Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Previous department EOC survey

  • Has all previous non-conformities been corrected?

Infection Control

  • Beverages / food at nurses station or medication carts?

  • Linen carts are covered and nothing on top?

  • Nothing under the sinks?

  • Hand washing protocols followed and observed?

  • Sterile package integrity?

  • Patient care equipment is clean and cleaned between patients, not dusty?

  • Torn or ripped mattress, cart pads, wheelchairs, task chairs?

  • Kitchen is clean / food is dated and no partially eaten food stored?

  • artificial nails not seen?

Plant Operations

  • Ceiling tiles look good (not stained or broken)?

  • Electrical areas and panels are secured and accessible, legends in place?

  • Walls free from needing patching or paint?

  • Lighting is adequate and covers are clean?

  • No broken or missing hardware?

  • Plumbing is intact with no leaks?

Environmental

  • hopper rooms and chemicals are secured, cleaners are labeled, secured carts?

  • High areas are free from dust, all ceiling HVAC vents clean?

  • Overall cleanliness of department is good?

  • Portable fans if in use are cleaned?

  • Floors areas are clean?

Security and Safety

  • Red folder / binder updated with fire drills?

  • Staff wearing ID badges?

  • Valuables are secured?

  • Have the security doors been comprised (combinations written in view, door propped, staff sharing combination)

  • Add media

Emergency Management

  • Unit specific response plans are known by staff and available?

Pharmacy issues

  • Open medications are dated?

  • Refrigerator temperature logs are current daily / values are in range? Temp issues are resolved?

  • Pyxis machine, medication rooms, med carts, medication Refrigerator are secured?

  • Code cart(s) log updated daily, secured and checksheet in use view?

  • All medications are secured?

  • K solutions stored appropriately ?

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Life Safety

  • Oxygen, Med gas shutoff valves FE's, pull stations not blocked?

  • No storage of equipment - plugged in corridor outlets - moves in 20 minutes?

  • No storage in the stairways?

  • Fire extinguishers are charged and inspected within 30 days intervals?

  • Storage below 18 inches of sprinkler heads?

  • Doors latch properly, no combustibles on doors, doors are not propped or blocked?

  • < 20% of wall covered (papers notes etc.)?

  • Auto shut off coffee pots, no toasters, no toaster ovens, other?

  • Lift equipment is stored properly / wheels are in the locked position?

  • Integrity of smoke and fire doors are intact with no paper or decorations?

  • Add media

Supply/core areas

  • Soiled linen in carts and linen bags are not on floor?

  • Appropriate use of clean and dirty storage, no cardboard boxes on floor?

  • Food trays are covered?

  • Broken or retired equipment is properly tagged as do not use, staff aware of procedures to remove any broken equipment?

  • Add media

Hazardous Materials

  • Cleaners, chemicals are properly labeled, not opened and secured

  • Full and empty 02 tanks are separated and secured, limit 12 full cylinders in storage areas?

  • RMW is covered, not mixed and stored appropriately

  • Sharps containers are secured and not overfilled?

  • Eyewash stations are inspected weekly?

  • Add media

Patient Advocate

  • Has the care met your expectations?

  • Did the food meet your expectations?

  • Did the overall patient experience meet your expectations?

Equipment and Supplies

  • Supply carts are dust free?

  • The Supply expiration dates are compliant?

  • Integrity of product packaging is intact?

  • Point of care – QC reagents expiration dates are compliant?

  • Blood draw supply expiration dates are compliant?

  • Add media

HIPAA

  • Absence of HIPAA violations, no open charts?

  • Availability of designated bins to dispose of patient health information?

  • Are gray and blue bins secured?

  • Patient health information is in correct containers and not in dept wastepaper baskets?

Top Three Concerns Based from the Hazards Surveillance Report

  • 1) emergency stickers are on telephones?

  • 2) Hallways are free from clutter?

Final Comments, Issues, Photos

  • Add media

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