JHH Ambulatory EOC Rounds EOC Only

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time of Audit:

  Date

• Location:

• Auditor Name:

Personnel Interviewed:

• Staff Names:

Miscellaneous Findings:

• Other Noncompliant Findings?

  Yes

  No

  N/A

Environment of Care

Oxygen Storage

• Appropriate storage of oxygen tanks: never used tanks (as indicated by green<br> cap over oxygen nozzle) are stored separately from partially used and empty <br> tanks

  Yes

  No

  N/A

• Full Unused and Partially Used signs are posted on the appropriate racks

  Yes

  No

  N/A

Supplies

• Point of care testing strips and control solutions are labeled with expiration date

  Yes

  No

  N/A

• Solutions and test strips used during HLD/sterile processes are within expiration<br> date.

  Yes

  No

  N/A

• No expired supplies

  Yes

  No

  N/A

• No expired specimen containers or specimen collection supplies

  Yes

  No

  N/A

Medications

• Multi-dose vials not stored in patient care area

  Yes

  No

  N/A

• No expired medications

  Yes

  No

  N/A

• Medications secured in a locked cabinet or locked room

  Yes

  No

  N/A

Marketing

• No drug samples

  Yes

  No

  N/A

• No products or educational material with vendor name on it

  Yes

  No

  N/A

HIPPA

• All patient information is stored properly. Computers, or patient equipment <br> displaying PHI, not in use are logged off

  Yes

  No

  N/A

Equipment Storage

• Assure the bottom shelf of storage carts has a solid bottom

  Yes

  No

  N/A

• Storage greater than 18 inches from sprinklers

  Yes

  No

  N/A

• IVF, syringes, needles are locked and secure, unless in visible area at all times

  Yes

  No

  N/A

Equipment Logs

• Thermometers in refrigerators and temperatures checked daily, if applicable

  Yes

  No

  N/A

• Crash cart is locked, lock number recorded/emergency equipment log maintained only current month available out on unit

  Yes

  No

  N/A

• Crash cart log completed for all days the area is open

  Yes

  No

  N/A

• Eye wash stations are operational and logs are completed weekly for each eyewash station

  Yes

  No

  N/A

Fluid and Blanket Warmers

• Blanket warmers have proper signage and are set not to exceed 130 degrees F (54.4 degrees C). No IV fluids are being warmed in blanket warmers.

  Yes

  No

  N/A

• Fluid warmers have proper signage and are set not to exceed 104 degrees F (40 degrees C).

  Yes

  No

  N/A

• Temperature logs are up to date with temperature documented daily

  Yes

  No

  N/A

• For fluid warmers, all IV fluids are dated and timed not to exceed 14 days in a warmer

  Yes

  No

  N/A

Cleaning and Disinfection

• Cleaning solutions labeled and do not exceed manufacturer expiration date

  Yes

  No

  N/A

• Medical equipment is clean

  Yes

  No

  N/A

• SDS and Instructions for Use (IFU) manual available in clinic

  Yes

  No

  N/A

• Eye wash in every room where chemicals are sprayed or high level disinfection or sterilization occurs

  Yes

  No

  N/A

• Patient care areas are free of visible dirt, dust, and stains

  Yes

  No

  N/A

• Staff speak to appropriate handling of used instruments as applicable to the device (pre-cleaning, rinsing, stored in open position, instruments kept moist prior to transport to CSD, e.g., sprayed with enzymatic)

  Yes

  No

  N/A

Patient Care Environment

• Patient Bill of Rights poster is present and current.

  Yes

  No

  N/A

• Hallways clear - no equipment stored in hallway

  Yes

  No

  N/A

• Medical equipment has appropriate clinical engineering services tag and not <br> expired (if applicable)

  Yes

  No

  N/A

• Fall Prevention: Floors not slippery. Adequate seating. Have ADA compliant restroom. Surfaces even for walkers and wheelchairs. Staff understand how to assist those appearing to be at risk for falling.

  Yes

  No

  N/A

• All red bag trash is covered

  Yes

  No

  N/A

• Emergency pull cords in exam rooms and patient bathrooms are no more than 6 inches from the floor without touching the floor

  Yes

  No

  N/A

• Emergency pull cords in exam rooms and patient bathrooms are functional

  Yes

  No

  N/A

• Electric panels and medical gas panels are free from obstructions

  Yes

  No

  N/A

• Medical equipment is plugged directly into wall outlet or plugged into a power strip that is permanently attached to the equipment assembly (e.g. a cart). Power strips are not plugged into other power strips (daisy chain).

  Yes

  No

  N/A

Staff Interview

• How to report a patient/visitor/staff event<br>Follow chain of command, notify provider as appropriate, enter events (e.g. falls, unexpected events) into event reporting system

  Yes

  No

  N/A

• * Preventing Infections information provided to patient<br> Know how your clinical area assures your patient receives this.<br>Posted in waiting area, sent via Smart Source, or in AVS.<br>

  Yes

  No

  N/A

• What to do if a patient, visitor, or staff member has a possible stroke, heart attack, or any other medical emergency<br>call 5-4444 at any time (24/7)

  Yes

  No

  N/A

• Where to pull up disaster plan information

  Yes

  No

  N/A

• What the key Performance Indicators are<br>Ex. Hand hygiene, patient satisfaction, reduce readmissions, etc.<br>

  Yes

  No

  N/A

• How critical action values (CAV) are handled

  Yes

  No

  N/A

• Frequency that BP cuffs, exam tables, and medical equipment are disinfected (minimum of once daily and when visibly soiled)

  Yes

  No

  N/A

• Secure storage of prescription pads including storage of controlled substance prescription pads in the Pyxis

  Yes

  No

  N/A