Hospital & Clinical Medications/Materials Checklist

Facility name
Physical Location
Facility hours
License No.
Date & Time
Audit Type: Renewal Concise/Follow up Adhoc
Name Title/License no. Name Title/License no.

HAAD Auditor HAAD Auditor

Name: Name:
Division: Division:
Auditor No.: Auditor No.:

International Patient Safety Goals

1. Improve the accuracy of patient identification

2. Improve the effectiveness of communication among care givers and care recipients
3. Improve the safety of using medications and medical devices
4. Reducing the risk of healthcare associated infections
5. Ensuring correct site, correct procedure, correct patient for all procedures
6. Accurately and completely reconcile medications across the continuum of care
7. Encourage patients active involvement in their own care as a patient safety strategy
8. Improve recognition and response to changes in a patient’s condition
9. Reducing risk of patient harm resulting from falls
10. Reduce the risk of hospital fires

P = PRIORITY PSG = PATIENT SAFETY GOALS

No. Ref Auditor Tasks Yes Partial No PSG Comments

MEDICATIONS
1 HAAD Standards Medications/Materials are appropriate 3
P (JCI)(HS) for scope of service.
#HRC32
2 HAAD Standards Medications/Materials practices comply 3
P (JCI)(HS) with staff license.
#HRC31,39
3 HAAD Standards Medications/Materials stored correctly
(JCI)(HS) HRC35 and safely on units.

4 HAAD Policy & Multi Dose Medications protocol, 3, 6

P Standards evidence it is implemented and
monitored.

1
 5 HAAD Standards Policies/procedures in place for
(JCI)(HS) management of
#HRC35,37 Medications/Materials/signed off by
staff.
6 HAAD Standards Competency program for staff on 3, 6
P (JCI)(HS) LDS15 Medications/Materials usage and
practices.
7 PHP/PHM/P0001 Pharmacovigilence program in place-
/09 evidence of reporting Medication Error
PHP/PHM/P0002
and Adverse Reaction
/09
8 Medication approved and on formulary, 3
P including controlled medicinal products
(such as narcotics)
9 Policy and procedure in place for patient 1
P identification- evidence of
implementation and monitoring
10 HAAD Standards System for Tracking the expiry date of
(JCI)(HS) HRC36 Medications/Materials.
11 HAAD Policy Emergency kit is available. 3, 8
P #PPR/DMP/P00
2/08
12 HAAD Policy Basic Life Support training certificate for 3,8
P #PPR/DMP/P00 clinical staff.
2/08
13 Federal law No Medications/Materials are being sold 3
P # 18 at HCF unless authorized to do so.
Total Met Partially Met Not Met NA
Priority
Non
priority

Hospital & Clinical Medications/Materials HAAD Auditor

Name: Name:
Signature: Signature:
Date: Date:

Section Head Comments:

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……………………………………………………………………………………………….….…………………….………………….…

Name: …………………………………………… Signature: ………………………………. Date ……………….…………