Kingdom Of Saudi Arabia ‫المملكة العربية السعودية‬

Directorate of Health Affairs in Taif ‫مديرية الشئون الصحية بمحافظة الطائف‬

King Faisal Medical Complex ‫مجمع الملك فيصل الطبي‬

Scope of risk (OPD) Checklist

WARD/UNIT: ________________________ DATE: ____________________
LEGEND: PT = Preparation Tool INT = Interview OBS = Observation MR = Medical Record O/I = Observation/Interview
DR=Document Review NM =Not met (Score = 0 when < 50 % compliance) PM = Partially met (Score=1 ≥ 50 to < 80 % compliance)
FM = Fully met( Score= 2 when ≥ 80 % compliance) NA = Not applicable(Cancelled Score )

RESULT
Points of measurement PT COMMENTS
NM PM FM NA

1- Health care providers are competent, qualified and credentialed to accomplish the DR
procedures performed.
2- Staffs are holding licenses and are displayed/available in their working areas. DR
3- Incidents are reported timely and accurately. DR
4- Staffs work according to their job description. DR
5- Policy-procedure in place for the unit OBS
6- Staffs are aware of emergency protocols in any kind of emergencies. INT
7- Staffs follow all policies and procedures pertaining to documentation. DR
8- Crash cart checklist maintained daily & replenished DR
9- Emergency medication tray checklist maintained OBS
10- Lifting & moving techniques adhered to for patients handling & lifting items. OBS
11- There is an updated usable Significant Data Sheet. DR
12- Patients are offered a scheduled appointment for follow-up visits, signed by the DR
Treating Physicians.
13-Information from assessments is integrated and analyzed to identify and priorities DR
each patient care needs.

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 Kingdom Of Saudi Arabia ‫المملكة العربية السعودية‬
Directorate of Health Affairs in Taif ‫مديرية الشئون الصحية بمحافظة الطائف‬
King Faisal Medical Complex ‫مجمع الملك فيصل الطبي‬

Scope of risk (OPD) Checklist

14-Wound infections initially noted in the OPD are reported to the Infection Control DR
Department.
15-A portable EKG service is always available whenever needed. OBS
16-Therapeutic Dietary Consultation is available for the high risk patients and whenever DR
recommended with the Dietician.
17-Patient’s rights are protected during admissions, assessments and management. DR/INT
18-Consent MR
 Is available for all admitted patients.
 Informed consent is available for patients under going any special procedures or MR
surgery.
 Consent is clearly written, signed and stamped. MR
19-Violent patients / family members / visitors are handled correctly & properly. DR
20-Signs posted in restricted areas OBS
21-Emergency door & exits are in good condition OBS
22-Medication cabinets, medication fridge, crash cart are locked securely OBS
23-Equipment and Utilities

 Emergency equipment are checked and documented daily. DR

 Equipment/machinery limited to authorized persons only DR
 Medical equipments tagged with Bio-med stickers PPM OBS
 Emergency power outlets are identified & staff are familiarized OBS/INT

 Electrical cords/cables for medical equipment in good condition not frayed. OBS
 Sufficient oxygen flow meters to meet the requirements OBS
 Reports and damages are reported promptly to Biomed/Facilities Engineering. OBS

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 Kingdom Of Saudi Arabia ‫المملكة العربية السعودية‬
Directorate of Health Affairs in Taif ‫مديرية الشئون الصحية بمحافظة الطائف‬
King Faisal Medical Complex ‫مجمع الملك فيصل الطبي‬

Scope of risk (OPD) Checklist

 Patients couch light working OBS
 Ceiling lights working OBS
 Switches without damage & cracks OBS
 Thermostats of room air-conditioning working OBS
 Tap water facility available & the temperature adequate. OBS
 Toilets flush properly OBS
 Water supplies free of leakage OBS
 Over-head paging system heard in the area OBS
24-Staff know to relay emergency information to Telephone Operator for paging INT
25-Employee Health DR
 All new hires are screened and routine medical check up carried out.
 Staff receives immunization as per employee health clinic schedule. DR
 Needle and sharp injury is reported to employee health clinics as per P & P. DR
26-Patient Complaints

 Was there any complaint from the patient or from the visitors DR
 Complaints are investigated promptly & resolved. DR
27-Event reporting system (HERF) DR/INT
 Adverse occurrences or unusual situations are reported at the time of discovery.
 Corrective actions are taken to prevent recurrences DR
28-Safety OBS
 Cables securely fastened to prevent tripping OBS
 Adequate lighting is available throughout the area. OBS

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 Kingdom Of Saudi Arabia ‫المملكة العربية السعودية‬
Directorate of Health Affairs in Taif ‫مديرية الشئون الصحية بمحافظة الطائف‬
King Faisal Medical Complex ‫مجمع الملك فيصل الطبي‬

Scope of risk (OPD) Checklist

 Items in the store room arranged correctly with heavy items on to the bottom of OBS
the shelf.
 Evacuation plan map is posted in all rooms & corridors indicating the evacuation OBS
route.
 Corridors & passages free of obstruction OBS
 Emergency exits are clearly labeled. OBS
 Rooms are locked when not in use. OBS
 Housekeepers use sign boards while mopping floors to prevent slips & falls. OBS
 Utility rooms locked when unattended.. OBS
 Furniture’s in the clinics are safe, no broken wheels etc OBS
 Rooms are clean, free of litters & debris. OBS
 Refrigerators are cleaned on regular basis OBS
 Temperature chart maintained for all indicated refrigerators. OBS
 Walls in good general condition OBS
 Doors free from damage or sharp edges OBS
 Ceiling tiles free from stains/dirts/soakages OBS
 Familiar with the Emergency Codes & the number to dial OBS
 “No smoking” signs are posted wherever indicated OBS
 “No smoking” policy strictly enforced OBS
 Staff aware of what to do in case of fire OBS
 Fire extinguishers are in place. OBS
 Staff oriented to Life Safety Emergency Response Program. INT

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 Kingdom Of Saudi Arabia ‫المملكة العربية السعودية‬
Directorate of Health Affairs in Taif ‫مديرية الشئون الصحية بمحافظة الطائف‬
King Faisal Medical Complex ‫مجمع الملك فيصل الطبي‬

Scope of risk (OPD) Checklist

29-Confidentiality DR
 All documentation respects the privacy and confidentiality of patient information.
30-Emergency Preparedness Factors INT
 Staff understands their role in Internal & External Disasters
31-Education & Training DR
 Staff trained in their specific job role, are records maintained
 Staff encouraged to seek further education-training in-house DR
 Are there a regular in-house training program to ensure that staff are kept
updated with new advancements & techniques
 Staff attend in-service educational activities DR
35-New hires are oriented & trained to fire & safety program DR/INT
37-Evacuation plan map is posted indicating the evacuation route. OBS

NAME&SIGNATURE OF ASSESSOR:__________________________ NAME&SIGNATURE OF HEAD DEPART:________________________

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