AHS ELT Sweep Validation Rounds

• Conducted on

  Date

• Prepared by

  Select

• Campus Location

  Select

• Department

  Select

• Unit

  Select

• Unit

  Select

• Unit

  Select

• Specify unit:

• Specify Clinic:

• Yes

  No

  N/A

  Not Reviewed

• Unit

  Select

• Clinic

  Select

• Units

  Select

• Yes

  No

  N/A

  Not Reviewed

• Units

  Select

EOC, Exits & Egress; Medication Room

• All Staff must wear name badges with photo ID visible above waist, with CURRENT COVID SCREENING STICKER

  Yes

  No

  N/A

  Not Reviewed

• Ceiling tiles are free of water stains and/or needing repair.

  Yes

  No

  N/A

  Not Reviewed

• Walls are free of penetrations/integrity intact (holes/dents, paint chipping/peeling)

  Yes

  No

  N/A

  Not Reviewed

• Egress is clear. