• Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

General safety

  • Staff knowledgeable about Bee Ready Survey Guide

  • Staff knowledgeable about NOSG's

  • United staff observed Washing In/Out

  • Staff observed not blocking fire extinguishers

  • MD, nursing, ancillary staff maintains confidentiality of patient information

  • ES staff knowledgeable about chemical safety

  • ES knowledgeable about their role in infection control

National Patient Safety Goals

  • Can you list the 2 patient identifiers used at SH

  • Can you explain how correct patient gets blood

  • Within what timeframe are critical test results communicated

  • Can you explain how medications in syringes/basins/cups are labeled

  • Can you explain how anticoagulant administration is kept safe

  • Can you explain when & how med reconciliation is completed

  • Can you explain how to keep patients fire from infection prior to giving care

  • Can you explain SH guidelines for preventing resistive organism infections

  • Can you e plain SH guidelines for preventing central line infections

  • Can you explain SH guidelines on preventing post operative surgical infections

  • Can you explain SH guidelines for preventing UTI's from catheters

  • Can you explain how the correct surgery on the correct patient is confirmed

  • Can you explain how the correct place on the patients body is marked for surgery

  • Can you explain how surgery is confirmed to prevent mistakes prior to the surgery

Life Safety

  • Can you explain your role if a disaster causes an influx of patients

  • Can you explain how to report a safety related issue

  • Can you explain your role in a fire event

  • Can you tell me where the fire extinguisher is

  • Can you explAin PASSAGE fire extinguishing technique

  • Can you explain the SAVE acronym

  • Can you explain to me where the fire alarm pull stations are

  • Can you explain your role when a disaster is paged

  • Can you explain how/where to find the SDS information

  • Can you explain the policy on coming to work sick

  • Can you explain how to take care of malfunctioning equipment

  • Can you tell me who can shut off O2 valves in an emergency

Additional Comments

  • Additional Comments

  • Surveyor's Signature

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