Audit

Date of Audit

Patient Initials (if needed)

Manager Name

Clinician Name

Clinician Discipline

GREETING

Uses 2 patient identifiers; Each clinician at initial contact uses Name and date of birth, and for subsequent contact Name and facial recognition prior to providing care. NPSG.01.01.01 EP1

Professional conduct of dress code, smile, greeting, etc.

Facility: Follows facility process of check in, communication with appropriate personnel and documentation.

COMMUNICATION SKILLS - ART OF CARING STANDARDS

Warm welcome with eye contact

Asked: "What is important to you today?"

Listened intently to patient and family

Provided opportunity for questions.

Patient and family offered choices in their care.

Concluded visit: "Is there anything further I can help you with today?"

Established patient centered goals of care for episode

Included patient, MD and relevant team members in decisions regarding the POC.

TEACHING

Identified learning needs, assessed readiness to learn and learning style. PC.02.03.01 EP1, PC.02.03.01 EP3; RI.01.01.03 EP1

Used teaching tools as appropriate and simplified language (written and verbal) PC.02.03.01 EP2, RI.01.01.03 EP1

Assessed patient/family response to teaching.
(Utilizing Teach back) PC.02.03.01 EP25

Instructed pt/family/CG in infection control procedures
(Hand hygiene/Resp.hygiene/Contact precautions). IC.02.01.01 EP7

Emergency telephone numbers (and Polst form as needed) posted and patient knows who to report safety concerns to.

INFECTION CONTROL

Followed Hand Hygiene policy. Hand hygiene before/after gloving, before/after touching patient, before entering clinical bag each time, before touching keyboard, when going from dirty to clean body site or area. Allows sanitizer to dry properly.

Please give count of the number of times hand washing should have been done during this observation visit. NPSG 7
Please give count of the number of times hand washing was done during this observation visit. NPSG 7

Isolation Precautions: Patient placed on proper precautions and precautions are followed. IC 02.01.01 EP 2 and IC.02.02.01 EP 2

Clinical Bag Technique: Followed appropriate bag technique. IC.02.01.01 EP 3

Medical Equipment: Removes needed items from bag, places on clean drape or barrier on appropriate surface (not the floor) IC.02.02.01 EP1

Medical Equipment: Pink drape or barrier under laptop and cleaned computer at the end of the visit. IC.02.02.01 EP1

Medical Supplies: Disposes of supplies properly.

Medical Equipment: Cleans and allows to dry before placing back in clinical bag (alcohol = 15 seconds, purple sanicloth = 2 mins, bleach sanicloth = 4 mins IC 02.02.01 EP 1

Medical Equipment: Cleans patient dedicated equipment, such as scissors, left in patients home with alcohol prior to use. IC 02.02.01 EP1

SAFETY

Used proper body mechanics. Performed safe transfers and asks for assistance when necessary.

Assessed/instructed in fire safety/fall safety/ and other identified risk areas. NPSG.09.02.01 EP1, 4

Uses Gait belt or other appropriate safety equipment with hi-fall risk activities

MEDICATION REVIEW / RECONCILIATION

Asked about med changes since last visit. Home/Facility list & meds patient acutally taking matches the computer med profile - Reconciled with MD any discrepancies.
NPSG.03.06.01 EP3; PC.01.02.01 EP10

An up to date hard copy of the medication list is in the patient's home. NPSG.03.06.01 EP4

INTERVENTIONS

Demonstrated skill and focus in assessments.

Followed POC for the next visit. PC.02.01.01 EP1

Planned goals and interventions for next visit. PC.02.01.01 EP1

Technical procedures demonstrated appropriate skills.

Followed MD orders for visits and interventions. PC 02.01.03

Notified MD of any changes in patient's condition. PC.02.01.05 EP8

Assessed and appropriately addressed pain. PC.01.02.07 EP1& Art of Caring

TIME MANAGEMENT / DOCUMENTATION

Documented on the computer in the home and/or completed in a timely manner

CASE MANAGEMENT

Supervises home health aide and updates aid POC.

Schedules next visit with patient/caregiver.

GREETING

Uses 2 patient identifiers; Each clinician at initial contact uses Name and date of birth, and for subsequent contact Name and facial recognition prior to providing care. NPSG.01.01.01 EP1

Professional conduct of dress code, smile, greeting, etc.

Facility: Follows facility process of check in, communication with appropriate personnel and documentation.

COMMUNICATION SKILLS - ART OF CARING STANDARDS

Warm welcome with eye contact

Asked: "What is important to you today?"

Listened intently to patient and family

Provided opportunity for questions.

Patient and family offered choices in their care.

Concluded visit: "Is there anything further I can help you with today?"

Established patient centered goals of care for episode

Included patient, MD and relevant team members in decisions regarding the POC.

