Information
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Facility Surveillance Audit
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Facility Audit Conducted and Address
- Aubrey- DBA: Baylor Emergency Hospital at Aubrey 26791 HWY 380 E Aubrey, TX 76227-7654
- Keller- DBA- Baylor Emergency Medical Center at Keller Legal Name: EBD BEMC Keller, LLC 620 S. Main, Suite 100 Keller, Texas 76248
- Murphy- Turnover January 13, 2013 DBA- Baylor Emergency Medical Center at Murphy Legal Name: EBD BEMC Murphy, LLC 511 FM 544, Suite 100 Murphy, Texas 75094
- Rockwall – Legal Name: EBD BEMC Rockwall, LLC DBA- Baylor Emergency Medical Center at Rockwall 1975 Alpha, Suite 100, Rockwall, TX, 75087
- Burleson- Legal Name: EBD BEMC Burleson, LLC DBA – Baylor Emergency Medical Center at Burleson 12500 South Freeway, Suite 100 Burleson, TX 76028
- Mansfield – Turnover June 2, 2014 Legal Name: EBD BEMC Mansfield, LLC DBA- Baylor Emergency Medical Center at Mansfield 1776 N. U.S. 287, Suite 100 Mansfield, TX 76063
- Colleyville - Turnover date is July 7, 2014 Legal Name: EBD BEMC Colleyville, LLC DBA- Baylor Emergency Medical Center at Colleyville 5500 Colleyville Blvd. Colleyville, TX 76034
- Thousand Oaks 16088 San Pedro Ave San Antonio, Texas 78232
- Westover Hills 10811 Town Center Dr. San Antonio, Texas 78251
- Overlook 25615 N US Hwy 281 San Antonio, Texas 78258
- Hausman 8230 N 1604 W San Antonio, Texas 78249
- Schertz 16977 I-35 N Schertz, Texas 78154
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Conducted on
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Prepared by
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Signature
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Personnel Participating in Drill
SAFETY
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1. Are all "E"oxygen cylinders secured and large "H" oxygen and medical air cylinders in Med Gas room chained/secured and room locked?
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2. Temperature Track operational? (confirm through TempTrak)
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3. All Fire Extinguishers in building within expiration date and marked with month, day, and year of inspection?
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4. All Sharps Containers less than ¾ full?
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5. All Eye Wash bottles within expiration date?
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6. All hallways free & clear of stored items and/or obstructions?
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7. Are the patient nutrition refrigerators clean/defrosted and free of staff items?
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8. Are the patient microwaves clean and in good working order?
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9. The building is void of any space heaters?
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10. If applicable, were all Interim Life Safety Measures implemented during the last month reported to the Quality Department? (typically related to construction projects)
INFECTION CONTROL
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1. Every room, closet, and enclosure inspected for visible contaminants?
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2. Clean and soiled linen stored off ground and covered?
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3. Clean linen stored separately from dirty linen?
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4. Soiled linen stored in proper linen bags in soiled utility room?
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5. All ventilation openings check and are free from visible dust or contaminants?
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6. Ceiling tiles clear of stains?
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7. Are hand washing posters posted?
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8. All negative pressure room(s) check and functioning properly (indicator lights green and small piece of tissue pulled into room form hallway under the closed door).
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9. Dietary room clean and no boxes stored on floor.
PHARMACY/MEDICATIONS
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1. Medication room door(s) locked.
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2. Medication room is clean and clear of food/drink?
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3. Narcotic cabinet locked.
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4. Controlled substances log checked and has no blanks or omissions (signatures, physician name, quantity dispensed, waste amount, time and date, and patient name?
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5. Medication refrigerator clear of food and drinks and open multi-dose medications correctly initialed, dated, and properly stored?
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6. Opened room temperature multi-dose medications are correctly initialed, dated, and properly stored?
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7. Topical Medications are kept separate from PO and IV Medications?
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8. Poison Control telephone number clearly posted in Medication Room?
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9. Crash cart medications within expiration dates? (check Epinephrine 1:10,000, Atropine, and Dopamine)
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10. Crash carts re-locked and secured with yellow plastic locks?
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11. Crash cart log completed every shift?
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12. Suture cart locked, secure, and no opened medication (to include multi dose) are present?
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13. CT closet where IV Contrast is stored is locked and secured?
LAB
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1. Are the following lab testing supplies within expiration date? CMP, Qualligen test packs, Urine drug tests. <br>
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2. Lab clean and clear of food and drink?
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3. Lab refrigerator clean and clear of food and drink?
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4. Glucometer log completed every shift?
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Monthly QA Review sent by the Regional Lab Manager been reviewed and corrective actions updated on log?
OTHER
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1. All Safety Recalls and Alerts that have been received been addressed?
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2. All previous month’s EOC discrepancies (questions answered “NO”) addressed and closed?