SAMPLE CHART AUDIT TOOL Based on missing …

1 SAMPLE CHART AUDIT TOOLB ased on missing JCAHO standards when random AUDIT conductedDate of AUDIT : _____Auditor: _____Audit response codes: Yes =X No = OElement/CriteriaMR#MR#MR#MR#Evidence of Resident/Patient rightsdiscussed and donor identification Assessment Tool Completed w/in24 hr of Assessment Tool Management Flow Sheetcompleted per Education FlowSheet Progress notes are dated CHART AUDIT TOOLB ased on critical documentation JCAHO standardsDate of AUDIT : _____Auditor: _____Audit response codes: Yes =X No = OJCAHO StandardMR#MR#MR#MR# Informed consent was Initial assessments are performed asdefined by the Development of a plan for care, treatment,and services is Plan of care is appropriate to the patient sneeds, strengths, limitations and Medication orders are written clearly andtranscribed Records contain patient-specificinformation to the care, treatment, and Improve the effectiveness ofcommunication among caregivers:MD orders are verified and noted as read back.

2 NPSG Improve the effectiveness of communicationamong caregivers: Do Not Use Abbreviations found Acronyms found Symbols foundNPSG Accurately and completely reconcilemedications across the continuum of care (to beimplemented 1/2006):Documentation of the complete list of patient scurrent medications upon Reduce the risk of patient harm resultingfrom falls:Fall Risk Assessment completed per Reduce the risk of patient harm resultingfrom falls:Fall Risk Protocol implemented if patient isidentified as high risk.