Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Department audited

  • Date of audit

  • Date audit closed

Departmental review

  • Do staff know the departments scope of service?

  • Comments/answers

  • Does the departments scope of service include Admission/Treatment/Discharge process?

  • Comments/answers

  • Do staff know where to access policies and procedures?

  • Comments/answers

  • Can staff verbalize how policies and procedures are maintained?

  • Comments/answers

  • Do staff know how to verify it is the most current policy?

  • Comments/answers

  • Can staff verbalize how to verify they have the most current version of a policy?

  • Comments/answers

  • Is only the most current information displayed on the bulletin board?

  • Comments/answers

  • Can staff verbalize how ,leadership communicates important information to them?

  • Comments/answers

  • Can the staff verbalize our mission and vision?

  • Comments/answers

Human Resources

  • Can staff verbalize how they were oriented to the hospital?

  • Comments/answers

  • Can staff verbalize how their competency is assessed and maintained?

  • Comments/answers

  • Have staff received periodic in-services or training regarding their job responsibilities?

  • What were some topics?

  • Can staff verbalize who is responsible for the supervision of students when they provide patient care and who is responsible for the patient?

  • Comment/answer

  • Do staff know what to do if they feel they cannot provide care to a patient due to religious or cultural values?

  • Comment/answer

Process review

  • Process or procedure audited:

  • Is there a documented policy and procedure for the process audited? Review the document

  • Comments/answers

  • Can staff verbalize how to verify that it is the most current version?

  • Comments/answers

  • Can staff verbalize if training is required for this process ?

  • Are training records/certificates available if training is required?

  • Can staff walk you through the process?

  • Comments/answers

  • Can staff verbalize PI activities for their department ?

  • What are the activities and what has improved?

  • Do you have the tools, equipment and resources to perform this process?

  • Comments/answers

  • Are there any corrective, preventive or improvement opportunities we can help you with?

  • What can we help with?

Action

  • Is a corrective or preventive action required

  • Which action is required?

  • Cause of the nonconformity

  • Organizational plan

  • Person or position responsible for implementation of action plan

  • Date actions implemented

  • Results of actions taken

  • Determine actions needed by

  • Review of effectiveness

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