Daily EOC Rounding All Areas

• Conducted on

  Date

• Prepared by

• Personnel

----- EIA -----

EOC

• Rooms 3 - 5 oxygen/suction functional and ready for use?

  Yes

  No

  N/A

• Bays 11 - 13 Oxygen functional and ready for use?

  Yes

  No

  N/A

• Ice machine clean, functional?

  Yes

  No

  N/A

• White boards filled out in rooms?

  Yes

  No

  N/A

• Sink cabinets zip-tied?

  Yes

  No

  N/A

• No restraints left on stretchers?

  Yes

  No

  N/A

• No pt info left up on computer screen?

  Yes

  No

  N/A

• No artificial nails or gel polish on staff?

  Yes

  No

  N/A

• Accu check controls dated, not expired.

  Yes

  No

  N/A

• Blanket warmer only has approved items, safety sticker present?

  Yes

  No

  N/A

• Oxygen tanks properly stored/used.

  Yes

  No

  N/A

• Two patient identifiers verbally stated whenever meds are given?

  Yes

  No

  N/A

• Area free of cardboard?

  Yes

  No

  N/A

• Temperature/Crash Cart Logs Completed?

  Yes

  No

  N/A

• No expired items on crash cart?

  Yes

  No

  N/A

• All curtains present, clean?

  Yes

  No

  N/A

• Percentage of ports capped with a Curos

• No Pharm meds left out?

  Yes

  No

  N/A

• No food or drinks at nurse's station?

  Yes

  No

  N/A

• Iso patients have sticker on door, tab on wristband?

  Yes

  No

  N/A

• No used UHS carts (iso or crash) left out?

  Yes

  No

  N/A

• Cabinets/drawers free of items that don’t belong there

  Yes

  No

  N/A

• No meds left out?

  Yes

  No

  N/A

• IV carts clean, free of items that don't belong in them?

  Yes

  No

  N/A

• IV Carts found locked?

  Yes

  No

  N/A

• IV Carts free of expired items?

  Yes

  No

  N/A

• IV Cart handles intact?

  Yes

  No

  N/A

• No tape or stickers on PC monitors, walls, floors, etc?

  Yes

  No

  N/A

• Nothing in front of fire extinguishers?

  Yes

  No

  N/A

• Sharps containers no more than ¾ full, none broken?

  Yes

  No

  N/A

• Linen not more than 3/4 full?

  Yes

  No

  N/A

• Shandswiches not expired?

  Yes

  No

  N/A

• Airway bags/crash carts have dated green tag?

  Yes

  No

  N/A

• All Pyxis machines clutter free on top?

  Yes

  No

  N/A

• Red bio cans clean, not overflowing, functional?

  Yes

  No

  N/A

• No clean items in dirty rooms?

  Yes

  No

  N/A

• No dirty items in clean rooms?

  Yes

  No

  N/A

• No patient belongings left out?

  Yes

  No

  N/A

• No gloves worn outside of patient vicinity.

  Yes

  No

  N/A

• Broken stretchers/damaged mattresses labeled for pickup?

  Yes

  No

  N/A

• Pt fridges clear of non-pt food/expired food

  Yes

  No

  N/A

• Staff/patient fridges don't need defrosting?

  Yes

  No

  N/A

• Labs/cultures labeled at bedside?

  Yes

  No

  N/A

• Red and Blue bins found closed?

  Yes

  No

  N/A

• No sterile packaging found compromised?

  Yes

  No

  N/A

• No sharps left out?

  Yes

  No

  N/A

• Hand hygiene before/after pt contact, after gloves off.

  Yes

  No

  N/A

• Product up off the floor?

  Yes

  No

  N/A

• No doors improperly propped open?

  Yes

  No

  N/A

• Alere cartridges individually labeled?

  Yes

  No

  N/A

• No gross infractions found?

  Yes

  No

  N/A

• All call bells in place?

  Yes

  No

  N/A

• Pharm Room checked?

• EKG Room checked?

• De-clutter nurse station counter storage bin.

