Audit

Housekeeping

High Reach Horizontal Surfaces are Clean 07.00.00

Show Evidence

Surfaces are uncluttered and free of dust 07.00.00

Show Evidence

Sprinkler Heads and Smoke detectors are free of dust and dirt. 11.04.06

Show Evidence

Vents are free of dust and dirt. 07.00.00

Show Evidence

Environmental Service carts not left unattended in Corridors. (Hospital Only)

Show Evidence

Empty pop cans are not stored with patient care items. 07.03.07

Show Evidence

Vending Machines are clean. 07.03.03

Show Evidence

Wheels on carts are clean and free of dust and/or debris 07.00.00

Show Evidence
ENVIRONMENTAL

Doors are not propped open. 11.04.05

Show Evidence

Ceiling tiles are not stained, missing, or broken. 07.03.04

Show Evidence

In sprinkled areas, supplies are stored 18 inches from ceiling. 11.04.06

Show Evidence

Items are not stored within 30" directly in front of electrical panels. 1910.303/NFPA

Show Evidence

Elevator Areas, Corridors, and Egress routes are free of equipment and any obstructions. 11.04.08

Show Evidence

Furniture and Equipment removed if in poor condition (cracked, torn, broken, ect) and Maintenance notified. 07.00.00

Show Evidence
PATIENT CONFIDENTIALITY

Computers are " Logged-off" when staff is not present.

Show Evidence

Monitor Screens are oriented to protect patient confidential information.

Show Evidence

Doors are locked to Medical record Storage areas. 10.00.04

Show Evidence

Check all areas for HIPPAA violations (check trash cans, patient charts, test results, etc)

Show Evidence
WORK PRACTICES

Staff, Doctors, Volunteers, and Students wearing ID at all times. 04.00.13

Show Evidence

Proper Lifting Equipment available if needed. (Hospital Only)

Show Evidence

Only Hospital approved hand lotion is available and in use.

Show Evidence
LIFE SAFETY

Exit Signs clearly visible and working properly. NFPA 99

Show Evidence

Fire doors and Emergency exits are unobstructed. Fire extinguishes and fire alarm pull stations and accessible (Not Blocked). 11.04.05/11.04.06

Show Evidence

Staff is familiar with the location of fire extinguishers, medical gas shut-off valves (if applicable), fire alarm pull stations (if applicable) and notification procedures if there was an Emergency situation in the department. 11.00.02/11.07.01

Show Evidence
STORAGE ISSUES

Items are not left unattended in corridors. 11.04.08

Show Evidence

Items are not being stored on the floor. 11.04.08

Show Evidence

No items (clean or sterile) stored under sinks. In non-patient areas, no paper items or non-labeled chemicals are stored under sinks. 07.02.04/07.02.07

Show Evidence

Items are not to be stored within the splash zone of the sink (3'). 07.03.05

Show Evidence

All linen items are stored properly-clean with clean, and dirty with dirty, and covered. 07.04.01/07.04.03

Show Evidence
HAZARDOUS MATERIALS AND WASTE

Staff knows how to access MSDS information. 11.05.04

Tank of Compressed gases (oxygen) are properly stored, not left on empty wheelchairs, stretchers, or left in corridors. Only 1 bottle is allowed to be stored at the Nurse's Station. 1910.253/NFPA 99

Show Evidence

All Biohazard containers are handled and labeled appropriately. 49 CFR

Show Evidence

In areas using hazardous materials, emergency phone numbers are posted in the case of a chemical spill. 1910.120

Show Evidence

All chemicals properly labeled and stored. 11.05.04

Show Evidence

If eyewash stations are in the department, they are inspected and operated weekly to verify working order, and are unobstructed. ANSI Z358.1

Show Evidence

Biohazards are disposed of in the proper containers-sharps, bio-bags, etc. 07.03.07/49 CFR 171/1910.1030

Show Evidence

If a department uses a high level disinfectant for equipment sterilization (Cidex OPA), daily checks are completed and logged.

Show Evidence

Food and Beverages are not stored or consumed in areas where chemicals are used or stored. 1910.120

Show Evidence
INFECTION PREVENTION

Staff food/drink items are not in patient care areas (i.e. nurses stations). Staff do not apply lip products in patient areas. 07.01.10

Show Evidence

Staff belongings are not stored in patient care areas.

