Information

  • Conducted on

  • Prepared by

  • Personnel

----- EIA -----

EOC

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

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

  • Ice machine clean, functional?

  • White boards filled out in rooms?

  • Sink cabinets zip-tied?

  • No restraints left on stretchers?

  • No pt info left up on computer screen?

  • No artificial nails or gel polish on staff?

  • Accu check controls dated, not expired.

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

  • Oxygen tanks properly stored/used.

  • Two patient identifiers verbally stated whenever meds are given?

  • Area free of cardboard?

  • Temperature/Crash Cart Logs Completed?

  • No expired items on crash cart?

  • All curtains present, clean?

  • Percentage of ports capped with a Curos

  • No Pharm meds left out?

  • No food or drinks at nurse's station?

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

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

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

  • No meds left out?

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

  • IV Carts found locked?

  • IV Carts free of expired items?

  • IV Cart handles intact?

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

  • Nothing in front of fire extinguishers?

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

  • Linen not more than 3/4 full?

  • Shandswiches not expired?

  • Airway bags/crash carts have dated green tag?

  • All Pyxis machines clutter free on top?

  • Red bio cans clean, not overflowing, functional?

  • No clean items in dirty rooms?

  • No dirty items in clean rooms?

  • No patient belongings left out?

  • No gloves worn outside of patient vicinity.

  • Broken stretchers/damaged mattresses labeled for pickup?

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

  • Staff/patient fridges don't need defrosting?

  • Labs/cultures labeled at bedside?

  • Red and Blue bins found closed?

  • No sterile packaging found compromised?

  • No sharps left out?

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

  • Product up off the floor?

  • No doors improperly propped open?

  • Alere cartridges individually labeled?

  • No gross infractions found?

  • All call bells in place?

  • Pharm Room checked?

  • EKG Room checked?

  • De-clutter nurse station counter storage bin.

EVS

  • No dust in areas?

  • No odor in dirty rooms?

  • Floors don't need mopping, sweeping?

  • Bathrooms clean?

  • Trash not overflowing?

Facilities

  • Lights all working, in good condition?

  • No ceiling tiles need replacing?

  • No paint chipping, holes need patching?

----- ECC -----

EOC

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

  • No restraints left on stretchers?

  • No pt info left up on computer screen?

  • No artificial nails or gel polish on staff?

  • No linen on shelf nearest floor?

  • Accu check controls dated, not expired.

  • Oxygen tanks properly stored/used.

  • Two patient identifiers verbally stated whenever meds are given?

  • Area free of cardboard?

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

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

  • Temperature Logs Completed?

  • All curtains present, clean?

  • Percentage of ports capped with a Curos

  • No Pharm meds left out?

  • No food or drinks at nurse's station?

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

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

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

  • No meds left out?

  • IV carts locked?

  • IV Carts free of expired items?

  • IV Cart handles intact?

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

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

  • Nothing in front of fire extinguishers?

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

  • Linen not more than 3/4 full?

  • Shandswiches not expired?

  • Airway bags/crash carts have dated green tag?

  • All Pyxis machines clutter free on top?

  • Red bio cans clean, not overflowing, functional?

  • No clean items in dirty rooms?

  • No dirty items in clean rooms?

  • No patient belongings left out?

  • No gloves worn outside of patient vicinity.

  • Broken stretchers/damaged mattresses labeled for pickup?

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

  • Staff/patient fridges don't need defrosting?

  • Labs/cultures labeled at bedside?

  • Alere machines clean, free of dried blood?

  • Red and Blue bins found closed?

  • No sterile packaging found compromised?

  • No sharps left out?

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

  • Product up off the floor?

  • No doors improperly propped open?

  • Alere cartridges individually labeled?

  • 4x4s available at Alere station?

  • Culture bottles labeled with "fill to" line?

  • No gross infractions found?

  • No meds left out in attending office?

  • No meds left out in Dr Workroom?

