Physical Environment Audit

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

Emergency Medication

• Crash cart locked and in date with the next expiring drug posted? Add crash cart information.

  Yes

  No

  N/A

• Crash cart lock number is same as documented on tag?

  Yes

  No

  N/A

• Crash cart red lock is pulled securely to prevent unauthorized access?

  Yes

  No

  N/A

Refrigerator

• The thermometer monitoring the refrigerator is working properly with the alarm set "On"?

  Yes

  No

  N/A

• The temperature range on the digital thermostat is within 36 to 46 degrees F?

  Yes

  No

  N/A

• Refrigerator exception log is available and properly dated?

  Yes

  No

  N/A

Medication Area

• All medications are within their expiration or beyond-use-date?

  Yes

  No

  N/A

• Ensure that only currently prescribed medications are present. Returns, discontinued, and unusable medications are in the authorized return to pharmacy location?

  Yes

  No

  N/A

Actions

• Are there any significant nursing management issues?

  Yes

  No

  N/A

• Any follow-up issues?

  Yes

  No

  N/A

• Manager emailed a copy?

  Yes

  No

  N/A

• Auditor's Signature

  Sign