Transcription of Audit Tool: Arteriovenous fistula/graft cannulation ...
1 CDC Dialysis Collaborative Facility Name: _____ Date: _____ Start time:_____AM / PM. Day: M W F Tu Th Sa Shift: 1st 2nd 3rd 4th Observer: _____ Location within unit:_____. Audit Tool: Arteriovenous fistula / graft cannulation observations (Use a if action performed correctly, a Ф if not performed. If not observed, leave blank). No contact Hand Skin Skin Site cleaned New, clean with fistula / cannulation Connect to Hand hygiene antiseptic antiseptic Gloves Discipline with soap gloves graft site performed blood lines hygiene Comments performed applied allowed removed and water worn (after aseptically aseptically performed (staff) appropriately to dry antisepsis). Discipline: P=physician, N=nurse, T=technician, S=student, O=other Duration of observation period = minutes Number of procedures performed correctly = Total number of procedures observed during Audit =.
2 ADDITIONAL COMMENTS/OBSERVATIONS: National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion CDC Dialysis Collaborative Facility Name: _____ Date: _____ Start time:_____AM / PM. Day: M W F Tu Th Sa Shift: 1 2 st nd 3. rd 4 Observer: _____ Location within unit:_____. th Audit Tool: Arteriovenous fistula / graft decannulation observations (Use a if action performed correctly, a Ф if not performed. If not observed, leave blank). If other activities Disconnect Clean gloves performed between Patient gloves Hand Clean gauze Staff from blood Needles worn (by needle removals, Staff removed and hygiene New, clean /bandage hand Discipline line removed patient/staff) hand hygiene is gloves hand hygiene Comments performed gloves worn applied to hygiene aseptically aseptically to compress performed and removed performed (staff) site performed site new, clean gloves (if applicable).
3 Are worn Discipline: P=physician, N=nurse, T=technician, S=student, O=other Duration of observation period = minutes Number of procedures performed correctly = Total number of procedures observed during Audit =. ADDITIONAL COMMENTS/OBSERVATIONS: National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotio
