DIALYSIS UNIT AUDIT CHECK LIST

S.No DISPLAY Status Remarks

1 5 moments of Hand Hygiene Yes
2 Hand wash Yes
3 Hand rub Yes
4 Needle stick Injury Protocol Yes
5 Blood and Body fluids spill protocol Yes
7 Biomedical waste management display Yes
8 Asset Label No
9 PM Label No
10 Calibration Label No
11 Instruction /operator protocol displayed in the Machine No
12 Emergency codes No
13 Material Safety Data Sheets Display Yes
14 Hazardous materials cupboard No
15 Medication Cupboard Yes
16 Dialyser Bundle volume check criteria No
17 List of procedures No
18 HIRA No
19 MEWS score No
20 LASA and high alert medication display Yes
22 Materials Holding area signages No
23 Dialysis Yes
24 Entry Restricted No
25 Please remove your footwear here Partially done Inside display available
26 Patient identification details (Patient name and UHID number) Yes
mentioned in dialyser
27 Department organogram display No
 IMPLEMENTATION
3 Availability of hand rub at the entrance No
Cot wise hand rub is not
4 Availability of Hand rub inside the Dialysis unit Yes
available
5 Availability of hand wash area and solution Yes
Face shield is not available
6 Availability of PPE for staffs Yes
for the staff
7 Segregation of sound alike, look alike and high alert medications Yes
8 Red dot in high alert medication ampoules No
9 Mobile oxygen cylinder Yes
10 Suction apparattus Yes
11 Crash Cart Yes
12 Ward Inventory Yes
13 Elbow or Knee action tap Yes
14 Availability of sterile trays Yes
15 Spill kit for Blood and body fluids Yes
17 Needle cutter No
18 Puncture proof container Yes
19 Availability of Biomedical waste bins Yes
20 High level disinfectants Yes
21 Employee health check up Yes
22 Staff vaccination Yes
23 Hazardous materials are identified and stored separately under lock No
and key
24 Storage area for Dialyser separately Yes
25 Dialyser washing area Yes
DOCUMENTATION
1 Dialyser Nominal register Yes
2 Dialysis procedure form No
 Doctor sign not available in
3 Consent for Dialysis Yes
some of the consents
4 Consent for procedures No
5 Patient instructions pamphlets No
6 Safety checklist for procedures No
7 Medication stock register Yes
8 Equipment Stock Register Yes
9 Communication Register Yes It is not followed
10 CSSD register No
11 Indent register Yes Through HIMS
12 Dialysis equipment maintenance checklist Partially done Format should be changed
13 Equipment Breakdown register Yes Through HIMS
14 Equipment operating manual No
15 Asset list of equipments No
16 Preventive Maintenance plan No
17 Complaint Register No
18 Referral form No
19 Refusal for treatment form No
21 CPR Register No
22 Endotoxin test report for RO water (Monthly once) Yes
Water quality check for physical and chemical parameters (3 months
23 Yes
once)
24 Deep cleaning Record No
25 List of sound alike, look alike and high alert medications list Yes
26 Emergency trolley medicine checklist Yes
27 O2 Cylinder checklist Yes
28 Code blue report form No
29 Medication error report form No
30 Adverse drug event reporting form No
31 Emergency drill reporting form No
32 Incident Reporting form No
33 Housekeeping cleaning checklist Yes
34 Biomedical waste collection checklist Yes
35 Yes 6 Nurses and 6 Technicians
Adequate staff available
36 Duty Roster Yes
Responsibility
HIC Champion
HIC Champion
HIC Champion
HIC Champion
HIC Champion
HIC Champion
FMS Champion
FMS Champion
FMS Champion
FMS Champion
FMS Champion
FMS Champion
FMS Champion
MOM Champion
HIC Champion
COP Champion
FMS Champion
AAC Champion
MOM Champion
COP Champion
FMS Champion
FMS Champion
FMS Champion
COP Champion
HRM Champion
HIC Champion
HIC Champion
HIC Champion
HIC Champion
MOM Champion
MOM Champion
FMS Champion
FMS Champion
MOM Champion
MOM Champion
HIC Champion
HIC Champion
HIC Champion
HIC Champion
HIC Champion
HIC Champion
HIC Champion
HRM Champion
HIC Champion
FMS Champion
FMS Champion
FMS Champion

COP Champion
COP Champion
COP Champion
COP Champion
PRE Champion
COP Champion
MOM Champion
FMS Champion
PRE Champion
HIC Champion
MOM Champion
FMS Champion
FMS Champion
FMS Champion
FMS Champion
FMS Champion
FMS Champion
AAC Champion
AAC Champion
COP Champion
HIC Champion
FMS Champion
HIC Champion
MOM Champion
MOM Champion
FMS Champion
COP Champion
MOM Champion
MOM Champion
PSQ Champion
PSQ Champion
HIC Champion
HIC Champion
HRM Champion
HRM Champion