TEACHING

Identified learning needs, assessed readiness to learn and learning style. PC.02.03.01 EP1, PC.02.03.01 EP3; RI.01.01.03 EP1

Used teaching tools as appropriate and simplified language (written and verbal) PC.02.03.01 EP2, RI.01.01.03 EP1

Assessed patient/family response to teaching.
(Utilizing Teach back) PC.02.03.01 EP25

Instructed pt/family/CG in infection control procedures
(Hand hygiene/Resp.hygiene/Contact precautions). IC.02.01.01 EP7

Emergency telephone numbers (and Polst form as needed) posted and patient knows who to report safety concerns to.

INFECTION CONTROL

Followed Hand Hygiene policy. Hand hygiene before/after gloving, before/after touching patient, before entering clinical bag each time, before touching keyboard, when going from dirty to clean body site or area. Allows sanitizer to dry properly.

Please give count of the number of times hand washing should have been done during this observation visit. NPSG 7
Please give count of the number of times hand washing was done during this observation visit. NPSG 7

Isolation Precautions: Patient placed on proper precautions and precautions are followed. IC 02.01.01 EP 2 and IC.02.02.01 EP 2

Clinical Bag Technique: Followed appropriate bag technique. IC.02.01.01 EP 3

Medical Equipment: Removes needed items from bag, places on clean drape or barrier on appropriate surface (not the floor) IC.02.02.01 EP1

Medical Equipment: Pink drape or barrier under laptop and cleaned computer at the end of the visit. IC.02.02.01 EP1

Medical Supplies: Disposes of supplies properly.

Medical Equipment: Cleans and allows to dry before placing back in clinical bag (alcohol = 15 seconds, purple sanicloth = 2 mins, bleach sanicloth = 4 mins IC 02.02.01 EP 1

Medical Equipment: Cleans patient dedicated equipment, such as scissors, left in patients home with alcohol prior to use. IC 02.02.01 EP1

SAFETY

Used proper body mechanics. Performed safe transfers and asks for assistance when necessary.

Assessed/instructed in fire safety/fall safety/ and other identified risk areas. NPSG.09.02.01 EP1, 4

Uses Gait belt or other appropriate safety equipment with hi-fall risk activities

MEDICATION REVIEW / RECONCILIATION

Asked about med changes since last visit. Home/Facility list & meds patient acutally taking matches the computer med profile - Reconciled with MD any discrepancies.
NPSG.03.06.01 EP3; PC.01.02.01 EP10

An up to date hard copy of the medication list is in the patient's home. NPSG.03.06.01 EP4

INTERVENTIONS

Demonstrated skill and focus in assessments.

Followed POC for the next visit. PC.02.01.01 EP1

Planned goals and interventions for next visit. PC.02.01.01 EP1

Technical procedures demonstrated appropriate skills.

Followed MD orders for visits and interventions. PC 02.01.03

Notified MD of any changes in patient's condition. PC.02.01.05 EP8

Assessed and appropriately addressed pain. PC.01.02.07 EP1& Art of Caring

TIME MANAGEMENT / DOCUMENTATION

Documented on the computer in the home and/or completed in a timely manner

CASE MANAGEMENT

Supervises home health aide and updates aid POC.

Schedules next visit with patient/caregiver.

DIRECT PATIENT CARE / WOUND CARE

Establishes plastic bag for waste

Cleanses hands then gloves

Remove old dressing and discards

Cleanses hands then gloves

Cleanses wounds with proper technique

Removes old dressing and discards

Cleanses hands then gloves

Applies clean dressing

New glove set up for individual wounds

Solutions are labeled with date opened and expiration date (7 DAY AFTER OPENING)

NURSING ONLY---INR & blood draw

Instructed on anti-coagulation information

Two patient identifiers were used when administering medications, collecting blood samples and other specimens or clinical testing, and providing other treatments or procedures. NPSG.01.01.01 EP1

Containers used for blood and other specimens are labeled in the presence of the patient. NPSG.01.01.01 EP2

Anticoagulation Venipuncture was done for high INR results per policy.
WT.01.01.01 EP7

Proper technique was used for INR testing. WT.01.01.01 EP6

INR test results were reported properly. WT.01.01.01 EP8

If giving test results over the phone has the receiver read back the results, and documents results as read back.

Sharps container used appropriately

MEDICATIONS & SUPPLY STORAGE

Instructed in storing medications and supplies.

Before administration of a medication, the clinician discusses any unresolved concerns about the medication with the patient's physician, prescriber, and/or staff involved with the patient's care/treatment/services. MM.06.01.01 EP 8

Before administration of a new medication, the patient or family is informed about any potential for clinically significant adverse drug reactions or other concerns. MM.06.01.01 EP 9; MM.06.01.03 EPs3-6; PC.02.03.01 EP 10.

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.