EVS

• No dust in areas?

  Yes

  No

  N/A

• No odor in dirty rooms?

  Yes

  No

  N/A

• Floors don't need mopping, sweeping?

  Yes

  No

  N/A

• Bathrooms clean?

  Yes

  No

  N/A

• Trash not overflowing?

  Yes

  No

  N/A

Facilities

• Lights all working, in good condition?

  Yes

  No

  N/A

• No ceiling tiles need replacing?

  Yes

  No

  N/A

• No paint chipping, holes need patching?

  Yes

  No

  N/A

----- ECC -----

EOC

• Urine cups, urinals, bedpans, diapers, chucks stocked?

  Yes

  No

  N/A

• No restraints left on stretchers?

  Yes

  No

  N/A

• No pt info left up on computer screen?

  Yes

  No

  N/A

• No artificial nails or gel polish on staff?

  Yes

  No

  N/A

• No linen on shelf nearest floor?

  Yes

  No

  N/A

• Accu check controls dated, not expired.

  Yes

  No

  N/A

• Oxygen tanks properly stored/used.

  Yes

  No

  N/A

• Two patient identifiers verbally stated whenever meds are given?

  Yes

  No

  N/A

• Area free of cardboard?

  Yes

  No

  N/A

• Yellow bin de-cluttered, free of old blood?

  Yes

  No

  N/A

• Yellow bin tubes labeled, no labels on bag exterior?

  Yes

  No

  N/A

• Temperature Logs Completed?

  Yes

  No

  N/A

• All curtains present, clean?

  Yes

  No

  N/A

• Percentage of ports capped with a Curos

• No Pharm meds left out?

  Yes

  No

  N/A

• No food or drinks at nurse's station?

  Yes

  No

  N/A

• No used UHS carts (iso or crash) left out?

  Yes

  No

  N/A

• Iso patients have sticker on door, tab on wristband?

  Yes

  No

  N/A

• Cabinets/drawers free of items that don’t belong there

  Yes

  No

  N/A

• No meds left out?

  Yes

  No

  N/A

• IV carts locked?

  Yes

  No

  N/A

• IV Carts free of expired items?

  Yes

  No

  N/A

• IV Cart handles intact?

  Yes

  No

  N/A

• IV carts clean, free of items that don't belong in them?

  Yes

  No

  N/A

• No tape or stickers on PC monitors, walls, floors, etc?

  Yes

  No

  N/A

• Nothing in front of fire extinguishers?

  Yes

  No

  N/A

• Sharps containers no more than ¾ full, none broken?

  Yes

  No

  N/A

• Linen not more than 3/4 full?

  Yes

  No

  N/A

• Shandswiches not expired?

  Yes

  No

  N/A

• Airway bags/crash carts have dated green tag?

  Yes

  No

  N/A

• All Pyxis machines clutter free on top?

  Yes

  No

  N/A

• Red bio cans clean, not overflowing, functional?

  Yes

  No

  N/A

• No clean items in dirty rooms?

  Yes

  No

  N/A

• No dirty items in clean rooms?

  Yes

  No

  N/A

• No patient belongings left out?

  Yes

  No

  N/A

• No gloves worn outside of patient vicinity.

  Yes

  No

  N/A

• Broken stretchers/damaged mattresses labeled for pickup?

  Yes

  No

  N/A

• Pt fridges clear of non-pt food/expired food

  Yes

  No

  N/A

• Staff/patient fridges don't need defrosting?

  Yes

  No

  N/A

• Labs/cultures labeled at bedside?

  Yes

  No

  N/A

• Alere machines clean, free of dried blood?

  Yes

  No

  N/A

• Red and Blue bins found closed?

  Yes

  No

  N/A

• No sterile packaging found compromised?

  Yes

  No

  N/A

• No sharps left out?

  Yes

  No

  N/A

• Hand hygiene before/after pt contact, after gloves off.

  Yes

  No

  N/A

• Product up off the floor?

  Yes

  No

  N/A

• No doors improperly propped open?

