CHCO Patient Identification Observation Audit Tool

• Location & Unit

• Conducted on

  Date

• Select date

  Date

• Observer

Labs

Labs

• ID Band on Patient

  Select Yes No

  • Yes
  • No

• ID Band Checked

  Select Yes No

  • Yes
  • No

• First, Last name & MRN/FIN used as two patient identifiers?

  Select Yes No

  • Yes
  • No

• Type of staff observed?

  Select CHCO Contracted (UH-MHC)

  • CHCO
  • Contracted (UH-MHC)

Procedure/Treatment

Procedure/Treatment

• ID Band on Patient

  Select Yes No

  • Yes
  • No

• ID Band Checked

  Select Yes No

  • Yes
  • No

• First, Last name & MRN/FIN used as two patient identifiers?

  Select Yes No

  • Yes
  • No

• Type of staff observed?

  Select CHCO Contracted (UH-MHC)

  • CHCO
  • Contracted (UH-MHC)

Other (see comment)

Other (see comment)

• Comment:

• ID Band on Patient

  Select Yes No

  • Yes
  • No

• ID Band Checked

  Select Yes No

  • Yes
  • No

• First, Last name & MRN/FIN used as two patient identifiers?

  Select Yes No

  • Yes
  • No

• Type of staff observed?

  Select CHCO Contracted (UH-MHC)

  • CHCO
  • Contracted (UH-MHC)

Medication Administration

Medication Administration

• ID Band on Patient

  Select Yes No

  • Yes
  • No

• ID Band Checked

  Select Yes No

  • Yes
  • No

• First, Last name & MRN/FIN used as two patient identifiers?

  Select Yes No

  • Yes
  • No

• Type of staff observed?

  Select CHCO Contracted (UH-MHC)

  • CHCO
  • Contracted (UH-MHC)