Sepsis Box Checking (size 208.9 KB)
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BEACON HOSPITAL GREEN SEPSIS BOX CHECKLIST Department: JCI (2013) Standard GLD 11.2 Month: Green Sepsis Box 1st Tuesday Date: 2nd Tuesday Date: 3rd Tuesday Date: 4th Tuesday Date: 5th Tuesday Date: Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Weekly Checklist GIVE BAG 1 Quantity Oxygen Nasal Cannula Tubing 1 Blood Administration Set 1 Normal Saline Bag 0.9% 500ml Normal Saline Bag 0.9% 500ml 1 1 INITIAL once Sepsis Box contents are complete and all expiry dates are checked and in date. 1 Please check contents of Sepsis Box weekly on a Tuesday. In the event that the Sepsis Box is used outside of weekly checking dates, please use recheck pages with date and shortest expiry date. Please see overleaf. *** Department Managers, please audit compliance with this checklist on Excel sheet provided *** BEACON HOSPITAL GREEN SEPSIS BOX CHECKLIST Department: JCI (2013) Standard GLD 11.2 Month: Green Sepsis Box Date: Date: Date: Date: Date: Date: Date: Date: Date: Date: Recheck List Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date GIVE BAG 1 Oxygen Nasal Cannula Tubing Blood Administration Set Normal Saline Bag 0.9% 500ml Normal Saline Bag 0.9% 500ml Quantity 1 1 1 1 INITIAL once Sepsis Box contents are complete and all expiry dates are checked and in date. 2 Please check contents of Sepsis Box weekly on a Tuesday. In the event that the Sepsis Box is used outside of weekly checking dates, please use recheck pages with date and shortest expiry date. Please see overleaf. *** Department Managers, please audit compliance with this checklist on Excel sheet provided *** BEACON HOSPITAL GREEN SEPSIS BOX CHECKLIST Department: JCI (2013) Standard GLD 11.2 Month: Sepsis Box Contents 1st Tuesday Date: 2nd Tuesday Date: 3rd Tuesday Date: 4th Tuesday Date: 5th Tuesday Date: Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Weekly Checklist Quantity TAKE BAG 1 IV Access Alcohol Swabs 2 IV 3000 Dressing 1 Tourniquet 1 IV Cannula 14 Gauge 1 IV Cannula 16 Gauge 1 IV Cannula 18 Gauge 1 IV Cannula 20 Gauge 1 Bi Clave Connector 1 3 Please check contents of Sepsis Box weekly on a Tuesday. In the event that the Sepsis Box is used outside of weekly checking dates, please use recheck pages with date and shortest expiry date. Please see overleaf. *** Department Managers, please audit compliance with this checklist on Excel sheet provided *** BEACON HOSPITAL GREEN SEPSIS BOX CHECKLIST Department: JCI (2013) Standard GLD 11.2 Month: Sepsis Box Contents Quantity Recheck List Date: Date: Date: Date: Date: Date: Date: Date: Date: Date: Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date TAKE BAG 1 IV Access Alcohol Swabs 2 IV 3000 Dressing 1 Tourniquet 1 IV Cannula 14 Gauge IV Cannula 16 Gauge 1 IV Cannula 18 Gauge 1 IV Cannula 20 Gauge 1 Bi Clave Connector 1 1 4 Please check contents of Sepsis Box weekly on a Tuesday. In the event that the Sepsis Box is used outside of weekly checking dates, please use recheck pages with date and shortest expiry date. Please see overleaf. *** Department Managers, please audit compliance with this checklist on Excel sheet provided *** BEACON HOSPITAL GREEN SEPSIS BOX CHECKLIST Department: JCI (2013) Standard GLD 11.2 Month: Sepsis Box Contents 1st Tuesday Date: 2nd Tuesday Date: 3rd Tuesday Date: 4th Tuesday Date: 5th Tuesday Date: Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Quantity Weekly Checklist TAKE BAG 2 Peripheral Blood Cultures Blood Culture Aerobic Bottle Blue Top 1 Blood Culture Anaerobic Bottle Purple Top ChloraPrep Frepp Applicator 1.5ml 1 U&E Blood Tube Orange 1 FBC Blood Tube Purple 1 Blood Sampler for Lactate Specimen (Transport