• Audit Title

  • Conducted on

  • Prepared by

  • Location
  • Personnel


  • Confidential Patient Information:<br>Cannot be overheard or seen by unauthorized persons:<br> * Computer terminals signed off when not in use.<br> * Patient information is not discussed in public areas.<br> * Labels and PHI are obliterated before discarding in the trash.

  • No clipboards displayed as sign-in sheets when multiple patient names on the list.

  • If fax machine is in public area, patient information is quickly removed.

  • Disclosure of confidential patient information only to those authorized by the patient.

  • Documentation plan for computer downtime.


  • Are PSG posted on unit.

  • Process/Action for sudden change/deterioration in patient's condition

  • Who can call a MET team?

  • Use of two (2) patient identifiers when administering medications, blood/blood components, and collecting specimens?

  • Specimens labeled in the presence of patient?

  • Two (2) person verification and use of bar coding for blood transfusions.

  • To whom are critical results/values of tests reported, and by when?

  • Label medications in syringes, cups on/off the sterile field.

  • Universal Protocol for ALL invasive procedures: pre-procedure verification, site marking, and time out.

  • Medication reconciliation done on admission and discharge.

  • Process to report adverse events.


  • Is department's PI project data posted.

  • Staff are familiar with their department's PI, goals and progress.

  • Nursing: Use of restraints process and data collection.

  • Nursing: Fall reduction measures, data collection and goals, injury-related falls.

  • ED/Code Blue committee: Results of resuscitation, data collection and evaluation.

  • Pharmacy: Significant medication errors and adverse drug reactions.


  • Greet the team with smiles and introductions.

  • Have a space designated for the team to conduct interviews and file reviews.

  • Promptly deliver materials required for review to the tracer team.

  • Any additional comments regarding positive or suboptimal issues observed during the tracer.

  • Surveyors Name

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