Environmental of Care

1 - How do you report an error that has occurred?

Medication error
Injury to employee
Injury to patient/visitor
Safety Concern
Near Miss Event

(refer to pg 26-27)

2 - What do you do if someone is in a care area without an ID badge?

3 - What are MSDS? Can you show me how you would access an MSDS sheet on a chemical?
(refer to pg 19)

4 - How can you tell if equipment you are using is clean?

5 - How do you clean equipment between patient and how long does cleaner take to work?
Pg 37

6 - What is the hospital's policy
pg we

Emergency Management

7. - Who is able to turn off a medical gas valve in an emergency? Where is the medical gas valve?

8 - What should you do if there is a missing child? What measures have been implemented to reduce the risk of a patient abduction?

(Interviewee needs to be able to name at least 2 of the listed options to be in compliance)

9 - What are the emergency codes? What is your role?

Refer pg 18

Human Resources

10 - What do you do for continuing education?

11 - How do you learn about new products, procedures?

12 - What competences are required for your job?

13 - Staff can locate physician/resident privileges?

Information Management

14 - Locate: H&P, Falls risk assessment, pain assessment, EC record, lab results

15 - Name 3 ways (or more) that you maintain patient privacy confidentiality?

Life Safety

16 - what type of safety training/education have you received?

17 - In the event of a fire, what does RACE stand for?

Pg 19

18 - When using a fire extinguisher, what does PASS stand for?

19 - Can you show me the location of the nearest fire pull station and fire extinguisher?

20 - What is your unit's evacuation plan and area of refuge?

21 - How do you ensure everyone was evacuated & the area is clear?

22 - How would you dispose of different kinds of waste? Hazardous Pharmaceutical, Biohazard-Infectious, Chemotheraphy?

Patient Safety/National patient Safety Goals

23 - How do you promote patient safety?

24 - What are the 3 identifiers used at ACH to ensure patients are safety? Is this in policy?

25 - When do you check patient identifiers?

Pg 7-8
(Interviewee needs to be able to name 2 to be in compliance)

26 - Where do you label specimens?

27 - What are the major safety risks for your patient population? (Name at least 2)

28 - What has been done to reduce those (safety) risks?
(Interviewee needs to be able to name interventions to at least 2 of the examples given above to be in compliance)

29 - How do you report critical results to the physician or ARNP?

Pg 8-9

30 - What are your processes for giving blood transfusions? Can you walk me through the process?
Pg 8

31 - When should a time out be preformed?

32 - Can you explain how you ensure the surgery for this patient is conducted on the right patient, on the right site and is the right procedure? (Universal Protocol?)

33 - How do you assess if a patient is at risk from falling?

34 - What do you give to the patient/family in regards to medications reconciled at discharge?

35 - Can you explain the procedure to give warfarin?

36 - What are some of the things you're doing at ACH to prevent surgical site infections?

37 - What if during the time out you are unsure of something being right-what should you do?

38 - Are you encouraged/expected to speak up to the team before the procedure begins?

39 - What are some of the things you're doing at ACH to prevent central line associated blood stream infections?

40 - When do you call the Rapid Response Team?

41 - Can families call them also?

Performance Improvement

42 - Can you show me where I would fine information on your department's Quality Improvement (Performance Improvement) activities?

43 -Can you tell me about a Quality Improvement project that you have done in your department?

44 - How do I report a quality of care concern?

(Interviewee needs to be able to name 1 to be in compliance)

Provision of Care Treatment and Service

45 - When does the physician/ARNP have to evaluate the child who is restrained for violent/self-destructive reason?

46 - What are examples of alternatives you might use to avoid using restraints on a patient?

47 - Where do you document the need for an interpreter?

48 - Tell me about the process for telephone orders or verbal orders?

49 - What is your hand-off communication?

50 - How do you instruct families to report a safety concern?

Infection Prevention

51 - What do you do to prevent the spread of infection?

(Interviewee needs to name Hand Hygiene and 1 other to be in compliance)

52 - Staff is not wearing artificial nails?

53 - Describe Standard precautions?

54 - How do you know a patient requires isolation? Is in isolation?

55 - How do you identify an MDR patient?

56 - How do you know your negative pressure room is functioning?

57 - Do you know your units infection prevention data?

58 - When are you supposed to preform hand hygiene?

59 - If a patient has a confirmed MRSA, what do about that?

Medication Management

60 - Can you show me how you would access the formulary on the intranet?

61 - What the precautions for look-alike-sound-alike drugs or high risk medications?

62 - Where would you find info on high alert medications?

(Interviewee needs to be able to name 1 to be in compliance)

63 - How do you report an Adverse Drug Reaction?

(Interviewee needs to be able to name 2 to be in compliance)

64 - How do you report a medication event (error), including a "near miss"?

65 - How are you alerted to Food and Drug Interactions (with drug prescribed for your patient)?

Interviewee needs to be able to name 2 to be in compliance)

66 - Can you describe your medication reconciliation processes?

(Interviewee needs to be able to name 2 to be in compliance)

67 - What resources are available if you have drug information question?

(Interviewee needs to be able to name 2 to be in compliance)

68 - What are the rights to medication administration?

69 - What is the procedure for wasting a narcotic drug?

Rights and Responsibilities of the Individual

70 - What do you do if a patient or family has a grievance?

Describe the Unit's response to your arrival

71 - Greet the team with smiles & introductions?

72 - Have a space designated for the team to conduct interviews and file reviews?

73 - Promptly deliver materials required for review to the tracer team?

74 - Any additional comments regarding positive or suboptimal issues observed during this tracer?

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.