SN STANDARDS/MEASURABLE ELEMENT Mets?

Remarks
Y N N.A N.T
H3 Emergency Resuscitation Activation (cop 3.2) Pass / Fail / N.A (Circle
one of this section)
a Staff able to recognize and assess cardiac arrest to activate
CPR
Staff know the steps/ who to call for emergency
resuscitation at:
b Clinical area (ward)
C Non clinical area (public)
D What number to call during emergency resuscitation?
I MEDICATION MANAGEMENT AND USE (MMU)
I 1 Storage (MMU 3) Pass / Fail / N.A (Circle
one of this section)
a How are the medications stored?
b Medications are stored using first- in- first -out principle.
c How do you label look-alike and sound –alike medications?
d There is segregation of look-alike and sound-alike
medication
e Controlled drugs are checked each shift and kept locked in
safe?
f The type of quality of controlled drugs physically available
tallies with the number recorded in the CD book?
g Staff able to show log on drug wastage
h Staff able to show specimen signature for controlled drugs?
i Drug fridge temperature maintained at 2 ◦C - C.
j Staff interviewed can explain what he/she is supposed to do
when the alarm for the medication fried goes off
k Medications are properly and safely stored according to
recommended storage conditions as specified by
manufactured
l What is a procedure for inpatient who bring their own
medication and for of patients own medication
m There is a procedure to stored and control sample
medications.
n Cartons are stacked in a “criss-cross” manner to improve
stability: will not topple when pushed gently and staff are
able to reach for the top carton without having to use a
stepper.
o There is no obstruction of firefighting equipment (e.g.
Sprinkler, fire hoses, fire extinguishers) in the medication
storage area.

I2 Ordering and transcribing (MMU 4) Pass / Fail / N.A (Circle

one of this section)
a Who or where can you look for where you have doubts/
clarification on the medications prescribed?
b Patients recorded contain a list of current medications
taken prior to admission and this information is made
available to the pharmacy and the patient’s care providers
SN STANDARDS/MEASURABLE ELEMENT Mets? Remarks
Y N N.A N.T
C The doctor screens though all the patient’s existing
medications and documents in the clerking case notes,
under “Present Medicines”.
D The doctor reviews if the medicines are still required by the
patient and enters the drugs to be continued in the e-IMR.
There drugs should be indicated in brackets under the
remarks columns “patient’s existing medications”
E Initial medication orders are compared to the list of
medications taken prior to admission, according to the
organization’s established process
F Where are special precautions or procedure for ordering
drugs with look-a like and sound-alike names?

I3 Preparing and dispensing (MMU 5) Pass / Fail / N.A (Circle

one of this section)
A Injection trolleys are:
Clean and tidy
Assigned are for drug dilution
Aseptic techniques observed during dilution
B Medication cart is clean and tidy
C Stock medication is dated upon opening
D There are no expired medications/tubes
E There are no expired medications prescriptions or orders for
appropriateness
F Staff is able to articulate how to dispense the medications
for the omnicell during omnicell downtime

I4 Administering Medications (MMU 6) Pass / Fail / N.A (Circle

one of this section)
A What is process of administrating medications to patients?
B Drug allergies are identified and indicated
C What are the 5 rights of medication administrations?
D Medication prescribed and administered in written in the
patient’s record.
E What do you do with the leftover cytotoxic drug and
consumable used during administration of cytotoxic drugs?
F For multiple uses of the drug/mixture the following are recorded
G For medication prepared in a syringe or burette for
continues infusion, the following is labeled:
H Are patients able to do self-administration of medication
during their hospital stay?
i eIMR and eMARS are logged off when not in use.

I5 monitoring( MMU7) Pass / Fail / N.A (Circle

one of this section)
a What do you do when adverse side effects are observed?
b What happens when there is a medication error/ near miss?
c There is a medication recall system in place

SN STANDARDS/MEASURABLE ELEMENT Mets? Remarks

Y N N.A N.T
J Injection control (PCI)
J1 Equipment (PCI 7.1) Pass / Fail / N.A (Circle
one of this section)
Staff have knowledge of:
a Who is supposed to clean equipment’s
b Devices which are reused in the hospital (None)
c The process for the collection, analysis and use of infection
prevention and control data related to reused devices and
materials

J2 Laundry and linen Management (PCI7.1,ME 3) Pass / Fail / N.A (Circle

one of this section)
a Soiled linen is appropriately disposed

b Linen carrier is properly covered

J3 waste Disposal (PCI 7.2) Pass / Fail / N.A (Circle

one of this section)
a Name some examples of biohazard waste

b How do you dispose biohazard materials ?

J4 sharps and needles (PCI 7.3) Pass / Fail / N.A (Circle

one of this section)
a Sharp boxes is less than2\3 filled

b What is the process of disposing the sharp box ?

c Staffs knowledge of needle stick injury protocol

J5 patients In Isolation (PCI 8) Pass / Fail / N.A (Circle

one of this section)
a What do you need to observe before entering an isolation
room\ward?
b Signage for isolation precaution are available and
appropriate
c Personal protection equipment (PPE) is available for use

d Staff educated patients relatives to take precautions for

patients in isolation room
e What happens when one bedded isolation rooms are
unavailable?
f Patients with known \suspected diseases are isolated
appropriately

J6 personal protective Equipment (PCI 9) Pass / Fail / N.A (Circle

one of this section)
a Staff know which situations to use different levels of PPE

b Staff demonstrates correct techniques of pulling on and

taking of PPE and known what to do removal of PPE