Two of the documents Lakeland (Fla.) Surgical & Diagnostic Center uses which are related to sterile processing are a sterile processing department testing and load form and sterile processing department testing and load QI worksheet.
"We use these forms for two purposes," says Bobbie Kendrick, infection control officer for the LSDC Florida Avenue campus. "First is to document the validity of the processing. Secondly, should an infection ever occur, we need to investigate that the process was not implicated in the occurrence. These records have to be on-hand for surveyors as part of their observations."
To download a sample copy of the sterile processing department testing and load form you can adapt for use in your ASC, click here (doc). To download a sample copy of the sterile processing department testing and load QI worksheet, click here (xls).
Learn more about Lakeland Surgical & Diagnostic Center.
Download other sample forms for adaptation and use in your ASC:
- Sample OR/Procedure Room Cleaning Checklist
- Sample General Area Cleaning Checklist
- Sample Incomplete Biological Result Form
