Audit

Scoring: 1= Very Poor; 2= Poor; 3= Fair; 4= Good; 5= Very Good

1. How would you rate the communication between you, your nurse, doctor, or others? How have we kept you informed/involved with your care?

2. How has your pain been managed? What is your pain rated now? What is your pain goal? Is the pain box in use & currently updated?

3. How have we satisfied your personal needs? Is the Guest Service book within patient's reach?

4. How has our timeliness & friendliness been with regard to the call light? Press the call button & time how long it takes to be answered. Ask for help in the room. See how long it takes RN,CNA to respond.

5. How would you rate the care we have given you?

6. What can we do to provide you with level 5 care?

3 MSU Room # 3.501

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3 MSU Room # 3.502

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3 MSU Room # 3.503

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3 MSU Room # 3.504

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3 MSU Room # 3.505

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3 MSU Room # 3.506

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3 MSU Room # 3.507

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3 MSU Room # 3.508

Patient Name

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3 MSU Room # 3.509

Patient Name

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3 MSU Room # 3.524

Patient Name

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3 MSU Room # 3.527

Patient Name

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Department Leader Signature
Auditors Signature
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.