| Survey | Description |
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2
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Anesthesia Scope Processing (Main OR)
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Bedside Cart Use & Maintenance
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Beta Shift Pulse
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Beta Shift Pulse
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CA 7 Daily High-touch Surface Cleaning-EVS
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EVS duties: Minimally, all of these surfaces will be cleaned each calendar day by a hospital approved disinfectant in patient room high touch areas.
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CA 7- 30 Day Deep Room Cleaning
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To be completed by EVS. Room vacated for cleaning purposes, minimally done every 30 days (regardless of number of admissions or patient occupancy) with hospital approved disinfectant.
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CAUTI Insertion K-Card
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HAC SPS Bundle Elements
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CAUTI Maintenance K-Card
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HAC SPS Bundle Elements
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Chemotherapy Administration
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Identify an RN who is about to give a chemotherapy medication
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Chemotherapy Verification
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Identify an RN who is about to give a chemotherapy medication
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CLABSI Insertion K-Card
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HAC SPS Bundle Elements
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CLABSI Maintenance K-Card
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HAC SPS Bundle Elements
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Code Cart Check
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Minimum of once a day checks for the care area/clinic’s open operating times
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ED - Gowning
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Audits for gowning project in the Emergency Department
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ED Rounding - Employee
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ED Rounding - Patient
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Fall Prevention K-Card
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HAC SPS Bundle Elements
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Hand Hygiene
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Hand Hygiene Survey
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Inpatient Psych Safety
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Identify a staff member who is sitting for a patient. Ensure the following elements are completed and documented (where applicable).
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Instrument Pre-Clean
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Checklist for pre-cleaning of instruments
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Instrument Transport to SPD
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Short survey about instruments transported to SPD
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Low Level Disinfection
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Low Level Disinfection Survey Pilot for imaging group
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MA/RN Ambulatory Clinic Medication Administration
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Medication Administration
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Identify an RN who is about to give a medication
If medication is high risk, ensure a second independent double check is also performed.
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Medication Security - Lock Box
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Medication Lock Box Security Audit
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Non-violent Restraint Compliance
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Pain & AIR (Assessment; Intervention; Reassessment)
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Identify a patient at risk for pain.
Ensure the following elements are completed and documented.
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PCH Ambulatory Clinic Med Safety and Security
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PD Catheter Insertion
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Peritonitis prevention bundle compliance
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PI Prevention K-Card
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HAC SPS Bundle Elements
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PIVIE Prevention K-Card
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HAC SPS Bundle Elements
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Restraint: Violent/Medication/Seclusion
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Please complete this compliance survey after a patient has had a violent or medication restraint or seclusion to capture compliant documentation.
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Safe Surgery - Count
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Safe Surgery - Debrief
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Safe Surgery - OR to PACU Handoff
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Safe Surgery - Pre Op to OR Handoff
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HARD STOPS:
Pre-Anesthesia Assessment Document completed,
H&P Completed (within 30 days and updated day of surgery),
Completed Surgery/Procedure Consent,
Completed Anesthesia Consent,
Site Marking (if applicable)
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Safe Surgery - Pre-Brief
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Safe Surgery - Pre-Op Process
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Safe Surgery - Time Out
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Safety Coach
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Safety Coach interactions Error Prevention Safety Behaviors to be entered here
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Safety Huddle Good Catches and Kudos
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Click here to share a good catch story!
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Safety Rounding
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Please ensure the following elements are completed when rounding on patients.
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Scope Processing POUT
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Short survey about processing scopes in SPD
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shane
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shane
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Shane Test
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testing; Retired on 03/04/2025 by jmauck
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Suicide Precaution Safety
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Identify an RN who is caring for a patient on Suicide Precautions.
Ensure the following elements are completed and documented (where applicable).
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test
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test
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Trach Safety
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To reduce trach-associated safety events
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Unplan Extubation Prevention
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Identify an RN or RCP who is caring for an intubated patient on a ventilator. Observe a high risk intervention as defined on back of card. Ensure all elements are completed .
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VAE & VAP K-Card
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HAC SPS Bundle Elements
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VTE Prevention K-Card
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HAC SPS Bundle Elements
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VTE Screening K-Card
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HAC SPS Bundle Elements
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WATCHER
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Identify a patient a Level 2 or 3 WATCHER alert. Ensure the following elements are completed within 1 hour of positive screen.
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