Guest Room Inspection

Chart Review

All medical documentation is dated

All medical documentation is timed

History and physical fully completed

History and physical updated if done prior to admission

Does the history contain "inventory by body system" (review of systems)

Does the history contain the "chief complaint"

If H&P older than 24 hrs, but less than 30 days, is there a 24-hr update completed, signed and dated? Or an admitting note in progress notes to update recent events

Verbal Order/Telephone Order read back initiated

Verbal Order/Telephone Order authenticated

Approved abbreviations utilized

Nursing assessment complete ED & Outpt records, complete last section)

Pain assessed and reassessed

Restraints documentation completed HCP order)

Restraints documentation completed (RN initial assessment)

Restraints documentation completed (RN ongoing evaluations)

Is there a specific restraint order sheet correctly signed

Is there an individual order for use of restraints

Is there a specific restraint order sheet correctly dated

Is there a specific restraint order sheet correctly timed

Is there evidence of medication reconciliation at transfer of care

A handwritten operative progress note is entered immediately post-op

Pre-anesthesia assessment is documented

Examination of the airway is documented

A plan for general anesthesia is developed

Patient is re-evaluated immediately prior to induction of anesthesia

Is there a completed education record

Time out in OR to ensure that procedure, side, and sight are correct (verbal consensus)

Is there a completed plan of care

Was advanced directive question asked

Advanced Directive in chart

Informed invasive procedure consent obtained

Before informed consent is obtained, the risks, benefits, and potential complications are discussed by surgeon

Is there a specific procedural consent correctly signed in the chart

Is there a specific procedural consent correctly dated in the chart

Is there a specific procedural consent correctly timed in the chart

Is there a reason for blood transfusion

Is there a signed consent for blood transfusion

Blood administration documentation completed

The disclaimer statement is signed/dated by the attending surgeon (find an operative permit

Braden Risk assessment (skin) within 12 hours of admission

Medicare form is signed/dated when appropriate

Fall risk assessment is completed

General consent for treatment is signed

General consent for treatment meant is dated

Medical Record Documentation

Initial nursing assessment completed

Vital signs taken every 2 hours

Focused reassessment completed (pain, resp, cardio, neuro, psych)

Pain documentation completed

Restraint documentation completed

Influenza vaccine documentation completed (Sept. 23-March 31st)

Pneumococcal vaccine documentation completed

Guest Room Amenities

Marketing material

Guest directory

Report card on experience

Tourist brochures

Hotel food and drink menu

Night table/desk

1 bible

1 pocket folder with 3 envelopes

1 am/fm clock

Closet

3 hangers + 3 hangers with skirt clips

General

1 ice bucket & poly liner

1 waste basket

3 ashtrays in guest room

1 memo pad with hotel pen

3 glasses

1 telephone book

Bathroom

1 frosted oval display tray

2 bars of soap (1.25 oz)

1 bottle of shampoo 22ml

3 bath towels

3 face cloths

1 bath mat

Hairdryer

2 toilet rolls

Misc

1 coffee maker

1 filter pack coffee

1 filter pack decaffeinated

1 tea bag

1 condiment package

1 iron

1 ironing board

1 fridge

2 porcelain coffee cups

Guest Room Settings

Room

Lights off

Heating set at 18 degrees or 70F

Windows closed

Television off with remotes out

Bathroom

Sinks off

Drain plugs open

Shower curtain centres

Shower head pointing towards wall

Toilet lid down

Bathroom door open

Light off

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.