UNIT : _________________________ Muscat Private Hospital Effective Date_____________

MONTH: _______________________ Page #: 1 of 1

INTERNAL AUDIT CHECKLIST

IPSG 2 IMPROVE EFFECTIVE COMMUNICATION (b)

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SIGNATURE (INTERNAL AUDITOR) Approved by: _________________________
Quality Manager

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SIGNATURE (EXTERNAL AUDITOR)
SCORE OBTAINED: MAXIMUM SCORE:
QUALITY INDEX: AVERAGE Q.I.: SAMPLE SIZE:
MRN: MRN: MRN: MRN: MRN: MRN:
AUDIT STRATEGIES USED : K E Y : Y - YES
_ ___ PATIENT INTERVIEW N - No
_____ STAFF INTERVIEWS NA - NOT APPLICABLE
_____ PRACTICE OBSERVATION Q.I. - QUALITY INDEX
_____ REVIEW NURSING RECORD Date: Date: Date: Date: Date: Date:
_____ OTHERS ( specify_________)

NA Y N NA Y N NA Y N NA Y N NA Y N NA COMMENTS
CRITERIA: Y N

Endorsement kardex maintained and

1 completed on each shift?
(ISBAR) Internal transfer form maintained and
2 completed?
(ISBAR) Multidisciplinary form Maintained
3 whenever needed?
Are the doctors using (ISBAR) clinical
4 Handover of Care form whenever needed?
GRAND TOTÀL