Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Previous department EOC survey
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Has all previous non-conformities been corrected?
Infection Control
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Beverages / food at nurses station or medication carts?
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Linen carts are covered and nothing on top?
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Nothing under the sinks?
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Hand washing protocols followed and observed?
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Sterile package integrity?
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Patient care equipment is clean and cleaned between patients, not dusty?
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Torn or ripped mattress, cart pads, wheelchairs, task chairs?
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Kitchen is clean / food is dated and no partially eaten food stored?
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artificial nails not seen?
Plant Operations
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Ceiling tiles look good (not stained or broken)?
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Electrical areas and panels are secured and accessible, legends in place?
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Walls free from needing patching or paint?
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Lighting is adequate and covers are clean?
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No broken or missing hardware?
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Plumbing is intact with no leaks?
Environmental
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hopper rooms and chemicals are secured, cleaners are labeled, secured carts?
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High areas are free from dust, all ceiling HVAC vents clean?
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Overall cleanliness of department is good?
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Portable fans if in use are cleaned?
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Floors areas are clean?
Security and Safety
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Red folder / binder updated with fire drills?
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Staff wearing ID badges?
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Valuables are secured?
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Have the security doors been comprised (combinations written in view, door propped, staff sharing combination)
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Emergency Management
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Unit specific response plans are known by staff and available?
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Pharmacy issues
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Open medications are dated?
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Refrigerator temperature logs are current daily / values are in range? Temp issues are resolved?
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Pyxis machine, medication rooms, med carts, medication Refrigerator are secured?
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Code cart(s) log updated daily, secured and checksheet in use view?
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All medications are secured?
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K solutions stored appropriately ?
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Life Safety
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Oxygen, Med gas shutoff valves FE's, pull stations not blocked?
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No storage of equipment - plugged in corridor outlets - moves in 20 minutes?
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No storage in the stairways?
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Fire extinguishers are charged and inspected within 30 days intervals?
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Storage below 18 inches of sprinkler heads?
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Doors latch properly, no combustibles on doors, doors are not propped or blocked?
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< 20% of wall covered (papers notes etc.)?
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Auto shut off coffee pots, no toasters, no toaster ovens, other?
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Lift equipment is stored properly / wheels are in the locked position?
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Integrity of smoke and fire doors are intact with no paper or decorations?
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Supply/core areas
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Soiled linen in carts and linen bags are not on floor?
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Appropriate use of clean and dirty storage, no cardboard boxes on floor?
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Food trays are covered?
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Broken or retired equipment is properly tagged as do not use, staff aware of procedures to remove any broken equipment?
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Hazardous Materials
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Cleaners, chemicals are properly labeled, not opened and secured
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Full and empty 02 tanks are separated and secured, limit 12 full cylinders in storage areas?
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RMW is covered, not mixed and stored appropriately
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Sharps containers are secured and not overfilled?
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Eyewash stations are inspected weekly?
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Patient Advocate
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Has the care met your expectations?
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Did the food meet your expectations?
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Did the overall patient experience meet your expectations?
Equipment and Supplies
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Supply carts are dust free?
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The Supply expiration dates are compliant?
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Integrity of product packaging is intact?
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Point of care – QC reagents expiration dates are compliant?
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Blood draw supply expiration dates are compliant?
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HIPAA
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Absence of HIPAA violations, no open charts?
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Availability of designated bins to dispose of patient health information?
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Are gray and blue bins secured?
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Patient health information is in correct containers and not in dept wastepaper baskets?
Top Three Concerns Based from the Hazards Surveillance Report
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1) emergency stickers are on telephones?
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2) Hallways are free from clutter?
Final Comments, Issues, Photos
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