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Ipsg Checklist

This document contains a checklist for standards and measurable elements at ITM Hospital and Research Centre. It includes 20 items related to patient identification, order documentation, critical test reporting times, high alert and LASA medication storage, hand hygiene practices, safety equipment, and staff protocols. The checklist is used to assess compliance with a yes, no, or not applicable option with space for remarks. It is signed by an auditor after review.

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RAJAN KUMAR thakur
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9K views2 pages

Ipsg Checklist

This document contains a checklist for standards and measurable elements at ITM Hospital and Research Centre. It includes 20 items related to patient identification, order documentation, critical test reporting times, high alert and LASA medication storage, hand hygiene practices, safety equipment, and staff protocols. The checklist is used to assess compliance with a yes, no, or not applicable option with space for remarks. It is signed by an auditor after review.

Uploaded by

RAJAN KUMAR thakur
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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ITM HOSPITAL AND RESEARCH CENTRE

Department :- Date:-
S.NO STANDARDS / MEASURABLE ELEMENTS YES NO N.A. REMARKS
1. Patient identify
2. Id band is available
3. To Patient handover written or verbal

4. Verbal order handover only consultant for emergency


situation
5. Order forms and checklist are adequately filled

6. Patient diagnosis is maintained


7. All lab, radiology, cardiology, endoscopy critical values
reported within 30 minutes
8. Critical result shall be documented in the critical reporting
form
9. In case of delay in reporting patient critical results, staff shall
be written on incidence report form filled
10. All High Alert Medications Is Stored Separately All Other
Medications & list is available
11. All LASA Medications Is Stored Separately All Other
Medications & list is available
12. Refrigerator drugs are maintained
13. The preoperative verification process is performed before the
surgery form filled
14. Staff practice correct hand washing and hand disinfection
techniques
15. Hand hygiene items are available

16. Washroom grapbar is available


17. Pvt room nursing call system working

18. Bed side rails is available


19. Initial Fall risk assessment for all patient form filled

20. Staff knowledge of needle-stick injury protocol

Auditor name and signature :-………………………………..

Designation :-…………………………………………………………
ITM HOSPITAL AND RESEARCH CENTRE
Department :- Date:-

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