  Yes

  No

  N/A

• Alere cartridges individually labeled?

  Yes

  No

  N/A

• 4x4s available at Alere station?

  Yes

  No

  N/A

• Culture bottles labeled with "fill to" line?

  Yes

  No

  N/A

• No gross infractions found?

  Yes

  No

  N/A

• No meds left out in attending office?

  Yes

  No

  N/A

• No meds left out in Dr Workroom?

  Yes

  No

  N/A

EVS

• No dust in areas?

  Yes

  No

  N/A

• No odor in dirty rooms?

  Yes

  No

  N/A

• Floors don't need mopping, sweeping?

  Yes

  No

  N/A

• Bathrooms clean?

  Yes

  No

  N/A

• Trash not overflowing?

  Yes

  No

  N/A

Facilities

• Lights all working, in good condition?

  Yes

  No

  N/A

• No ceiling tiles need replacing?

  Yes

  No

  N/A

• No paint chipping, holes need patching?

  Yes

  No

  N/A

----- Resus -----

EOC

• No restraints left on stretchers?

  Yes

  No

  N/A

• No pt info left up on computer screen?

  Yes

  No

  N/A

• No artificial nails or gel polish on staff?

  Yes

  No

  N/A

• Accu check controls dated, not expired.

  Yes

  No

  N/A

• Blanket warmer only has approved items

  Yes

  No

  N/A

• Fluid warmer has no expired fluids?

  Yes

  No

  N/A

• Fluid fridge stocked, has no expired fluids?

  Yes

  No

  N/A

• Oxygen tanks properly stored/used.

  Yes

  No

  N/A

• Two patient identifiers verbally stated whenever meds are given?

  Yes

  No

  N/A

• Area free of cardboard?

  Yes

  No

  N/A

• Temperature Logs Completed?

  Yes

  No

  N/A

• All curtains present, clean?

  Yes

  No

  N/A

• Percentage of ports capped with a Curos

• No Pharm meds left out?

  Yes

  No

  N/A

• No food or drinks at nurse's station?

  Yes

  No

  N/A

• Iso patients have sticker on door, tab on wristband?

  Yes

  No

  N/A

• No used UHS carts (iso or crash) left out?

  Yes

  No

  N/A

• Cabinets/drawers free of items that don’t belong there

  Yes

  No

  N/A

• No meds left out?

  Yes

  No

  N/A

• IV carts clean, free of items that don't belong in them?

  Yes

  No

  N/A

• IV Carts free of expired items?

  Yes

  No

  N/A

• IV Cart handles intact?

  Yes

  No

  N/A

• IV Carts locked?

  Yes

  No

  N/A

• No tape or stickers on PC monitors, walls, floors, etc?

  Yes

  No

  N/A

• Nothing in front of fire extinguishers?

  Yes

  No

  N/A

• Sharps containers no more than ¾ full, none broken?

  Yes

  No

  N/A

• Linen not more than 3/4 full?

  Yes

  No

  N/A

• Airway bags/crash carts have dated green tag?

  Yes

  No

  N/A

• All Pyxis machines clutter free on top?

  Yes

  No

  N/A

• Red bio cans clean, not overflowing, functional?

  Yes

  No

  N/A

• No dirty items in clean rooms?

  Yes

  No

  N/A

• No patient belongings left out?

  Yes

  No

  N/A

• No gloves worn outside of patient vicinity.

  Yes

  No

  N/A

• Broken stretchers/damaged mattresses labeled for pickup?

  Yes

  No

  N/A

• Staff/patient fridges don't need defrosting?

  Yes

  No

  N/A

• Labs/cultures labeled at bedside?

  Yes

  No

  N/A

• Red and Blue bins found closed?

  Yes

  No

  N/A

• No sterile packaging found compromised?

  Yes

  No

  N/A

• No sharps left out?

  Yes

  No

  N/A

• Hand hygiene before/after pt contact, after gloves off.

  Yes

  No

  N/A

• Product up off the floor?

  Yes

  No

  N/A

• No doors improperly propped open?

