Date and Time of Audit:


Patient MRN:

Type of Isolation

Compliance Area:

Is there an order for isolation in the orders section of the chart?
(An order is not required per policy however there is a mixed practice for this. The order is what drives the information being in the header of Sunrise )

Is the order placed by RN?
(Mark N/A if no order)

Is the order placed by MD?
(Mark N/A if no order)

Is the isolation status documented under Treatment and Care section of POE?

Does the isolation status documented in Treatment and Care section match needed documentation on the HEIC Isolation report?

Does the isolation status documented in EPIC match isolation needs identified on HEIC Isolation Report?

Is there evidence of patient/family education documentation regarding: Prevention of Infection and isolation?
(Patient education website has specific patient education tools addressing each of these topics:
“Prevention of Infection - You are Part of the Healthcare Team”, MRSA, VRE, CDIFF also )

Were staff observed following correct isolation guidelines?
(Based on type of isolation)

Did family members follow correct isolation guidelines?
(Based on type of isolation)

Were staff able to speak to the need for documentation of negative pressure verification with patients requiring airborne isolation?
(Which method of documentation was the unit using- log or isolation sign? )

Were staff able to identify how to tell if the negative pressure room was working adequately?

Miscellaneous Notes and Findings:

Are additional Findings Present?

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.