Page 517 - eBook Version 8 Book 1 of 2 JUL 2022

Inv. Drug Worksheet
Standard/ Policy/ Gudance
Location
Present in Chart (Circle ONLYone)
Notes
Is this a drug study?
YES
NO
Applicable to this vist date?
YES
NO
Order or prescription signed by the investigator (physician)
Joint Commission MM.06.01.05
EPIC: Physician Orders and MAR
YES
NO
Order or prescription includes Patients Name
Joint Commission MM.06.01.05
EPIC: Physician Orders and MAR
YES
NO
D ate / Time
Joint Commission MM.06.01.05
EPIC: Physician Orders and MAR
YES
NO
Dose
Joint Commission MM.06.01.05
EPIC: Physician Orders and MAR
YES
NO
Route
Joint Commission MM.06.01.05
EPIC: Physician Orders and MAR
YES
NO
Frequency
Joint Commission MM.06.01.05
EPIC: Physician Orders and MAR
YES
NO
Administration of study medication is documented on MAR
Joint Commission
EPIC: Physician Orders and MAR
YES
NO
Medication indication, Patient tolerance, Adverse events
Joint Commission
EPIC: Physician Orders and MAR
YES
NO
Orders Worksheet
Standard/ Policy/ Gudance
Location
Present in Chart (Circle ONLYone)
Notes
Applicable to this visit date?
YES
NO
All handwritten RESEARCH notes, Orders, etc. have patient ID on Every page and are: Legible
Joint Commission
EPIC: Scanned document
YES
NO
Dated/Timed
Joint Commission
EPIC: Scanned document
YES
NO
Signed with Title (i.e., RN, RRT, MA, etc.)
Joint Commission
EPIC: Scanned document
YES
NO
All RESEARCH procedures HAVE orders and are signed by the Physician.
Joint Commission
EPIC: Orders
YES
NO
There are no Dangerous Abbreviations used in ANY research Doucmentation.
Joint Commission
EPIC: Orders, Progress notes, Consent Form
YES
NO
MR#_____________________________________
Date______________________________
Auditor Initials________________________________
FOR AUDIT PURPOSES ONLY