Patient Safety Checklist

Health Care-Associated Infections

  • Ask doctors, nurses and other staff if they have washed their hands when they enter your room. Request that visitors also wash their hands often. Washing can be with alcohol gel (wall units) or soap and water.
  • If you have any type of catheter, ask every day if that catheter can be removed. Catheters can cause infections.

Identification Errors

  • If you are admitted to the hospital, check your ID bracelet to make sure all information is correct. All staff should use this bracelet to confirm your name before any treatments or tests.
  • If you are making a visit as an outpatient, staff should ask you to confirm your name and another unique identifier, such as your date of birth, before treatments or tests.
  • Make sure that blood and other specimens taken from your body are labeled in front of you.

Hospital Falls

  • Ask a nurse about your fall risk level and what steps are being taken to reduce that risk.
  • Keep the nurse call bell, eyeglasses and other items within reach, and wear non-skid footwear.
  • If you need assistance walking, request help before the need to use the bathroom becomes urgent.

Venous Thromboembolism (blood clots)

  • Ask if you are observed by clinicians to identify your risk for blood clots.
  • If you are at risk for blood clots, ask what treatments you should receive.
  • Ask every day if you are getting the treatments you should to reduce blood clots.

Communication and Teamwork Errors

  • When you enter the hospital, be familiar with what medications you are taking, your allergies, and your complete medical history.
  • Participate when doctors and nurses meet at your bed to discuss your care and ask for an explanation if you are confused about something with your treatment
  • Make sure you will be able to care for yourself when you leave the hospital by being involved in developing your discharge plan, reading back your discharge plan and make sure that you know:
    • Your treatment, including your medications
    • What risks to watch out for and what to do if they occur
    • Follow-up instructions— Which provider you should visit, how soon, and when this provider will receive the records from your hospital stay

Based on A Safety Checklist for Patients by Peter Pronovost, MD. This material was prepared by Quality Insights of Pennsylvania, the Medicare Quality Improvement Organization for Pennsylvania, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number 10SOW-PA-IPC-KD-060112. App. 6/12


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