Dialysis Audit Tool: Hemodialysis Injectable medication ... Tool: Hemodialysis injectable medication preparation . ... Audit Tool: Hemodialysis Injectable medication ... Hemodialysis Injectable medication preparation

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    Facility Name:_________________________________________ Observer:___________________________________________ Date(s):________________________ Location of Medication Preparation:______________________________________

    Audit Tool: Hemodialysis injectable medication preparation Observe a medication preparation session. (Use a if acton performed correctly, a if not performed/performed incorrectly. If

    not observed, leave blank. All applicable actions within a row must have for the procedure to be counted as successful.)

    Day (i.e., M, Tu, W)

    Shift (i.e., 1 - 4)

    Discipline

    Med prep

    done in

    designated

    area

    Med prep

    area is

    clean

    *

    All vial(s)

    are

    inspected

    **

    Hand

    hygiene

    performed

    Septum of

    all vial(s)

    disinfected

    All vials

    entered with

    new needle

    and new

    syringe

    Med prep

    done

    aseptically

    All single

    dose vial(s)

    discarded

    All multi

    dose vial(s)

    discarded or

    stored

    properly

    Discipline: P=physician, N=nurse, T=technician, S=student, O=other

    Number of sessions performed correctly = Total number of sessions observed =

    ADDITIONAL COMMENTS/OBSERVATIONS:

    *Preparation of injectable medications must be performed in a designated clean area that is free of obvious contamination sources (e.g., blood, body fluids, contaminated equipment, tap water).**Vial should be discarded if sterility is questionable, or expiration date or beyonduse date has been exceeded. If a multidose vial will not be immediately discarded after use, the vial should be labeled upon

    opening to indicate the beyonduse date.

    National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

  • Facility Name:__________________________________________ Observer:___________________________________________ Date:_________________________ Day: M W F Tu Th Sa Shift: 1st nd 32 rd 4th Start time:____________AM / PM

    Audit Tool: Hemodialysis injectable medication administration (Use a if action performed correctly, a if not performed/performed incorrectly. If not observed, leave blank. All applicable actions within a row must have for the procedure to be counted as successful.)

    Discipline

    Medication properly

    transported to patient station*

    Hand hygiene performed

    Clean gloves worn

    Injection port disinfected with

    antiseptic**

    Medication administered

    aseptically

    Syringe discarded at point of use

    Gloves removed

    Hand hygiene performed

    Discipline: P=physician, N=nurse, T=technician, S=student, O=other Duration of observation period: ________________ Number of procedures performed correctly =

    Total number of procedures observed during audit =

    ADDITIONAL COMMENTS/OBSERVATIONS:

    * Medications should be transported directly from medication preparation area to individual patient. Medications should be prepared as close as possible to the time of medication administration. Medicationsthat are not immediately administered by the person who prepared the medication must be labeled appropriately.

    **Appropriate antiseptics are chlorhexidine, povidoneiodine, tincture of iodine, and 70% alcohol.

    National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

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