auditor in preventing disallowances

SOUZA et al, 2022.
It is concluded that the nursing audit has a fundamental role as a tool for improving health actions, also observing the results from the medical record, so, by the essence of the profession, the auditor nurse has a lot to contribute to avoid glosses and in the training of the team in improving the quality of care.
Nursing audit: the importance of nursing notes in the control of hospital glosses ALMEIDA et al, 2021. They found that incorrect nursing notes are the biggest cause of disallowance in hospital environments.
Quality of nursing records in an intensive care unit: contribution to auditing and health care processes FREITAS JÚNIOR, 2020. It was possible to identify a strong influence of nursing records in the health audit process, in addition to the expressive correlation with the improvement of care provided by nursing professionals.
Analysis of glosses through the audit of accounts performed by nurses: an integrative review VIGNA et al, 2020. It was verified that the audit is part of the verticalized process of analysis of glosses, which identifies non-conformities and suggests improvements, aiming at care quality, as well as billing and consequent financial sustainability to health organizations. It is noted the importance of auditing in nursing at all levels of health care, its purpose is to contribute to the quality of nursing care and health care for the population, as well as consolidate what is recommended in the SUS.
The contribution of auditing to the quality of health service management EVANGELISTA & BEZERRA, 2021.
The analysis carried out reinforces the importance of the nurse auditor's performance in improving the processes of health services, whether, in financial aspects, quality and the care provided Nursing audit: weaknesses and potential for improving the quality of health care VAL et al, 2018. Incomplete notes were the most pointed nonconformities and showed how much this nonconformity harms the patient, the team and the institution. The great potential of the nursing audit is to be a management tool that improves the quality of nursing care provided.
From the analysis of the studies covered in this review, it was possible to perceive, as Val, et al., (2018), that the nursing audit can be understood as the official examination of nursing records and aims to evaluate, verify and improve the assistance provided to the client, which can be centred on nursing records and notes.
The quality of care in health services is directly influenced by the performance of the auditor, the concern with care falls on the nursing team, which is the one who spends more time with the patient. The audit directly accompanies the assistance and this makes the nurse auditor able to contemplate the weaknesses found and thus intervene in them, to minimize the problems that may be the result of errors/failures, as is the case with what happens in the notes of nursing, which are often incomplete. The lack of steps in the nursing process, and the incompatibility between the record of the prescribed care and the performed one compromises the quality of care (Gomes, et al, 2021;Silva et al, 2021).
When analyzing the nursing records, through the audit, several points were identified that need to be improved given the notes related to the nursing procedures and their execution, it is an efficient working tool and through this document and its review, it is possible to the improvement of care to correct existing errors (Silva, et al., 2017).
The quality of nursing care can be measured through auditing, which in turn will help to support scientific research because they need evidence that leads to the construction of scientific knowledge (Sá, 2018).
Inside the medical record, there is information about the care provided to the clients and all the assistance provided to them from admission to their departure from the institution. It is through the medical record that communication takes place, the patient's history, among the professionals of the team that assist this client, which provides him with adequate assistance for his safety. These notes are still of great help to other sectors such as administrative, research and teaching, billing, statistical references, planning and management. And for professionals, legal and confidential support, as well as questions about the conduct taken by the team (Costa, et al., 2021).
Soon, it appears that the medical record and its notes must be recorded in a chronological, descriptive and narrative way. It must present the biological, social, psychological and spiritual conditions of each patient attended. According to the guidelines of competent bodies, notes must be taken immediately after each action with the patient, so that relevant and important information is not lost, and is finally identified and filed in the medical record (Júnior, 2020).
However, it is clear and perceptible that notes that are taken properly favour communication between the team itself, as well as an efficient and effective audit process. Medical records with enough information for care to continue, also provide time optimization, reduce expenses, avoid inappropriate procedures, and guarantee patient safety and the quality of hospital service (Vigna, et al., 2020). Thus, we can see in Figure 1. the summary of the importance of auditing in nursing.

Conclusion
The nursing audit process is very important for health institutions, as it has an educational role in care, improving customer service and thus making care more effective and less prone to errors. In addition, the nursing audit, through technical glosses, retrospective and competitive audits, ensures the reliability of care regardless of the time in which they were provided, based on the patient's medical record, or the daily monitoring of the sectors in front of their demands, thus generating not only economic benefits for the institution, especially for patients in terms of safety.