June 2017 Floor/Unit Inspection

• June 2017 Floor/Unit Inspection

• Conducted on

  Date

• Prepared By:

  Select Megan Hempel Amber Haver Caleb Griger Dianna Palmer Amy Shantz Corey Jackson Tammy Hildebrand Jennifer Green Andrea Miller Carol Heath Katie Goodwin Inga Heidebrecht Matthew Kirby Corey Jackson Erica Martin Ashleigh Spellman Gage Joy Shea Duncan Amy Reeves

  • Megan Hempel
  • Amber Haver
  • Caleb Griger
  • Dianna Palmer
  • Amy Shantz
  • Corey Jackson
  • Tammy Hildebrand
  • Jennifer Green
  • Andrea Miller
  • Carol Heath
  • Katie Goodwin
  • Inga Heidebrecht
  • Matthew Kirby
  • Corey Jackson
  • Erica Martin
  • Ashleigh Spellman
  • Gage Joy
  • Shea Duncan
  • Amy Reeves

• Area of Inspection

  Select 1 North ED (Both) 2 Adults + 1 Pediatric NUCMED MRI Gi-Lab CT IR3 CCL01 CCL02 PACU IR19 Employee Health PT EP-Lab Cardiopulmonary Rehab 3S DSC 4 South 5 South 6 South 7 South 8 South 9 South 6 North 7 North 8 North 9 North Main OR (BOTH) Respiratory

  • 1 North
  • ED (Both) 2 Adults + 1 Pediatric
  • NUCMED
  • MRI
  • Gi-Lab
  • CT
  • IR3
  • CCL01
  • CCL02
  • PACU
  • IR19
  • Employee Health
  • PT
  • EP-Lab
  • Cardiopulmonary Rehab
  • 3S DSC
  • 4 South
  • 5 South
  • 6 South
  • 7 South
  • 8 South
  • 9 South
  • 6 North
  • 7 North
  • 8 North
  • 9 North
  • Main OR (BOTH)
  • Respiratory

Crash Carts

• Locked upon inspection

  Yes

  No

  N/A

• Are all medications currently in date?

  Yes

  No

  N/A

• Lock number matches number in book?

  Yes

  No

  N/A

• Is there a second crash cart?

  Yes

  No

  N/A

• Locked upon inspection? If not, please take a photo of the unlocked drawers.

  Yes

  No

  N/A

• Lock number matches lock number in book. Please attach a photo if incorrect.

  Yes

  No

  N/A

OMNICELL

• Are all medications currently in date?

  Yes

  No

  N/A

• Please attach photo of outdated medication

  Media

• Please attach a photo of the Crash cart sheet

  Media

• Please specify location of OMNICELL

• Is the OMNICELL clean and non cluttered? If no, attach photo.

  Yes

  No

  N/A

• Please take a picture of the OMNICELL

  Media

• Are all medications in the OMNICELL currently in date? If no, attach photo of expired item/product.

  Yes

  No

  N/A

• Please attach photo of expired product.

  Media

• Check box to verify you have checked both paper and label dispenser.

• Check box to verify you have cleaned the screen, scanner and keyboard with PDI wipes.

• Does the OMNICELL appear undamaged? If no, please take a photo of damaged equipment.

  Yes

  No

  N/A

• Please take a photo of the damage to the OMNICELL

  Media

• Is there a second OMNICELL

  Yes

  No

  N/A

• Please specify location of OMNICELL

• Is the OMNICELL clean and non cluttered? If no, please attach photo of cluttered/dirty OMNICELL

  Yes

  No

  N/A

• Please attach photo of dirty/cluttered OMNICELL.

  Media

• Are all medications in the OMNICELL currently in date? If no, attach photo of expired item/product.

  Yes

  No

  N/A

• Please attach photo of expired item/product.

  Media

• Check box to verify you have checked both paper and label dispenser.

• Check box to verify you have cleaned the screen, scanner and keyboard with PDI wipes.

• Does the OMNICELL appear undamaged? If no, Please take a photo of damaged equipment.

  Yes

  No

  N/A

• Please take a photo of the damaged OMNICELL

  Media

REGRIGERATOR

• Is the REFRIGERATOR clean and non cluttered?

  Yes

  No

  N/A

• Please attach a photo of the dirty/cluttered REFRIGERATOR.

  Media

• Is the REFRIGERATOR absent of all food/drink?

  Yes

  No

  N/A

• Please attach a photo of the food/drink in the refrigerator.

  Media

• Is there a second REFRIGERATOR?

  Yes

  No

  N/A

• Please specify the location of the second REFRIGERATOR.

• Is the REFRIGERATOR clean and non cluttered?

  Yes

  No

  N/A

• Please attach a photo of the dirty/cluttered OMNICELL.

  Media

• Is the REFRIGERATOR absent of food/drink?

  Yes

  No

  N/A

• Please take a photo of the food/drink.

  Media

• Please specify the location of the refrigerator.

SERVIDORS (IF APPLICABLE)

• Are the SERVIDORS clean and non cluttered?

  Yes

  No

  N/A

• Please specify room numbers of dirty/cluttered SERVIDORS and/ or attach photo.

• Are the SERVIDORS locked upon inspection?

  Yes

  No

  N/A

• Please document unlocked room #'s of SERVIDORS.

Other cabinets/drawers/locked areas that need to be inspected

• Are the medications/supplies locked upon inspection

  Yes

  No

  N/A

• Please attach photo

  Media

• Are all medications currently in date? Please attach photo of dates on supplies/ medications

  Yes

  No

  N/A

• Medication/supply pictures

  Media

OVERALL INSPECTION GRADE

• EXCELLENT

  GOOD

  FAIR

  POOR

• PLEASE SIGN

  Sign