OPERATION THEATER AUDIT CHECK LIST

S.No DISPLAY Status

1 5 Moments of Hand Hygiene Not Available
2 Hand wash Not Available
3 Hand rub Not Available
4 Surgical Hand Rub Not Available
5 Needle stick Injury Protocol Not Available
6 Blood and Body fluids spill protocol Not Available
7 Mercury spill protocol display Not Available
8 Biomedical waste management display Not Available
9 Wearing of PPE Not Available
10 Removing of PPE Not Available
11 Caution X ray signage for Radiation exposure Not Available
12 Asset label Not Available
13 PM Label Not Available
14 Calibration label Not Available
15 Instruction /operator protocol displayed in Not Available
the Machine
16 Emergency codes Not Available
17 Material Safety Data Sheets Displayed Not Available
18 Hazardous materials cupboard Not Available
19 Medication Cupboard Not Available
20 BLS protocol Displayed Not Available
21 Evacuation plan Not Available
22 HIRA Not Available
23 MEWS score Not Available
24 LASA and high alert medication display Available
25 Fire Exit Not Available
26 Materials Holding area signages Not Available
27 Departmental signages Available
28 Operation theatre Available
29 Entry Restricted Not Available
30 Please remove your footwear here Available
31 Dress change area Available
32 Fridge medications Available
33 Escalation Matrix Not Available
34 Complaint contact number-OT Waiting area Not Available
35 Department organogram display Not Available
IMPLEMENTATION

Safety of electrical plugs & Sockets-(Check for

1 loosely tangling wires)

Any damaged items in the area which has

2 potential for Injury.
3 Separate dress for wearing Available
4 Separate Slippers for wearing Available
5 Cap and mask availability Available
6 Availability of hand rub Available
7 Availability of hand wash solution Available

Segregation of sound alike, look alike and

8 high alert medications Not Available

9 Red dot in high alert medication ampoules Not Available

10 Narcotic Cupboard-Double lock Not Available

11 Mobile oxygen cylinder Not Available
12 Nitrous cylinder Available
13 Suction Apparattus Available
14 Crash Cart Available
15 Uniflow direction-Man, material Not Available
16 HEPA Filter Available
17 RO water facility Available
18 Elbow or Knee action tap Available
19 Spill kit for Blood and body fluids Not Available
20 Spill kit for Mercury Not Available
21 Separate stretcher with safety belts Not Available
22 Linen trolley-Clean linen and Soiled linen Not Available
separately
23 Sterile instruments transport trolly-Closed Not Available

24 Unsterile instruments transport trolly-Closed Not Available

25 Biomedical waste transport trolly Not Available

26 Needle cutter Not Available
27 Puncture proof container Available
28 Availability of Biomedical waste bins Available
29 Zoning in OT Not Available
30 Temperature monitor Available
31 Humidity monitor Available
32 Pressure monitor Available
33 Fridge Temperature monitor Available
34 High level disinfectants
35 Employee health check up Available
36 Staff vaccination Available
37 Medication label Not Available
38 Sterile Zone stickering Not Available
39 Clean Zone stickering Not Available
40 Unsterile Zone stickering Not Available
41 Eye wash Not Available

42 Not Available
Treatment of Drainage water
43 Hazardous materials are identified and stored Not Available
separately under lock and key
DOCUMENTATION
1 OT booking register-Counselling area Not Available
2 OT Nominal register Available
3 Quality indicators register Available
4 Drug inventory register Available
5 Narcotic request form Not Available
6 Narcotic stock Register Not Available
7 Narcotic usage and discard register Not Available
8 Fridge medications list Available
9 Departmental Manual Not Available
10 Equipment Stock Register Not Available
11 HPE register Not Available
12 Communication Register for Doctors Not Available
13 CSSD register Not Available
14 Equipment Breakdown register Available
15 Equipment operating manual Not Available
16 Complaint Register Not Available
17 HEPA Filter service report file Not Available
Temperature, Humidity and Pressure monitor
18 Checklist Available

19 Temperature checklist for Refrigerator Available

20 Fumigation Record Available
List of sound alike, look alike and high alert
21 medications list Available
22 Emergency trolley medicine Available
23 O2 Cylinder checklist Available
24 Pre-operative oxygen checklist
25 Suction apparattus checklist Not Available
26 Boyle's machine checklist Not Available
27 Defibrillator checklist Available
28 Multiparamonitor checklist Not Available
29 Code blue report form Not Available
30 Medication error report form Not Available
31 Adverse drug event reporting form Not Available
32 Emergency drill reporting form Not Available
33 CSSD Recall Register Not Available
34 Anesthesia Record-Preanesthesia
Incident Reporting form Not Available
assessment, Immediate preoperative
35 reevaluation, Intraoperative monitoring, Post Not Available
anaesthesia status
36 Preoperative assessment form Not Available
37 Consenr for procedure Not Available
38 Consent for surgery Not Available
39 Consent for anaesthesia Not Available
40 WHO surgical safety checklist Not Available
41 OT record/notes-Post op plan of care Not Available
42 Preoperative checklist Not Available
43 Blood transfusion register Not Available
44 Blood request form Not Available
45 Blood transfusion monitoring chart Not Available
46 Post transfusion reaction reporting form Not Available
47 Needle stick injury reporting form-OR Not Available
48 Post exposure reporting form-OR Not Available
49 Supplier evaluation and Approved suppliers Not Available
for Implants
50 Implant- Scientific criteria or article Not Available
51 Implant stock register Not Available
52 Implant usage register Available
53 CPR Register Not Available
54 Asset list of equipments Not Available
55 Preventive Maintenance plan Not Available
56 Hospital Formulary Not Available
57 Swab culture report Available
58 Settleplate culture report Available
59 MSDS file Not Available
60 Water quality check report Not Available
61 Antibiotic policy Not Available
62 Housekeeping cleaning checklist Available
63 Biomedical waste collection checklist Available
64 Duty Roster Available
TRAINING
Remarks