HEALTHCARE QUALITY ASSURANCE CHECKLIST: PATIENT OUTCOMES & STANDARDS

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--- PATIENT ADMISSION & ASSESSMENT ---
[ ] Patient Age
[ ] Date of Admission
[ ] Chief Complaint
[ ] Allergies (Select All That Apply) (Medications, Food, Environmental, Other (Specify))
[ ] Allergy Details (If Applicable)
[ ] Insurance Type (Private, Medicare, Medicaid, Self-Pay)
[ ] Insurance Card Front
[ ] Relevant Medical History

--- MEDICATION MANAGEMENT ---
[ ] Medication Order Verification Method (Verbal Order, Written Order, Electronic Order)
[ ] Dosage Verified (mg)
[ ] Route of Administration (Oral, IV, IM, Subcutaneous, Topical)
[ ] Medication Administration Date
[ ] Medication Administration Time
[ ] Nurse's Notes/Observations
[ ] Nurse Signature

--- INFECTION CONTROL & PREVENTION ---
[ ] Last Hand Hygiene Audit Date
[ ] Hand Hygiene Compliance Rate (%)
[ ] Surface Disinfection Protocol Followed? (Yes, No, N/A)
[ ] PPE Used (Check all that apply) (Gloves, Mask, Gown, Eye Protection)
[ ] Last Sterilization Equipment Maintenance
[ ] Waste Disposal Protocol Followed? (Yes, No, N/A)

--- CARE PLAN IMPLEMENTATION & MONITORING ---
[ ] Date of Care Plan Implementation
[ ] Frequency of Monitoring (e.g., Daily, Weekly)
[ ] Summary of Progress Towards Goals
[ ] Current Status of Goal 1 (On Track, Needs Adjustment, Not Applicable)
[ ] Current Status of Goal 2 (On Track, Needs Adjustment, Not Applicable)
[ ] Notes on Adjustments Made to Care Plan
[ ] Date of Last Care Plan Review

--- PATIENT COMMUNICATION & EDUCATION ---
[ ] Explain Diagnosis and Treatment Plan
[ ] Patient Understanding Confirmation (Verbal) (Yes, No, Needs Further Explanation)
[ ] Educational Materials Provided (Check all that apply) (Brochures, Videos, Website Links, Written Instructions)
[ ] Date of Patient Education Session
[ ] Family/Caregiver Present (Name)
[ ] Summary of Patient Questions and Answers
[ ] Patient/Representative Signature (acknowledging education)

--- DISCHARGE PLANNING & FOLLOW-UP ---
[ ] Planned Discharge Date
[ ] Scheduled Discharge Time
[ ] Discharge Disposition (e.g., Home, Rehab, Skilled Nursing) (Home, Rehabilitation Facility, Skilled Nursing Facility, Hospice, Other)
[ ] Summary of Patient Education Provided at Discharge
[ ] Medications to be Continued Post-Discharge (Medication 1, Medication 2, Medication 3)
[ ] Follow-Up Appointments Scheduled? (Yes, No)
[ ] Notes Regarding Special Instructions or Needs
[ ] Discharge Summary Document (Optional)

--- INCIDENT REPORTING & ANALYSIS ---
[ ] Date of Incident
[ ] Time of Incident
[ ] Detailed Description of Incident
[ ] Incident Type (Medication Error, Patient Fall, Equipment Malfunction, Communication Breakdown, Infection Control Issue, Other)
[ ] Contributing Factors (Staff Fatigue, Inadequate Training, Process Failure, Equipment Defect, Communication Error)
[ ] Severity Score (1-5, 1=Minor, 5=Severe)
[ ] Immediate Actions Taken
[ ] Department Involved (Emergency Department, Medical-Surgical, Cardiology, Pharmacy, Other)
[ ] Reporting Staff Signature

--- REGULATORY COMPLIANCE & AUDITING ---
[ ] Last Compliance Audit Date
[ ] Applicable Regulations (Select all that apply) (HIPAA, Joint Commission, CMS Conditions of Participation, State-Specific Regulations)
[ ] Audit Score (if applicable)
[ ] Summary of Audit Findings
[ ] Audit Report (Upload)
[ ] Corrective Action Plan Status (In Progress, Completed, Not Applicable)
[ ] Date of Next Scheduled Audit

--- STAFF TRAINING & COMPETENCY ---
[ ] Training Module Completed (e.g., HIPAA, Safety) (HIPAA Compliance, Patient Safety, Infection Control, Emergency Procedures, Documentation Best Practices)
[ ] Training Completion Date
[ ] Score on Competency Assessment (0-100)
[ ] Supervisory Sign-Off Required? (Yes, No)
[ ] Notes on Performance/Areas for Improvement
[ ] Upload Training Certificate (if applicable)

--- PATIENT FEEDBACK & SATISFACTION ---
[ ] Overall Satisfaction (1-10)
[ ] How likely are you to recommend our services? (Very Likely, Likely, Neutral, Unlikely, Very Unlikely)
[ ] What did we do well?
[ ] How could we improve?
[ ] Which areas of your experience were most important to you? (Communication with Staff, Cleanliness of Facility, Timeliness of Care, Pain Management, Overall Experience)
[ ] Did you feel your concerns were addressed? (Yes, No, Partially)

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