Information
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Department(s)
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Conducted on
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Prepared by
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Personnel Involved
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Room is accessible for patients?
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The call-bell is functional and within reach of the patient?
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All equipment alarms are turned on?
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Staff know steps to follow for medical device malfunction?
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Patient's privacy is respected (i.e., curtain pulled during care, staff knock before entering)?
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Nurse station is neat?
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Bulletin boards are neat and not overloaded?
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Defibrilators are checked while unplugged and documented per policy?
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Patient care equipment is inventoried and checked by bio-med as indicated by attached inspection sticker?
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Broken equipment is identified properly?
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There are no expired blood tubes in Med Rooms/Storage Areas?
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Open multi-dose vials are labeled with the expiration date?
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There are no expired supplies in supply rooms?
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There are no expired supplies or medications on crash carts or intubation boxes?
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Dirty equipment is not stored in clean utility room / no clean equipment in dirty utility room?
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Grab bars in patient restrooms are securely fastened?
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Emergency call system in restrooms and showers are working properly?
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There are no expired medications in Med Rooms/Pharmacy?
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Information on communication boards in patient rooms, or at door comply with HIPAA?
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Refrigerators are labeled properly for patient food or medication?
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There are no open containers in patient refrigerators or freezers?
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Food in refrigerator is marked/dated appropriately?
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Required temperature logs are complete (equipment, refrigerator, etc.) ?
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There is no medication or non-patient food items stored in pantry refrigerator?
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No items are stored under sinks?
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Additional Comments