Unit visit - duplicate

• Document No.

• Audit Title unit visit original

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Overall unit

• Orderly<br>

  Safe

  At Risk

  N/A

• Hallways

  Safe

  At Risk

  N/A

Medication room

• Temperature control

  Yes

  No

  N/A

• Romm temperature

  Yes

  No

  N/A

• Refridgerator temperature

  Yes

  No

  N/A

• Medication preparation area appropriate and clean

  Safe

  At Risk

  N/A

• Medication storage for individual patients appropriate?

  Yes

  No

  N/A

Knowldge of staff regarding

• Csh cart and defibriator

  Yes

  No

  N/A

• How to call. Code

  Yes

  No

  N/A

• Gases turnoff on unit or for rooms

  Yes

  No

  N/A

• Fire/ emergency actions

  Yes

  No

  N/A

• Evacuation practice

  Yes

  No

  N/A

Patient room

• Nurse call systen at bed side in reach

  Yes

  No

  N/A

• Emergency call in bathroom?

  Safe

  At Risk

  N/A

• Crowded, equipment, privacy

  Safe

  At Risk

  N/A

• Clean, ready for occupancy

  Yes

  No

  N/A

Patient chart review

• Physician admission assessment

  Yes

  No

  N/A

• Timely

  Yes

  No

  N/A

• Complete According to organization policy

  Yes

  No

  N/A

• Legible

  Yes

  No

  N/A

• Diagnosis

  Yes

  No

  N/A

• Plan of care

  Yes

  No

  N/A

• Measurable goals

  Yes

  No

  N/A

• Scope of assessment appropriate to patient condition

  Yes

  No

  N/A

• Nursing admission assessment

  Yes

  No

  N/A

• Timely

  Yes

  No

  N/A

• Complete according to organization policy/ form

  Yes

  No

  N/A

• Nursing diagnoses

  Yes

  No

  N/A

• Plan of care

  Yes

  No

  N/A

• Measurable goals

  Yes

  No

  N/A

• Physician review and

  Yes

  No

  N/A

• Nutrition screening effective

  Yes

  No

  N/A

• Functional screeninf effective

  Yes

  No

  N/A

• Special patient populatios assessments

  Yes

  No

  N/A

• Pediatrics

  Yes

  No

  N/A

• Head circumferance

  Yes

  No

  N/A

• Growth - hight abd weight

  Yes

  No

  N/A

• Development -developmental milestones

  Yes

  No

  N/A

• Immunizations

  Yes

  No

  N/A

• Neonatal

  Yes

  No

  N/A

• Apgar score

  Yes

  No

  N/A

• Lumen

  Yes

  No

  N/A

• Neonatal assessment prior to discharge

  Yes

  No

  N/A

• Hip movement

  Yes

  No

  N/A

• Extremities

  Yes

  No

  N/A

• Labor and delivery

  Yes

  No

  N/A

• Geriatrics

  Yes

  No

  N/A

• Psychiatry

  Yes

  No

  N/A