EVS

  • No dust in areas?

  • No odor in dirty rooms?

  • Floors don't need mopping, sweeping?

  • Bathrooms clean?

  • Trash not overflowing?

Facilities

  • Lights all working, in good condition?

  • No ceiling tiles need replacing?

  • No paint chipping, holes need patching?

----- Resus -----

EOC

  • No restraints left on stretchers?

  • No pt info left up on computer screen?

  • No artificial nails or gel polish on staff?

  • Accu check controls dated, not expired.

  • Blanket warmer only has approved items

  • Fluid warmer has no expired fluids?

  • Fluid fridge stocked, has no expired fluids?

  • Oxygen tanks properly stored/used.

  • Two patient identifiers verbally stated whenever meds are given?

  • Area free of cardboard?

  • Temperature Logs Completed?

  • All curtains present, clean?

  • Percentage of ports capped with a Curos

  • No Pharm meds left out?

  • No food or drinks at nurse's station?

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

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

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

  • No meds left out?

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

  • IV Carts free of expired items?

  • IV Cart handles intact?

  • IV Carts locked?

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

  • Nothing in front of fire extinguishers?

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

  • Linen not more than 3/4 full?

  • Airway bags/crash carts have dated green tag?

  • All Pyxis machines clutter free on top?

  • Red bio cans clean, not overflowing, functional?

  • No dirty items in clean rooms?

  • No patient belongings left out?

  • No gloves worn outside of patient vicinity.

  • Broken stretchers/damaged mattresses labeled for pickup?

  • Staff/patient fridges don't need defrosting?

  • Labs/cultures labeled at bedside?

  • Red and Blue bins found closed?

  • No sterile packaging found compromised?

  • No sharps left out?

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

  • Product up off the floor?

  • No doors improperly propped open?

  • Percentage Resus shelves stocked

  • Brochoscopes cleaned less than 6 days ago?

  • SPD Cart utilized appropriately?

  • Extra cords in clear ziploc bags?

  • Nothing in front of O2 shutoff valves?

  • No gross infractions found?

EVS

  • No dust in areas?

  • Floors don't need mopping, sweeping?

  • Trash not overflowing?

Facilities

  • Lights all working, in good condition?

  • No ceiling tiles need replacing?

  • No paint chipping, holes need patching?

----- Trauma -----

EOC

  • No restraints left on stretchers?

  • No pt info left up on computer screen?

  • No artificial nails or gel polish on staff?

  • Accu check controls dated, not expired.

  • Blanket warmer only has approved items

  • Fluid warmer stocked, has no expired fluids?

  • Oxygen tanks properly stored/used.

  • Two patient identifiers verbally stated whenever meds are given?

  • Area free of cardboard?

  • Temperature/Lifepak Logs Completed?

  • All curtains present, clean?

  • Percentage of ports capped with a Curos

  • No Pharm meds left out?

  • No food or drinks at nurse's station?

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

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

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

  • No meds left out?

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

  • Nothing in front of fire extinguishers?

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

  • Linen not more than 3/4 full?

  • Shandswiches not expired?

  • Airway bags/crash carts have dated green tag?

  • All Pyxis machines clutter free on top?

  • Red bio cans clean, not overflowing, functional?

  • No clean items in dirty rooms?

  • No dirty items in clean rooms?

  • Urine strips have QC label?

  • Urine preg cartridges have QC label?

  • Urine put into tubes and dated/timed?

  • Clinitek Calibration Bar clean?

  • No patient belongings left out?

  • No gloves worn outside of patient vicinity.

  • Broken stretchers/damaged mattresses labeled for pickup?

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

  • Staff/patient fridges don't need defrosting?

  • Microwave clean?

  • Labs/cultures labeled at bedside?

  • Red and Blue bins found closed?

  • No sterile packaging found compromised?

  • No sharps left out?

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

  • Product up off the floor?

  • No doors improperly propped open?