  Yes

  No

  N/A

• Percentage Resus shelves stocked

• Brochoscopes cleaned less than 6 days ago?

  Yes

  No

  N/A

• SPD Cart utilized appropriately?

  Yes

  No

  N/A

• Extra cords in clear ziploc bags?

  Yes

  No

  N/A

• Nothing in front of O2 shutoff valves?

  Yes

  No

  N/A

• Yes

  No

  N/A

• No gross infractions found?

  Yes

  No

  N/A

EVS

• No dust in areas?

  Yes

  No

  N/A

• Floors don't need mopping, sweeping?

  Yes

  No

  N/A

• Trash not overflowing?

  Yes

  No

  N/A

Facilities

• Lights all working, in good condition?

  Yes

  No

  N/A

• No ceiling tiles need replacing?

  Yes

  No

  N/A

• No paint chipping, holes need patching?

  Yes

  No

  N/A

----- Trauma -----

EOC

• No restraints left on stretchers?

  Yes

  No

  N/A

• No pt info left up on computer screen?

  Yes

  No

  N/A

• No artificial nails or gel polish on staff?

  Yes

  No

  N/A

• Accu check controls dated, not expired.

  Yes

  No

  N/A

• Blanket warmer only has approved items

  Yes

  No

  N/A

• Fluid warmer stocked, has no expired fluids?

  Yes

  No

  N/A

• Oxygen tanks properly stored/used.

  Yes

  No

  N/A

• Two patient identifiers verbally stated whenever meds are given?

  Yes

  No

  N/A

• Area free of cardboard?

  Yes

  No

  N/A

• Temperature/Lifepak Logs Completed?

  Yes

  No

  N/A

• Yes

  No

  N/A

• All curtains present, clean?

  Yes

  No

  N/A

• Percentage of ports capped with a Curos

• No Pharm meds left out?

  Yes

  No

  N/A

• No food or drinks at nurse's station?

  Yes

  No

  N/A

• Iso patients have sticker on door, tab on wristband?

  Yes

  No

  N/A

• No used UHS carts (iso or crash) left out?

  Yes

  No

  N/A

• Cabinets/drawers free of items that don’t belong there

  Yes

  No

  N/A

• No meds left out?

  Yes

  No

  N/A

• No tape or stickers on PC monitors, walls, floors, etc?

  Yes

  No

  N/A

• Nothing in front of fire extinguishers?

  Yes

  No

  N/A

• Sharps containers no more than ¾ full, none broken?

  Yes

  No

  N/A

• Linen not more than 3/4 full?

  Yes

  No

  N/A

• Shandswiches not expired?

  Yes

  No

  N/A

• Airway bags/crash carts have dated green tag?

  Yes

  No

  N/A

• All Pyxis machines clutter free on top?

  Yes

  No

  N/A

• Red bio cans clean, not overflowing, functional?

  Yes

  No

  N/A

• No clean items in dirty rooms?

  Yes

  No

  N/A

• No dirty items in clean rooms?

  Yes

  No

  N/A

• Urine strips have QC label?

  Yes

  No

  N/A

• Urine preg cartridges have QC label?

  Yes

  No

  N/A

• Urine put into tubes and dated/timed?

  Yes

  No

  N/A

• Clinitek Calibration Bar clean?

  Yes

  No

  N/A

• No patient belongings left out?

  Yes

  No

  N/A

• No gloves worn outside of patient vicinity.

  Yes

  No

  N/A

• Broken stretchers/damaged mattresses labeled for pickup?

  Yes

  No

  N/A

• Pt fridges clear of non-pt food/expired food

  Yes

  No

  N/A

• Staff/patient fridges don't need defrosting?

  Yes

  No

  N/A

• Microwave clean?

  Yes

  No

  N/A

• Labs/cultures labeled at bedside?

  Yes

  No

  N/A

• Red and Blue bins found closed?

  Yes

  No

  N/A

• No sterile packaging found compromised?

  Yes

  No

  N/A

• No sharps left out?

  Yes

  No

  N/A

• Hand hygiene before/after pt contact, after gloves off.

