Date of Graduation
Master of Science in Nursing (MSN)
School of Nursing and Health Professions
Mary S. Seed, PhD, RN, CNL
Elena Capella, EdD, MSN, MPA, RN, CNL, CPHQ, LNCC
A hospice and home health care agency with an estimated 300 current patients looking to gain Joint Commission accreditation tasked its quality improvement department with identifying and improving deficiencies in the nursing documentation of patients’ charts. In order to do so, a redesign of their current chart auditing system needed to occur to take the process from pen and paper to an electronic database where the data gathered from the audit could be disseminated. The quality improvement team focused on ensuring that the new electronic process was user-friendly, encompassed all the quality areas needed, and allowed charts to be reviewed more quickly. Once the electronic audit was implemented, preliminary surveys showed that nurses were pleased with the new program and the time needed to complete the audit decreased from 45 minutes to 20 minutes. The hospice and home health care agency expects to gain Joint Commission accreditation once the changes are firmly in place.
Hiroi, Nicole, "Meeting Joint Commission Compliance by Improving the Chart Audit Process" (2017). Master's Projects and Capstones. 511.