  • Extra cords in clear ziploc bags?

  • No gross infractions found?

  • De-Clutter Ortho Cart

  • De-Clutter Ortho Cabinet

EVS

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

  • Trash not overflowing?

  • No dust in areas?

  • No odor in dirty rooms?

  • Floors don't need mopping, sweeping?

  • Bathrooms clean?

Facilities

  • Lights all working, in good condition?

  • No ceiling tiles need replacing?

  • No paint chipping, holes need patching?

----- Peds -----

EOC

  • No restraints left on stretchers?

  • No pt info left up on computer screen?

  • No artificial nails or gel polish on staff?

  • Accu check controls dated, not expired.

  • Blanket warmer only has approved items

  • Oxygen tanks properly stored/used.

  • Two patient identifiers verbally stated whenever meds are given?

  • Area free of cardboard?

  • Temperature/Lifepak Logs Completed?

  • All curtains present, clean?

  • Percentage of ports capped with a Curos

  • No Pharm meds left out?

  • No food or drinks at nurse's station?

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

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

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

  • No meds left out?

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

  • IV Carts locked?

  • IV Carts free of expired items?

  • IV Cart handles intact?

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

  • Nothing in front of fire extinguishers?

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

  • Linen not more than 3/4 full?

  • Airway bags/crash carts have dated green tag?

  • All Pyxis machines clutter free on top?

  • Red bio cans clean, not overflowing, functional?

  • No clean items in dirty rooms?

  • No dirty items in clean rooms?

  • Urine preg cartridges have QC label?

  • Urine strips have QC label?

  • Urine put into tubes and dated/timed?

  • Clinitek Calibration Bar clean?

  • No patient belongings left out?

  • No gloves worn outside of patient vicinity.

  • Broken stretchers/damaged mattresses labeled for pickup?

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

  • Staff/patient fridges don't need defrosting?

  • Labs/cultures labeled at bedside?

  • Red and Blue bins found closed?

  • No sterile packaging found compromised?

  • No sharps left out?

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

  • Product up off the floor?

  • No doors improperly propped open?

  • Outlet covers in sockets?

  • Ice machine clean, functional?

  • Nothing on top of lockers?

  • No gross infractions found?

  • De-clutter supply room.

  • De-clutter lab bin at nurse station

EVS

  • No dust in areas?

  • No odor in dirty rooms?

  • Floors don't need mopping, sweeping?

  • Bathrooms clean?

  • Trash not overflowing?

Facilities

  • Lights all working, in good condition?

  • No ceiling tiles need replacing?

  • No paint chipping, holes need patching?

----- CDU -----

EOC

  • No restraints left on stretchers?

  • No pt info left up on computer screen?

  • No artificial nails or gel polish on staff?

  • Accu check controls dated, not expired.

  • Oxygen tanks properly stored/used.

  • Two patient identifiers verbally stated whenever meds are given?

  • Area free of cardboard?

  • Temperature/Crash Cart Logs Completed?

  • No expired items on crash cart?

  • All curtains present, clean?

  • Percentage of ports capped with a Curos

  • No Pharm meds left out?

  • No food or drinks at nurse's station?

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

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

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

  • No meds left out?

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

  • IV Carts locked?

  • IV Carts free of expired items?

  • IV Cart handles intact?

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

  • Nothing in front of fire extinguishers?

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

  • Linen not more than 3/4 full?

  • Shandswiches not expired?

  • Airway bags/crash carts have dated green tag?

  • All Pyxis machines clutter free on top?

  • Red bio cans clean, not overflowing, functional?

  • No clean items in dirty rooms?

  • No dirty items in clean rooms?

  • Urine preg cartridges have QC label?

  • Urine strips have QC label?

  • Urine put into tubes and dated/timed?

  • Clinitek Calibration Bar clean?

  • No patient belongings left out?

  • No gloves worn outside of patient vicinity.

  • Broken stretchers/damaged mattresses labeled for pickup?

