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
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Add signature
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Dressing clean, dry, intake. No blood under dressing.
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Add media
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Bio patch in place correctly?
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Add media
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Dressing dated. And within in date. Changed every 7days or as needed.
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Needless connectors are capped using curios?
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IV tubing labeled with "change dates" and are in date. Change every 96 hrs/4days.
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TPN/ lipids port labeled and in date. Changed every 24 hrs.
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All lines connected correctly. No IV lines plugged back into itself.
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Hand hygiene performed before line access procedures.
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Scrub the hub 15 seconds prior to each access.
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Line necessity has been reviewed and documented in care manager. Line meets appropriate reason for CVL.
