HD-TE-001-F1 · Daily Water Treatment Log (UPDATED)

Daily Water Treatment System Monitoring Log

Form HD-TE-001-F1 · Hemodialysis Unit – [Hospital Name]
Month/Year: _________ RO System ID: _________
📋 Updated June 26, 2026 Enhanced chlorine monitoring · new EBCT field · post‑PM validation
PROPOSED UPDATES
  • Tests must be completed before the first patient each shift and recorded before treatments begin.
  • Use DPD kit for chlorine. Results must be <0.1 mg/L to proceed.
  • Notify charge nurse + biomedical engineer immediately if any result is at Action Level or above.
  • Charge nurse to review and sign at end of each shift.
Update 1 Chlorine monitoring & EBCT
Chlorine: pre‑carbon & post‑carbon (single). No EBCT field.
Pre‑carbon, Post‑1st tank, Post‑2nd tank chlorine; added Carbon EBCT OK? Y/N field to verify ≥10 min total.
Rationale: AAMI/ISO 23500:2024 requires monitoring after each carbon tank; EBCT verification ensures adequate contact time for chlorine removal.
Update 2 Post‑maintenance validation
No specific field for PM validation.
Added "Post‑PM Validation OK?" column (not shown in table but included in "Actions Taken" section) – staff to document that daily tests were run after any maintenance before patient use.
Rationale: Ensures water quality is restored after filter changes, membrane replacement, or disinfection before patient treatment.
Date Shift Time Staff
Initials		 Total Chlorine (mg/L) Hardness
GPG		 RO Cond.
µS/cm		 Feed Cond.
µS/cm		 %
Rejection		 RO Temp
°C		 Flow Rate
L/min		 Carbon EBCT
OK? Y/N		 Softener
Brine OK? Y/N		 Actions Taken
(incl. PM validation)		 Charge RN
Signature
Pre‑Carbon Post‑1st Tank Post‑2nd Tank
___/___ AM ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ☐ Y ☐ N ☐ Y ☐ N ________ ________
___/___ PM ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ☐ Y ☐ N ☐ Y ☐ N ________ ________
___/___ Night ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ☐ Y ☐ N ☐ Y ☐ N ________ ________
Additional days – copy rows as needed (one per shift per day)
___/___ AM ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ☐ Y ☐ N ☐ Y ☐ N ________ ________
___/___ PM ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ☐ Y ☐ N ☐ Y ☐ N ________ ________
___/___ Night ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ☐ Y ☐ N ☐ Y ☐ N ________ ________
% Rejection = [(Feed Cond. – Product Cond.) / Feed Cond.] × 100
Action Levels:
Total Chlorine ≥0.1 mg/L: Retest. If confirmed, change carbon tanks.
Total Chlorine ≥0.5 mg/L: STOP treatments immediately. Notify MD + MOH.
Hardness ≥1 GPG: Regenerate softener.
% Rejection <90%: Notify biomedical. <85%: STOP treatments.
EBCT: must be ≥10 min total for two carbon tanks.
Weekly Checks – Complete Every Sunday AM Shift:
Carbon Tank EBCT: Volume (gal) / Flow (GPM) = ____ min (must be ≥10 min)
Loop Disinfection Date: Last: ________   Next: ________
UV Lamp Hours: ____   (Replace at 9000h or annually)
Post‑PM Validation: ☐ Completed this week (daily tests run after maintenance)

Monthly Sign-Off

I verify all daily tests for this month were completed and reviewed. Any deviations had corrective action documented.

Unit In-Charge Date: ________
Biomedical Engineer Date: ________

📌 How to Use This Log in Your Unit

  • Printing: Print 1 sheet per day if you run 3 shifts, or 1 sheet per week if AM/PM only. Most units in Amman laminate a weekly sheet and use whiteboard marker.
  • Location: Keep on RO room door. MOH inspectors check it first.
  • Training: Do a 15-minute huddle with staff this week to show where ports are and how to use DPD kit. Document training.
  • Filing: Keep completed logs for 3 years minimum per MOH requirement. Bind by month for QAPI.
Form HD-TE-001-F1 · Updated June 26, 2026 All updates align with AAMI/ISO 23500:2024 & MOH-Jordan 2023

Daily Water Treatment System Monitoring Log · Version 2026-06-27 · Hemodialysis Unit

📋 Back to All Policies · 🖨️ Print This Page

Aligned with KDOQI, AAMI/ISO, CDC, MOH-Jordan 2023, JCI 8th Ed.

✍️ Author: Ahmed Mohmad Rashyd Musleh Registered Staff Nurse