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

  • Staff/patient fridges don't need defrosting?

  • Labs/cultures labeled at bedside?

  • Red and Blue bins found closed?

  • No sterile packaging found compromised?

  • No sharps left out?

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

  • Product up off the floor?

  • No doors improperly propped open?

  • Alere cartridges individually labeled?

  • Culture bottles labeled with "fill to" line?

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

  • Iso Room - Negative Pressure Alarms functional?

  • Room 10 cart satisfactory?

  • No gross infractions found?

  • Nothing in stairwell behind CDU?

  • Microwave clean?

  • Check Bay 1 drawers.

  • Check Bay 4 drawers.

  • Check and de-clutter back nurse station.

  • De-clutter Alere alcove.

EVS

  • No dust in areas?

  • No odor in dirty rooms?

  • Floors don't need mopping, sweeping?

  • Bathrooms clean?

  • Trash not overflowing?

Facilities

  • No ceiling tiles need replacing?

  • No paint chipping, holes need patching?

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

EOC

  • Triage Cabinets/drawers satisfactory?

  • Quick Reg cabinets/drawers satisfactory?

  • Waiting Room bathroom satisfactory?

  • No restraints left on stretchers?

  • No pt info left up on computer screen?

  • No artificial nails or gel polish on staff?

  • Accu check controls dated, not expired.

  • Oxygen tanks properly stored/used.

  • Two patient identifiers verbally stated whenever meds are given?

  • Area free of cardboard?

  • Temperature/Crash Cart Logs Completed?

  • No expired items on crash cart?

  • All curtains present, clean?

  • Percentage of ports capped with a Curos

  • No Pharm meds left out?

  • No food or drinks at nurse's station?

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

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

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

  • No meds left out?

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

  • IV Carts locked?

  • IV Carts free of expired items?

  • IV Cart handles intact?

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

  • Nothing in front of fire extinguishers?

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

  • Linen not more than 3/4 full?

  • Shandswiches not expired?

  • Airway bags/crash carts have dated green tag?

  • All Pyxis machines clutter free on top?

  • Red bio cans clean, not overflowing, functional?

  • No clean items in dirty rooms?

  • No dirty items in clean rooms?

  • Urine preg cartridges have QC label?

  • Urine strips have QC label?

  • Urine put into tubes and dated/timed?

  • Clinitek Calibration Bar clean?

  • No patient belongings left out?

  • No gloves worn outside of patient vicinity.

  • Broken stretchers/damaged mattresses labeled for pickup?

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

  • Staff/patient fridges don't need defrosting?

  • Labs/cultures labeled at bedside?

  • Red and Blue bins found closed?

  • No sterile packaging found compromised?

  • No sharps left out?

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

  • Product up off the floor?

  • No doors improperly propped open?

  • Alere cartridges individually labeled?

  • Trophon logbook properly filled out?

  • Trophon supplies stocked?

  • Trophon in working order?

  • Culture bottles labeled with "fill to" line?

  • Triage EKG Machine Cables Clean?

  • Triage wheelchairs not blocking O2 shutoff?

  • Eye room cart satisfactory?

  • Room 5 cart satisfactory?

  • Room 12 cart satisfactory?

  • Cubby cart satisfactory?

  • No gross infractions found?

  • 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?

  • No dust in areas?

  • No odor in dirty rooms?

  • Floors don't need mopping, sweeping?

  • Bathrooms clean?

  • Trash not overflowing?

Facilities

  • Lights all working, in good condition?

  • No ceiling tiles need replacing?

  • No paint chipping, holes need patching?

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

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

  • Peds specialty supply room neat?

  • Decon Shower Room clean?

  • Air Room clean, stocked?

  • Viewing Room clean?

  • Resus Quiet Room clean?

  • Both Trauma Quiet Rooms clean, TV working?

  • Forms Room clean?

  • Peds fellows office - Items off of floor?

  • No gross infractions found?

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