  Yes

  No

  N/A

• Product up off the floor?

  Yes

  No

  N/A

• No doors improperly propped open?

  Yes

  No

  N/A

• Extra cords in clear ziploc bags?

  Yes

  No

  N/A

• No gross infractions found?

  Yes

  No

  N/A

• De-Clutter Ortho Cart

• De-Clutter Ortho Cabinet

EVS

• Not more than 2 big red bins in Dirty Room?

  Yes

  No

  N/A

• Trash not overflowing?

  Yes

  No

  N/A

• No dust in areas?

  Yes

  No

  N/A

• No odor in dirty rooms?

  Yes

  No

  N/A

• Floors don't need mopping, sweeping?

  Yes

  No

  N/A

• Bathrooms clean?

  Yes

  No

  N/A

Facilities

• Lights all working, in good condition?

  Yes

  No

  N/A

• No ceiling tiles need replacing?

  Yes

  No

  N/A

• No paint chipping, holes need patching?

  Yes

  No

  N/A

----- Peds -----

EOC

• No restraints left on stretchers?

  Yes

  No

  N/A

• No pt info left up on computer screen?

  Yes

  No

  N/A

• No artificial nails or gel polish on staff?

  Yes

  No

  N/A

• Accu check controls dated, not expired.

  Yes

  No

  N/A

• Blanket warmer only has approved items

  Yes

  No

  N/A

• Oxygen tanks properly stored/used.

  Yes

  No

  N/A

• Two patient identifiers verbally stated whenever meds are given?

  Yes

  No

  N/A

• Area free of cardboard?

  Yes

  No

  N/A

• Temperature/Lifepak Logs Completed?

  Yes

  No

  N/A

• All curtains present, clean?

  Yes

  No

  N/A

• Percentage of ports capped with a Curos

• No Pharm meds left out?

  Yes

  No

  N/A

• No food or drinks at nurse's station?

  Yes

  No

  N/A

• Iso patients have sticker on door, tab on wristband?

  Yes

  No

  N/A

• No used UHS carts (iso or crash) left out?

  Yes

  No

  N/A

• Cabinets/drawers free of items that don’t belong there

  Yes

  No

  N/A

• No meds left out?

  Yes

  No

  N/A

• IV carts clean, free of items that don't belong in them?

  Yes

  No

  N/A

• IV Carts locked?

  Yes

  No

  N/A

• IV Carts free of expired items?

  Yes

  No

  N/A

• IV Cart handles intact?

  Yes

  No

  N/A

• No tape or stickers on PC monitors, walls, floors, etc?

  Yes

  No

  N/A

• Nothing in front of fire extinguishers?

  Yes

  No

  N/A

• Sharps containers no more than ¾ full, none broken?

  Yes

  No

  N/A

• Linen not more than 3/4 full?

  Yes

  No

  N/A

• Airway bags/crash carts have dated green tag?

  Yes

  No

  N/A

• All Pyxis machines clutter free on top?

  Yes

  No

  N/A

• Red bio cans clean, not overflowing, functional?

  Yes

  No

  N/A

• No clean items in dirty rooms?

  Yes

  No

  N/A

• No dirty items in clean rooms?

  Yes

  No

  N/A

• Urine preg cartridges have QC label?

  Yes

  No

  N/A

• Urine strips have QC label?

  Yes

  No

  N/A

• Urine put into tubes and dated/timed?

  Yes

  No

  N/A

• Clinitek Calibration Bar clean?

  Yes

  No

  N/A

• No patient belongings left out?

  Yes

  No

  N/A

• No gloves worn outside of patient vicinity.

  Yes

  No

  N/A

• Broken stretchers/damaged mattresses labeled for pickup?

  Yes

  No

  N/A

• Pt fridges clear of non-pt food/expired food

  Yes

  No

  N/A

• Staff/patient fridges don't need defrosting?

  Yes

  No

  N/A

• Labs/cultures labeled at bedside?

  Yes

  No

  N/A

• Red and Blue bins found closed?

