Free JCI Ambulatory Care templates

Audit tools, logs and forms for clinics preparing for JCI Ambulatory Care (4th Edition), grouped by standard identifier. Fill them in online or download the PDF - no account needed. Written in our own words; the standards themselves are JCI's.

Standard IPSG: Patient safety goals

• Patient identification audit - JCI IPSG.1, outpatient clinics (international) - Audit tool. Supports JCI Ambulatory Care · Standard IPSG.1. Fill it in online. An audit tool for outpatient clinics to observe staff confirming patient identity using two identifiers before medication, tests, samples, or procedures, ensuring identifiers match requests, labels, and records.
• High-alert medication management audit - JCI IPSG.2.1, clinics (international) - Audit tool. Supports JCI Ambulatory Care · Standard IPSG.2.1. Fill it in online. Audit how a clinic manages high-alert medications, covering identification, storage, administration, staff knowledge, and documentation to enhance patient safety.
• Pre-procedure pause checklist for ambulatory care (JCI IPSG.3) - Inspection checklist. Supports JCI Ambulatory Care · Standard IPSG.3. Fill it in online. A pre-procedure pause checklist for ambulatory care, ensuring correct patient, procedure, and site, along with equipment, imaging, and team readiness.
• Hand hygiene observation audit tool for clinical areas (JCI IPSG.5) - Audit tool. Supports JCI Ambulatory Care · Standard IPSG.5. Fill it in online. An observation audit tool for assessing hand hygiene compliance in clinical areas, covering staff roles, moments, methods, and performance.
• Outpatient falls risk screening record - JCI IPSG.6.1, ambulatory care (international) - Form. Supports JCI Ambulatory Care · Standard IPSG.6.1. Fill it in online. Record outpatient falls risk screening, including history, risk factors, assessed risk level, implemented precautions, and patient education, for ambulatory care settings.

Standard ACC: Access to care and continuity of care

• Patient record audit: informed consent for procedures (JCI ACC.3, MOI.2) - Audit tool. Supports JCI Ambulatory Care · Standard ACC.3. Fill it in online. Audit patient records for informed consent for procedures, checking for form presence, procedure details, explanation of risks/benefits/alternatives, signatures, dates, and interpreter documentation.
• Missed appointment log - JCI ACC.6, all healthcare settings (international) - Log. Supports JCI Ambulatory Care · Standard ACC.6. Fill it in online. A log for tracking missed patient appointments, detailing clinical risk, contact attempts, follow-up actions, and documentation of the process.

Standard PFR: Patient and family rights

• Outpatient record audit: JCI standards for documentation quality (international) - Audit tool. Supports JCI Ambulatory Care · Standard PFR.1.1. Fill it in online. An audit tool for outpatient records, checking documentation quality against JCI standards for patient identification, assessment, diagnosis, treatment, and follow-up.

Standard AOP: Assessment of patients and medication use in care

• Outpatient falls risk screening record - JCI IPSG.6.1, ambulatory care (international) - Form. Supports JCI Ambulatory Care · Standard AOP.6.1.1. Fill it in online. Record outpatient falls risk screening, including history, risk factors, assessed risk level, implemented precautions, and patient education, for ambulatory care settings.
• Medication and vaccine refrigerator temperature log - JCI MMU.2, AOP.6.5.1 (international) - Log. Supports JCI Ambulatory Care · Standard AOP.6.5.1. Fill it in online. A daily log for medication and vaccine refrigerators, recording temperature readings, safe range compliance, and actions for out-of-range events.
• Emergency trolley check - JCI AOP.7.4, clinics (international) - Equipment check. Supports JCI Ambulatory Care · Standard AOP.7.4. Fill it in online. This template helps clinics check their emergency trolley or grab bag for readiness, ensuring all essential items are present, in date, and functional.
• Medicines storage audit tool for clinics (JCI MMU.2, AOP.7.6) - Audit tool. Supports JCI Ambulatory Care · Standard AOP.7.6. Fill it in online. An audit tool for clinics to check that medicines are stored securely, correctly, and safely, covering security, stock management, controlled drugs, and emergency supplies.

Standard MMU: Medication management

• Medication and vaccine refrigerator temperature log - JCI MMU.2, AOP.6.5.1 (international) - Log. Supports JCI Ambulatory Care · Standard MMU.2. Fill it in online. A daily log for medication and vaccine refrigerators, recording temperature readings, safe range compliance, and actions for out-of-range events.
• Medicines storage audit tool for clinics (JCI MMU.2, AOP.7.6) - Audit tool. Supports JCI Ambulatory Care · Standard MMU.2. Fill it in online. An audit tool for clinics to check that medicines are stored securely, correctly, and safely, covering security, stock management, controlled drugs, and emergency supplies.
• Patient identification audit - JCI IPSG.1, outpatient clinics (international) - Audit tool. Supports JCI Ambulatory Care · Standard MMU.5.1. Fill it in online. An audit tool for outpatient clinics to observe staff confirming patient identity using two identifiers before medication, tests, samples, or procedures, ensuring identifiers match requests, labels, and records.