Show Evidence

Sterile/Clean equipment stored (6" from outside wall, 18" from the ceiling, and 6" from the floor) and rotated appropriately. 07.02.04/07.02.07

Show Evidence

Sterile/Clean equipment not stored together with "dirty" utility items or in traffic areas. 07.02.04/07.02.07

Show Evidence

Specimens are transported correctly (gloves are used when transporting to soiled utility room, specimens are in bio-hazard whenexiting the department). 1910.1030

Show Evidence

Linen is covered during transport. 07.04.01/07.04.03

Show Evidence

All clean linen carts are covered, or in an enclosed room. All dirty linen hamper lids are closed. 07.04.01/07.04.03

Show Evidence

Areas under sinks show no evidence of mold/mildew growth.

Show Evidence

Opened and outdated nourishments are removed from refrigerators. 07.02.07

Show Evidence

Refrigerators and freezers for specimens are properly labeled with a biohazard label. 07.03.07

Show Evidence

Refrigerated specimens are not stored in with refrigerated food items, and patient food is not stored with staff food in refrigerators. 07.00.00/07.03.07

Show Evidence

Refrigerators are periodically cleaned inside and out.

Show Evidence

Dirty Equipment is cleaned before being sent to CPD.

Show Evidence

PPE is available and used properly. 07.01.01/OSHA 1910.1030

Show Evidence

Alcohol based hand hygiene products are available for staff. 07.03.05

Show Evidence

Soap and hand towels are available at each hand washing sink. 07.03.05

Show Evidence

Sterile supplies are not expired and are labeled with a lot number. 07.02.07

Show Evidence

No evidence of pests or entranceways for pests. 07.05.01

Show Evidence

No evidence of poisons used to exterminate pests. 07.05.02

Show Evidence

Brushes used for cleaning medical equipment evaluated and cleaned daily.

Show Evidence

Upon opening an in-house processed sterile tray or set, the chemical indicators are validated. 07.02.04

Show Evidence
MEDICAL EQUIPMENT

Preventive maintenance stickers are up-to-date. 11.08.06

Show Evidence

ERT carts are checked daily ( seals are not broken).

Show Evidence

ERT Carts are plugged into red outlets. 11.08.04

Show Evidence

Emergency equipment/supplies (ambu bag, Ephinephrine, Benadryl, airways) are monitored monthly for expiration.

Show Evidence

Blanket warmer temperature set at 130 degree F (if not automatically monitored)

Show Evidence

IV solutions in volumes of 150 ml or greater are warmed to 104 degree F for no longer than 14 days

Show Evidence

Pour bottle solutions are warmed to 150 degree F for no longer than 3 days

Show Evidence

All comfort bath warmers are set to 125 degree F +5 degrees

Show Evidence

Non-functioning electrical and patient care equipment removed from service and Clinical Engineering notified

Show Evidence

Your HEPA hoods are present, labeled correctly for your department, and plugged in. The hood itself is free from damage or tears.

Show Evidence
ELECTRICAL

Extension cords are not in use (power strips are permitted). 1910.303/1910.334/NFPA 99 & 70E

Show Evidence

Electrical equipment (including outlets) are in good repair and are secure. 1910.305/NFPA 70E

Show Evidence
MEDICATION SAFETY

Medications are secure. 25.01.03

Show Evidence

Medications are not outdated. 07.00.00

Show Evidence

Medications are properly labeled with the name of the medication, manufacturer, concentration, lot number, and expiration date in month/day/year format. 25.01.07

Show Evidence

Multi-dose vials are labeled with the initials of person who opened the vial, and the expiration date (28 days after opening). 07.00.00

Show Evidence

Pill crushers are clean.

Show Evidence
RADIATION SAFETY ISSUES

Staff members are wearing appropriate badges (radiation dosimeter). 19.00.01

Show Evidence

Appropriate shielding is available for patients, staff and visitors. 19.00.01

Show Evidence

Rooms housing radiation sources are labeled.

Show Evidence

Lead aprons and gloves are worn when necessary. 19.00.01

Show Evidence

Lead apron checks are completed annually. 19.00.01

Show Evidence
PATIENT CARE AND NURSING (HOSPITAL ONLY)

All audible alarms are set on patient care equipment.

Show Evidence

Emergency pull cords are 4 inches from the floor and free hanging.

Show Evidence
STAFF INTERVIEWS (Instructions: Interview 3 staff members(from different shifts if possible) with the below questions)

How can you access an MSDS sheet?

Do you know who the Safety Officer is and how to contact him/her?

How are employees notified if Metro activates one of our disaster plans?

Where are the nearest fire extinguishers and AND fire alarm pull station located?

How is the fire code announced overhead?

Where is the medical gas shutoff valve located?

TOTAL SCORE
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.