  Yes

  No

  N/A

• No sterile packaging found compromised?

  Yes

  No

  N/A

• No sharps left out?

  Yes

  No

  N/A

• Hand hygiene before/after pt contact, after gloves off.

  Yes

  No

  N/A

• Product up off the floor?

  Yes

  No

  N/A

• No doors improperly propped open?

  Yes

  No

  N/A

• Outlet covers in sockets?

  Yes

  No

  N/A

• Ice machine clean, functional?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Nothing on top of lockers?

  Yes

  No

  N/A

• No gross infractions found?

  Yes

  No

  N/A

• De-clutter supply room.

• De-clutter lab bin at nurse station

EVS

• No dust in areas?

  Yes

  No

  N/A

• No odor in dirty rooms?

  Yes

  No

  N/A

• Floors don't need mopping, sweeping?

  Yes

  No

  N/A

• Bathrooms clean?

  Yes

  No

  N/A

• Trash not overflowing?

  Yes

  No

  N/A

Facilities

• Lights all working, in good condition?

  Yes

  No

  N/A

• No ceiling tiles need replacing?

  Yes

  No

  N/A

• No paint chipping, holes need patching?

  Yes

  No

  N/A

----- CDU -----

EOC

• No restraints left on stretchers?

  Yes

  No

  N/A

• No pt info left up on computer screen?

  Yes

  No

  N/A

• No artificial nails or gel polish on staff?

  Yes

  No

  N/A

• Accu check controls dated, not expired.

  Yes

  No

  N/A

• Oxygen tanks properly stored/used.

  Yes

  No

  N/A

• Two patient identifiers verbally stated whenever meds are given?

  Yes

  No

  N/A

• Area free of cardboard?

  Yes

  No

  N/A

• Temperature/Crash Cart Logs Completed?

  Yes

  No

  N/A

• No expired items on crash cart?

  Yes

  No

  N/A

• All curtains present, clean?

  Yes

  No

  N/A

• Percentage of ports capped with a Curos

• No Pharm meds left out?

  Yes

  No

  N/A

• No food or drinks at nurse's station?

  Yes

  No

  N/A

• Iso patients have sticker on door, tab on wristband?

  Yes

  No

  N/A

• No used UHS carts (iso or crash) left out?

  Yes

  No

  N/A

• Cabinets/drawers free of items that don’t belong there

  Yes

  No

  N/A

• No meds left out?

  Yes

  No

  N/A

• IV carts clean, free of items that don't belong in them?

  Yes

  No

  N/A

• IV Carts locked?

  Yes

  No

  N/A

• IV Carts free of expired items?

  Yes

  No

  N/A

• IV Cart handles intact?

  Yes

  No

  N/A

• No tape or stickers on PC monitors, walls, floors, etc?

  Yes

  No

  N/A

• Nothing in front of fire extinguishers?

  Yes

  No

  N/A

• Sharps containers no more than ¾ full, none broken?

  Yes

  No

  N/A

• Linen not more than 3/4 full?

  Yes

  No

  N/A

• Shandswiches not expired?

  Yes

  No

  N/A

• Airway bags/crash carts have dated green tag?

  Yes

  No

  N/A

• All Pyxis machines clutter free on top?

  Yes

  No

  N/A

• Red bio cans clean, not overflowing, functional?

  Yes

  No

  N/A

• No clean items in dirty rooms?

  Yes

  No

  N/A

• No dirty items in clean rooms?

  Yes

  No

  N/A

• Urine preg cartridges have QC label?

  Yes

  No

  N/A

• Urine strips have QC label?

  Yes

  No

  N/A

• Urine put into tubes and dated/timed?

  Yes

  No

  N/A

• Clinitek Calibration Bar clean?

  Yes

  No

  N/A

• No patient belongings left out?

  Yes

  No

  N/A

• No gloves worn outside of patient vicinity.

  Yes

  No

  N/A

• Broken stretchers/damaged mattresses labeled for pickup?

