Dissatisfied with the use of an audit tool not applicable to home health nursing, administrators of the Missoula Home Health Agency formed a special audit committee to review audits used by agencies around the country. After examining 50 audit tools, the committee agreed that the Phaneuf public health nursing audit did not adequately emphasize nursing care and charting specific to home health agencies but did fit most of their criteria. After redesigning the Phaneuf audit and testing it through two quarterly audits, the new Missoula Home Health Audit tool has been found very satisfactory. The Missoula Audit emphasizes: 1. home health's goal of independent living and/or self-care; 2. service provider-family-patient relationship; 3. nurse-physician relationship; 4. charting and recording; 5. coordination of careproviders. Unlike many existing audit tools, the Missoula Audit is specific to home health nursing, covers the spectrum of home health services, has sensitive scoring which reflects true differences in quality of care, and initially, at least, appears to be consistent from audit to audit.