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 CPA Findings
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Are there any previous CPA findings?<br>
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If yes, have they been resolved?<br>
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If no, what is the status update?
Radiology
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Are patient fluoro logs being kepti
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Are weekly fluoroscopy checks being performed?<br>
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How are dosimetry badges being managed?
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How do staff access P&Ps?
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Caution X-ray signs posted?
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Notice to Employees signs posted (5/09)?
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Radiation Safety Operating Procedures sign posted?
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Pregnancy Warning sign posted?
Lead aprons hung properly?
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Lead apron checks performed annually?
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Dose charts posted on all x-ray units?
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Technique charts posted on all x-ray units?
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Clinical Tech PM stickers posted and current?
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Physician S&O permits posted & Current?
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Technologists licenses posted and current?
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Repeat Rate - Staff knowledge?
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Any contract staff used?
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Do staff know how to find MD privileges?
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Nubile C-arms - MD S&O Permits?
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Contrast media security
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Radiation Safety Training
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Crash carts?
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X-ray generator affixed?
CT
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CT Protocols - approved by P&T?
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CT physicist report - Annual and any fails fixed?
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Contrast Media documentation?
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Reduced technique factors for pediatric and small patients?
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Who dispenses or administers contrast media?
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CT Competencies?
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CT Injector Competency?
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Crash Cart?
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SAS 916 - CT Radiation Dose Monitoring
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SB 1237
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CT Table wipe down?
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CT injector wipe down?
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Critical Results Documentation?
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Stroke Alert process?
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Code Blue workflow?
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MD Contrast Orders?
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Contrast media security?
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Dose rates posted for 8, 16, or 64 slice CT?
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Medication labeling?
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Contrast warmer?
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Caution X-ray signs posted?
MRI
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MRI Protocols approved by P&T?
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Screening procedures?
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MRI Safety Zones posted?
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MRI Safety Training?
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Code Blue process in MRI?
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Are the O2 tanks non-ferrous?
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MRI physicist report?
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Protocols documented?
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Is procedural sedation used?
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MRI Tech Competencies?
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MRI Tech injector Competencies?
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Venipuncture (10/10)?
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MRI QC
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MRI Crash Cart?
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MRI Safety - SAS 910
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List of employees with MRI Safety Training?
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List of employees with access?
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MRI Safety Training?
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Cleaning process for MRI Table between patients?
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Is procedural sedation performed in MRI?
NM
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Pregnancy warning signage?
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Is I131 used?
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Is there post procedure information given by the NM MD?
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Who is the RSO?
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Explain the radiopharmaceutical delivery process.
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Microwave approved by engineering?
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Microwave oven labeled "For patient use only"!
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Is there a refrigerator?
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NM Protocols approved by P&T?
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Are medications placed in a secondary container?<br>Are they labeled?
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Is waste storage secure?
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Who has access to the Hot Lab?
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Describe the process for reinjecting blood?
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PPE used?
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Ring & Body dosimeters used?
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Is waived testing performed?
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Informed consent?
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Hood Inspection?
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Radiation Safety Committee Meeting minutes - quorom
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Radiation Detector testing and exit routes?
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Radiation Safety Training?
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Correct signage?
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Is Regadenosn (Lexiscan) used? If yes, who administers and where is the NM MD?
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Cleaning procedures foe NM table?
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Posted NM contacts ICE?
Mammography
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RHB Inspection status?
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Physicist report?
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QA program for Interpreting MDs?
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Repeat Rate?
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Information for breast implant patients?
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IR procedures - side site verification?
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QC?
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Technique chart?
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Dose chart?
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Cleaning procedure for Mammo unit between patients?
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Title 22 Informed Choice booklet for IR patients?
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Mammo Tech competency?
US
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Clinical tech PMs?
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US equipment cleanliness?
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Daily QC of Cidex?
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Pre-procedure for EV probes - demonstrate.
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Cleaning process for cleaning scanning table between patients?
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Time-outs for IR procedures?
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Side-site verification?
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Secondary container labeling practice?
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Title 22 Informed Choice booklet?