  Yes

  No

  N/A

• Pt fridges clear of non-pt food/expired food

  Yes

  No

  N/A

• Staff/patient fridges don't need defrosting?

  Yes

  No

  N/A

• Labs/cultures labeled at bedside?

  Yes

  No

  N/A

• Red and Blue bins found closed?

  Yes

  No

  N/A

• No sterile packaging found compromised?

  Yes

  No

  N/A

• No sharps left out?

  Yes

  No

  N/A

• Hand hygiene before/after pt contact, after gloves off.

  Yes

  No

  N/A

• Product up off the floor?

  Yes

  No

  N/A

• No doors improperly propped open?

  Yes

  No

  N/A

• Alere cartridges individually labeled?

  Yes

  No

  N/A

• Culture bottles labeled with "fill to" line?

  Yes

  No

  N/A

• Iso Room - Cart free of items that shouldn't be there?

  Yes

  No

  N/A

• Iso Room - Negative Pressure Alarms functional?

  Yes

  No

  N/A

• Room 10 cart satisfactory?

  Yes

  No

  N/A

• No gross infractions found?

  Yes

  No

  N/A

• Nothing in stairwell behind CDU?

  Yes

  No

  N/A

• Microwave clean?

  Yes

  No

  N/A

• Check Bay 1 drawers.

• Check Bay 4 drawers.

• Check and de-clutter back nurse station.

• De-clutter Alere alcove.

EVS

• No dust in areas?

  Yes

  No

  N/A

• No odor in dirty rooms?

  Yes

  No

  N/A

• Floors don't need mopping, sweeping?

  Yes

  No

  N/A

• Bathrooms clean?

  Yes

  No

  N/A

• Trash not overflowing?

  Yes

  No

  N/A

Facilities

• Yes

  No

  N/A

• No ceiling tiles need replacing?

  Yes

  No

  N/A

• No paint chipping, holes need patching?

  Yes

  No

  N/A

----- Flex, Triage, Waiting Room -----

EOC

• Triage Cabinets/drawers satisfactory?

  Yes

  No

  N/A

• Quick Reg cabinets/drawers satisfactory?

  Yes

  No

  N/A

• Waiting Room bathroom satisfactory?

  Yes

  No

  N/A

• No restraints left on stretchers?

  Yes

  No

  N/A

• No pt info left up on computer screen?

  Yes

  No

  N/A

• No artificial nails or gel polish on staff?

  Yes

  No

  N/A

• Accu check controls dated, not expired.

  Yes

  No

  N/A

• Oxygen tanks properly stored/used.

  Yes

  No

  N/A

• Two patient identifiers verbally stated whenever meds are given?

  Yes

  No

  N/A

• Area free of cardboard?

  Yes

  No

  N/A

• Temperature/Crash Cart Logs Completed?

  Yes

  No

  N/A

• No expired items on crash cart?

  Yes

  No

  N/A

• All curtains present, clean?

  Yes

  No

  N/A

• Percentage of ports capped with a Curos

• No Pharm meds left out?

  Yes

  No

  N/A

• No food or drinks at nurse's station?

  Yes

  No

  N/A

• Iso patients have sticker on door, tab on wristband?

  Yes

  No

  N/A

• No used UHS carts (iso or crash) left out?

  Yes

  No

  N/A

• Cabinets/drawers free of items that don’t belong there

  Yes

  No

  N/A

• No meds left out?

  Yes

  No

  N/A

• IV carts clean, free of items that don't belong in them?

  Yes

  No

  N/A

• IV Carts locked?

  Yes

  No

  N/A

• IV Carts free of expired items?

  Yes

  No

  N/A

• IV Cart handles intact?

  Yes

  No

  N/A

• No tape or stickers on PC monitors, walls, floors, etc?

  Yes

  No

  N/A

• Nothing in front of fire extinguishers?

  Yes

  No

  N/A

• Sharps containers no more than ¾ full, none broken?

  Yes

  No

  N/A

• Linen not more than 3/4 full?

  Yes

  No

  N/A

• Shandswiches not expired?

