Welcome to the ACORN Practice Audit Tools frequently asked questions (FAQs) page.
ACORN will be pleased to assist you with questions regarding the use of the Practice Audit Tools, whether you are a members or non-member. Below are some common questions. (Click on the question to see the answer.) If your question is not answered below or you would like to report an issue, please contact us.
To be an auditor you will need to be an experienced perioperative nurse, ideally with three or more years’ nursing experience in a perioperative setting. You will also need to be familiar with the specific ACORN standard being audited, including the specific principles, rationales for practice and the individual performance criteria. Experience or training with other audit programs will be very helpful, i.e. Infection Control audits, Hand Hygiene Australia, WH&S audits, ACHS etc.
You do not need to be an experienced Excel user for conducting the audit. It is essential however, that an experienced Excel user is responsible for entering the data, analysing the results and ongoing management of the audit program.
The time taken to audit one standard will depend upon many things and will change over time as you become more experienced and efficient. At the beginning, you should schedule one hour to conduct an audit, including time to return to the PAT if there are some practices you did not observe at the time. You will get faster and more efficient with experience. For example, you may feel skilled enough to audit more than one standard during an observation period. Eventually, you may feel skilled enough to conduct audits while doing your other work.
Practice audits are designed to take a random snapshot of many nurses' practice within your workplace at many varied times and situations. The result of the audit will tell you whether there are many nurses who are practising according to the standards at a variety of times and in various situations. Audits are the measurement tools in quality improvement.
Competency assessments are designed to focus on a single nurse's practice at an agreed point in time. The result of the competency assessment will tell you whether this nurse knows how to practise according to the standards when asked to do so. Assessments are measurement tools in training and education.
All staff, including the nurses, medical officers and ancillary staff, should be aware that practice audits are being conducted. We recommend that you display reminder posters as part of your audit program. These posters should inform the staff of the period of time, i.e. dates of the month, when the nursing practice audits will be conducted.
At the beginning, the nurses may notice when you are observing their practice. Aim to be discrete when using the audit tool – carrying a piece of paper is more discrete than a clipboard. Eventually, your colleagues will become used to this and you will be able to observe without being noticed as much.
Remember, the audit is designed to be a random snapshot of many nurses' practice within your workplace, so you should try to observe more than two or three nurses whenever that is possible. This will be more of a challenge for small departments with only one or two rooms.
Avoid audits that observe only new nurses or only experienced nurses.
With each audit, consider whether you are observing a range of nursing experience and consider whether this reflects the usual mix of nursing experience in your workplace. Your set of ten audits should be representative of the diversity of your workplace.
Some standards include practices which must be performed in the correct sequence of procedural steps. In these instances, you should focus on one nurse when observing these practices: for example, complete stages of surgical hand antisepsis technique from the sink to the gown trolley, and/or from the gown trolley to the instrument table.
It is very important to observe different nurses for each of the ten audits with this standard so your results are representative of your workplace.
Non-routine or emergency procedures are not appropriate times to conduct the practice audit. Observe more than two or three nurses whenever possible. Avoid audits that observe only new nurses or only experienced nurses. With each audit, consider whether you are observing a range of nursing experience and consider whether this reflects the usual mix of nursing experience in your workplace.
Your set of ten audits should be representative of the diversity of your workplace. An exception is when standards include practices which must be performed in the correct sequence of procedural steps: for example, complete stages of surgical hand antisepsis technique from the sink to the gown trolley, and/or from the gown trolley to the instrument table (see FAQ 7). In these instances, you should focus on one nurse. It is very important to observe different nurses for each of the ten audits with this standard to ensure that your results are representative of the diversity of your workplace.
Each standard should be audited on ten separate and diverse occasions. You should try to provide a wide snapshot of nurses' practice within your workplace in many different surgical lists, clinical situations and teams.
Consider the results you get when you conduct ten audits in one week, compared with ten audits in one month – the first example will provide you with a narrow snapshot of practices (not representative and potentially biased), while the second example will provide you with a wider snapshot of practices and is likely to represent more of the diversity in your workplace.
Score practices as non-compliant as and when you observe them.
Patient and staff safety are paramount at all times and practice audits are no different in this respect. You should be prepared to speak up if you observe practices that compromise patient or staff safety. Consider whether non-compliant practices are likely to compromise patient or staff safety. It may require immediate intervention or it may require corrective instruction. For example, you may observe a nurse at the scrub sink without protective eyewear. You could observe until the the nurse approaches the instrument trolley and prepares for direct patient care. If the nurse has not yet corrected their practice and the circulating nurse has not noticed and provided assistance, you should intervene. You would then score the practice as non-compliant.
A general rule of observational audits is that you cannot audit practices that you do not observe. In most instances, it is preferable for you to leave the practice unscored and wait to observe the practice again – in this way you will score it based on the nurse's practice (i.e. what the nurse does – their real practice), not the nurse's knowledge (i.e. what the nurse knows – their ideal practice).
In some instances, you might be able to ask the nurses what they did when you were not looking, for example: – if you did not see the nurse pour the prep solution into the bowl you might ask them how they did it – you might read a specimen label yourself and check if the nurse has completed it correctly – to audit whether the nurse has been compliant with scrub duration and consistent with the use of agents you might ask the nurse about the scrub techniques and agents they used. However, it would NOT be acceptable to ask the nurse what they did before you arrived in the room for the audit.
When a nurse's practice deviates from the accepted standard it is considered non-compliant and scored zero. Generally, this score is not influenced by the reason for the nurse's non-compliance. As auditor, you could make a note of the reason so that the manager can take action. For example, 'plastic aprons not available'. This may explain to the manager why the nurses were non-compliant for the month that the equipment was out of stock.
The Excel formula will ignore the NAs when it calculates the compliance rate. The first edition of the PATs required the NAs to be manually subtracted but that is no longer necessary unless you wish to check the Excel calculations.
Whenever the nurse performs surgical hand antisepsis (SHA), they will use either the traditional surgical hand scrub (SHS) with running water or they will use the waterless technique with alcohol-based hand rub (ABHR). Both of these techniques are acceptable and, when performed correctly, they are considered compliant practice. Therefore, the criteria for the observed technique should be scored '1' when the nurse's practice is compliant. The criteria for the other technique (the technique you did not observe) are not applicable and should all be scored 'NA'. The Excel formula will ignore the NAs when it calculates the compliance rate.
The intention of the ACORN PAT Project is to look for evidence of Australian perioperative nurses’ compliance with their national standards, as in Standards for Perioperative Nursing in Australia. While individual standards might refer to the multidisciplinary team and might describe what members of the multidisciplinary team should be doing, the focus of the ACORN standards is the nurses’ roles. So, the ACORN PATs are specifically designed as audit tools for perioperative nursing staff only. The PATs have not been validated for use as audit tools for other professions.