tube in ice) Large Blue Vacutainer 2 Blood Sampler 1 Alcohol Swabs 2 Safety Multifly 23 Gauge 1 1 1 5 Please check contents of Sepsis Box weekly on a Tuesday. In the event that the Sepsis Box is used outside of weekly checking dates, please use recheck pages with date and shortest expiry date. Please see overleaf. *** Department Managers, please audit compliance with this checklist on Excel sheet provided *** BEACON HOSPITAL GREEN SEPSIS BOX CHECKLIST Department: Sepsis Box Contents JCI (2013) Standard GLD 11.2 Month: Quantity Date: Date: Date: Date: Date: Date: Date: Date: Date: Date: Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Recheck List TAKE BAG 2 Peripheral Blood Cultures Blood Culture Aerobic Bottle Blue Top 1 Blood Culture Anaerobic Bottle Purple Top 1 ChloraPrep Frepp Applicator 1.5ml 1 U&E Blood Tube Orange 1 FBC Blood Tube Purple 1 Blood Sampler for Lactate Specimen (Transport tube in ice) Large Blue Vacutainer 2 Blood Sampler 1 Alcohol Swabs 2 Safety Multifly 23 Gauge 1 1 6 Please check contents of Sepsis Box weekly on a Tuesday. In the event that the Sepsis Box is used outside of weekly checking dates, please use recheck pages with date and shortest expiry date. Please see overleaf. *** Department Managers, please audit compliance with this checklist on Excel sheet provided *** BEACON HOSPITAL GREEN SEPSIS BOX CHECKLIST Department: Sepsis Box Contents Weekly Checklist JCI (2013) Standard GLD 11.2 Month: Quantity 1st Tuesday Date: 2nd Tuesday Date: 3rd Tuesday Date: 4th Tuesday Date: 5th Tuesday Date: Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date TAKE BAG 3 Central Blood Cultures Blood Culture Aerobic Bottle Blue Top 1 Blood Culture Anaerobic Bottle Purple Top Alcohol Swabs Blood Sampler Blood Sampler - Central Line Connector LARGE TAKE BAG 1 Dressing Pack 1 Sterile Swabs 3 Sterile Specimen Containers 2 2 1 1 INITIAL once Sepsis Box contents are complete and all expiry dates are checked and in date. 7 Please check contents of Sepsis Box weekly on a Tuesday. In the event that the Sepsis Box is used outside of weekly checking dates, please use recheck pages with date and shortest expiry date. Please see overleaf. *** Department Managers, please audit compliance with this checklist on Excel sheet provided *** BEACON HOSPITAL GREEN SEPSIS BOX CHECKLIST Department: Month: Sepsis Box Contents Recheck List JCI (2013) Standard GLD 11.2 Quantity Date: Date: Date: Date: Date: Date: Date: Date: Date: Date: Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date Expiry Date TAKE BAG 3 Central Blood Cultures Blood Culture Aerobic Bottle Blue Top 1 Blood Culture Anaerobic Bottle Purple Top Alcohol Swabs Blood Sampler Blood Sampler - Central Line Connector LARGE TAKE BAG 1 Dressing Pack 1 Sterile Swabs 3 Sterile Specimen Containers 2 2 1 1 INITIAL once Sepsis Box contents are complete and all expiry dates are checked and in date. 8 Please check contents of Sepsis Box weekly on a Tuesday. In the event that the Sepsis Box is used outside of weekly checking dates, please use recheck pages with date and shortest expiry date. Please see overleaf. *** Department Managers, please audit compliance with this checklist on Excel sheet provided *** BEACON HOSPITAL GREEN SEPSIS BOX CHECKLIST Department: JCI (2013) Standard GLD 11.2 Month: VERIFICATION Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ Initial_____Print Name____________________ 9 Please check contents of Sepsis Box weekly on a Tuesday. In the event that the Sepsis Box is used outside of weekly checking dates, please use recheck pages with date and shortest expiry date. Please see overleaf. *** Department Managers, please audit compliance with this checklist on Excel sheet provided ***