  Yes

  No

  N/A

• Airway bags/crash carts have dated green tag?

  Yes

  No

  N/A

• All Pyxis machines clutter free on top?

  Yes

  No

  N/A

• Red bio cans clean, not overflowing, functional?

  Yes

  No

  N/A

• No clean items in dirty rooms?

  Yes

  No

  N/A

• No dirty items in clean rooms?

  Yes

  No

  N/A

• Urine preg cartridges have QC label?

  Yes

  No

  N/A

• Urine strips have QC label?

  Yes

  No

  N/A

• Urine put into tubes and dated/timed?

  Yes

  No

  N/A

• Clinitek Calibration Bar clean?

  Yes

  No

  N/A

• No patient belongings left out?

  Yes

  No

  N/A

• No gloves worn outside of patient vicinity.

  Yes

  No

  N/A

• Broken stretchers/damaged mattresses labeled for pickup?

  Yes

  No

  N/A

• Pt fridges clear of non-pt food/expired food

  Yes

  No

  N/A

• Staff/patient fridges don't need defrosting?

  Yes

  No

  N/A

• Labs/cultures labeled at bedside?

  Yes

  No

  N/A

• Red and Blue bins found closed?

  Yes

  No

  N/A

• No sterile packaging found compromised?

  Yes

  No

  N/A

• No sharps left out?

  Yes

  No

  N/A

• Hand hygiene before/after pt contact, after gloves off.

  Yes

  No

  N/A

• Product up off the floor?

  Yes

  No

  N/A

• No doors improperly propped open?

  Yes

  No

  N/A

• Alere cartridges individually labeled?

  Yes

  No

  N/A

• Trophon logbook properly filled out?

  Yes

  No

  N/A

• Trophon supplies stocked?

  Yes

  No

  N/A

• Trophon in working order?

  Yes

  No

  N/A

• Culture bottles labeled with "fill to" line?

  Yes

  No

  N/A

• Triage EKG Machine Cables Clean?

  Yes

  No

  N/A

• Triage wheelchairs not blocking O2 shutoff?

  Yes

  No

  N/A

• Eye room cart satisfactory?

  Yes

  No

  N/A

• Room 5 cart satisfactory?

  Yes

  No

  N/A

• Room 12 cart satisfactory?

  Yes

  No

  N/A

• Cubby cart satisfactory?

  Yes

  No

  N/A

• Yes

  No

  N/A

• No gross infractions found?

  Yes

  No

  N/A

• De-clutter Flex nurse station cabinets/drawers.

• De-clutter Rainbow Room.

• De-clutter Eye Room cart.

• De-clutter Room 5 cart.

• De-clutter Room 12 cart.

• De-clutter ortho cart.

EVS

• No bugs in Triage light covers?

  Yes

  No

  N/A

• No dust in areas?

  Yes

  No

  N/A

• No odor in dirty rooms?

  Yes

  No

  N/A

• Floors don't need mopping, sweeping?

  Yes

  No

  N/A

• Bathrooms clean?

  Yes

  No

  N/A

• Trash not overflowing?

  Yes

  No

  N/A

Facilities

• Lights all working, in good condition?

  Yes

  No

  N/A

• No ceiling tiles need replacing?

  Yes

  No

  N/A

• No paint chipping, holes need patching?

  Yes

  No

  N/A

----- Special Rooms -----

• Peds back locker area clutter free, exit not blocked?

  Yes

  No

  N/A

• Peds specialty supply room neat?

  Yes

  No

  N/A

• Decon Shower Room clean?

  Yes

  No

  N/A

• Air Room clean, stocked?

  Yes

  No

  N/A

• Viewing Room clean?

  Yes

  No

  N/A

• Resus Quiet Room clean?

  Yes

  No

  N/A

• Both Trauma Quiet Rooms clean, TV working?

  Yes

  No

  N/A

• Forms Room clean?

  Yes

  No

  N/A

• Peds fellows office - Items off of floor?

  Yes

  No

  N/A

• No gross infractions found?

  Yes

  No

  N/A