JCIA Champions Checklist

Information

Organization and Departmental Related

ENVIRONMENT OF CARE

No items stored under sinks?
Equipment / Furniture: * No broken equipment or furniture stored on the patient care units. * Coverings are intact - no rips or repairs needed.
Refrigerators: Contain only those items designed for that refrigerator (specimen, medications or patient food)
Refrigerators: Temp-track accessible. Documentation is present for actions taken to correct out of range temps.
Electrical safety: Use of hospital grade power strips, plugs & receptacles in good condition.
No outer shipping carton boxes in patient care areas.
No expired items. * Random sampling of meds and items checked.
Temperature and humidity are monitored and maintained within accepted standards of practice; and if monitoring determined temperature or humidity levels were not within acceptable parameters, that corrective actions were performed in a timely manner to achieve acceptable levels. 20%-60% humidity temperature
Preventative Maintenance: * Random sampling of equipment checked with up to date bio-med sticker.

MEDICATION MANAGEMENT

Medication rooms are clean and uncluttered.
Visual inspection of medication containers: No Issues.
Area free of distractions.
Medication is appropriately labeled. * Medication name * Medication strength * Initials of person drawing up medication * Date and time of draw * Expiration date and time(one hour from draw)
All medications, needles and syringes are secured in locked cabinet or locked room or under constant surveillance.
Medications stored appropriately to maintain stability.
Medications & solutions not expired beyond expiration date.
Staff check ID band and allergies prior to administering medications.
Opened multi-dose vials dated and initialed. Not expired.
Crash Carts: * Locked and marked with then first drug to expire. * Checked per policy. * Include defibrillator check. * Extra locks kept secured. * All supplies & drugs that are on the inventory list are on the cart. *. Cart is clean. *. O2 tank is >1/2 full
Patient Bedside: *. IV tubing is labeled per policy. *. Medication is secured and labeled. *. All solutions are labeled at the bedside.
Medication Carts: Doors and drawers are locked.

UNIVERSAL PROTOCOL

A pre-procedure verification process to make sure all relevant documents (including the patient’s signed informed consent) and related information are available, correctly identified, match the patient, and are consistent with the procedure the patient and the ASC’s clinical staff expect to be performed;
Site marking conducted according to policy
Time out conducted according to policy

POINT OF CARE TESTING

Point of Care testing lab controls documented and control solution labeled & dated. *expiration and open dates
Training for staff that are completing waived testing is available.

EMERGENCY PREPAREDNESS

Appropriate storage of boxes and pt care items: * Not directly on floor. * 18" clearance from sprinkler head. * Boxes stored on shelves close to floor must have solid bottom and high enough to not incur water damage from mopping.
Fire alarm, fire extinguishers, medical gas shutoff valves are not blocked.
Fire extinguishers have been inspected monthly. * extinguisher tags checked.
Fire doors are not blocked or propped and when closed there is positive latching.
Exit signs are illuminated.
Everyone has ID badges and worn appropriately: * Staff and Visitors
Ceiling tiles are in place, no cracks, holes, misaligned or visible stains.
Floors, ceilings, walls, and other surfaces intact and free from holes.

STANDARD PERFORMANCE IMPROVEMENT

Are units/or wards quality improvement dashboards posted on unit.
Staff can speak to current Quality projects and goals
Is unit's PI project data posted and current
Staff can speak about Tracer Methodology and its types
Staff can speak about Quality Methodology
Staff is aware about Key Performance Indicator
Staff is aware about NNI Key Performance Indicator
Staff are aware about the two (2) Main sections of JCIA Standards
Staff can speak about International Patient Safety Goals? (explain each standard)

RIGHTS AND RESPONSIBILITIES OF THE INDIVIDUAL

Patients and families properly informed of their rights. *Rights and Responsibilities statement
Provide the patient or, the patient’s representative was provided with written information concerning its policies on advance directives, including a description of applicable State health and safety laws and, if requested, official State advance directive forms.

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