Standard QPS: Quality improvement and patient safety

• Patient safety incident report form - ambulatory care (international) - Incident form. Supports JCI Ambulatory Care · Standard QPS.6. Fill it in online. A report form for patient safety incidents or near misses in ambulatory care, covering what happened, people involved, harm, immediate actions, and follow-up.
• Patient complaints and compliments register - JCI 4th Ed. QPS.7, MOI.13, healthcare (international) - Register. Supports JCI Ambulatory Care · Standard QPS.7. Fill it in online. A register to track patient complaints and compliments, from receipt to resolution and follow-up, supporting continuous improvement in healthcare settings.

Standard PCI: Infection prevention and control

• Infection prevention walk-round checklist: clinical and waiting areas (international) - Inspection checklist. Supports JCI Ambulatory Care · Standard PCI.1. Fill it in online. A walk-round checklist for clinical and waiting areas to check infection prevention practices, including cleanliness, hand hygiene, waste management, and staff knowledge.
• Steriliser cycle log and daily/weekly tests - JCI PCI.6, healthcare (international) - Log. Supports JCI Ambulatory Care · Standard PCI.6. Fill it in online. A detailed log for each steriliser cycle, including load contents, cycle parameters, indicator results, and daily/weekly tests, to support compliance with JCI PCI.6.

Standard GLD: Governance and leadership

• Outpatient record audit: JCI standards for documentation quality (international) - Audit tool. Supports JCI Ambulatory Care · Standard GLD.8. Fill it in online. An audit tool for outpatient records, checking documentation quality against JCI standards for patient identification, assessment, diagnosis, treatment, and follow-up.

Standard FMS: Facility management and safety

• Fire and facility safety inspection checklist for clinics (international) - Inspection checklist. Supports JCI Ambulatory Care · Standard FMS.1, FMS.3.1. Fill it in online. A walk-round checklist for clinics to inspect fire and facility safety, covering exits, fire equipment, electrical safety, hazardous materials, and general facility conditions.
• Fire evacuation drill record - JCI FMS.3.1, healthcare (international) - Form. Supports JCI Ambulatory Care · Standard FMS.3.1. Fill it in online. Record details of a fire evacuation drill, including scenario, evacuation time, patient safety, staff roles, and identified corrective actions.
• Medical equipment planned maintenance log - JCI FMS.7, FMS.2, healthcare (international) - Log. Supports JCI Ambulatory Care · Standard FMS.7. Fill it in online. Log planned maintenance, testing, and calibration of medical equipment, including identification, service details, test results, and follow-up dates to support JCI FMS.7 and FMS.2.

Standard SQE: Staff qualifications and education

• Patient safety incident report form - ambulatory care (international) - Incident form. Supports JCI Ambulatory Care · Standard SQE.2. Fill it in online. A report form for patient safety incidents or near misses in ambulatory care, covering what happened, people involved, harm, immediate actions, and follow-up.
• Clinician file audit: JCI SQE.7 & SQE.5, healthcare (international) - Audit tool. Supports JCI Ambulatory Care · Standard SQE.5, SQE.7. Fill it in online. This template provides an in-depth audit of a clinician's or staff member's file, covering licensure, qualifications, competence, training, and performance review, aligned with JCI SQE.7 and SQE.5 standards.

Standard MOI: Management of information

• Patient record audit: informed consent for procedures (JCI ACC.3, MOI.2) - Audit tool. Supports JCI Ambulatory Care · Standard MOI.2. Fill it in online. Audit patient records for informed consent for procedures, checking for form presence, procedure details, explanation of risks/benefits/alternatives, signatures, dates, and interpreter documentation.
• Outpatient record audit: JCI standards for documentation quality (international) - Audit tool. Supports JCI Ambulatory Care · Standard MOI.9. Fill it in online. An audit tool for outpatient records, checking documentation quality against JCI standards for patient identification, assessment, diagnosis, treatment, and follow-up.
• Patient complaints and compliments register - JCI 4th Ed. QPS.7, MOI.13, healthcare (international) - Register. Supports JCI Ambulatory Care · Standard MOI.13. Fill it in online. A register to track patient complaints and compliments, from receipt to resolution and follow-up, supporting continuous improvement in healthcare settings.

2 more templates are being prepared and checked.

AccrediMe is not affiliated with or endorsed by Joint Commission International (JCI). Standards are cited by identifier only; the standards are JCI's and are not reproduced.