NURS 8750 Week 2 Final Document Audit Example

Where the Early Sections Stop Agreeing With the Late Ones: An Audit of the Assembled Mobilization Project Document, With Page References

Student Name

College of Nursing, Walden University

NURS 8750: Doctoral Seminar V

Instructor Name

Month Day, Year

Where the Early Sections Stop Agreeing With the Late Ones: An Audit of the Assembled Mobilization Project Document, With Page References

Purpose and Method

The final document for the nurse-led mobilization project was assembled from sections written across four seminars, from the classification post in the first term to the discussion draft in the fourth. Sections written months apart can each be correct and still contradict one another. This audit reads the assembled draft of 68 pages for one thing only: places where one section says something different from another about the same fact. A sentence can be well written, correctly cited and still wrong about the project because it was true when drafted and stopped being true later. It is not a proofread. Spelling, citation format and style were checked separately.

The method was a two-pass read. On the first pass, every statement of a key fact was copied into a list with its page number: the aim, the baseline figure, the eligibility rule, the size of the unit, the dates of each period, the names of the measures and the number of patients. On the second pass, the list was sorted by fact, so that every version of the same fact sat together. Any fact appearing in more than one version became an audit entry. Reporting guidance asks for consistency between the stated aim, the methods and the results (Ogrinc et al., 2016), and this method checks that directly.

Findings

Table 1 lists the eleven entries found. Each gives the conflicting statements with their pages, the version that is correct and the fix.

Table 1

Inconsistencies Found in the Assembled Draft, With Pages and Fixes

Note. Page numbers refer to the assembled draft dated three weeks before the audit.

What the Pattern Shows

The eleven entries fall into three groups. Six are leftovers: statements from an early draft that were never updated after the project changed, such as the 48-hour threshold, the respiratory therapist leading the screen and the count of four measures. These are the easiest to fix and the most damaging if left, because they show a reader that the document was assembled rather than written.

Three are wording drift, where the same fact is named in different ways in different sections: the aim, the process measure and the classification. Wording drift matters more than it looks. A reader who sees "out of bed" on page 61 may reasonably wonder whether passive transfers to a chair were counted, which the operational definition specifically excludes. The definition depends on the exact phrase, so the phrase has to be the same everywhere.

Two are genuine double facts that need labels rather than corrections. The 18% and 22.2% baselines are both correct; they come from different sources and periods. Without labels, they look like an error. Entry 1 therefore keeps both and names each one wherever it appears.

The Most Serious Entry

Entry 11 is the most serious, because it is about oversight rather than wording. Page 34 described the project as exempt, a word copied from a proposal draft written before the ethics board was consulted. The memo in the third seminar concluded that the project should request a determination and not predict it, and page 35 says a determination was requested. The board's actual answer, that the improvement work did not require full review and that the interview procedures were approved with conditions, is not stated anywhere. A reader could reasonably conclude that the project decided its own oversight. The fix is to state the determination, its date and its conditions once, in the methods, and to remove the word exempt. Improvement ethics guidance places responsibility for oversight decisions with the reviewing body, not with the project team (Lynn et al., 2007).

Preventing New Inconsistencies

Three habits will keep the final revision from creating new conflicts. A one-page fact sheet now lists the agreed version of every key fact, and any edit touching one of them starts by checking the sheet. Search terms for each fact, such as "hours", "beds" and "baseline", will be run across the whole document before submission. And the abstract will be written last, from the fact sheet rather than from earlier sections, because the abstract is the page most readers see and the one most likely to inherit an old number. Run charts and tables will be regenerated from the cleaned data file, not copied from earlier drafts, so that their numbers cannot drift either (Perla et al., 2011).

The fact sheet will be attached to the submission as an appendix for the committee.

References

Lynn, J., Baily, M. A., Bottrell, M., Jennings, B., Levine, R. J., Davidoff, F., Casarett, D., Corrigan, J., Fox, E., Wynia, M. K., Agich, G. J., O'Kane, M., Speroff, T., Schyve, P., Batalden, P., Tunis, S., Berlinger, N., Cronenwett, L., Fitzmaurice, J. M., . . . James, B. (2007). The ethics of using quality improvement methods in health care. Annals of Internal Medicine, 146(9), 666-673. https://doi.org/10.7326/0003-4819-146-9-200705010-00155

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895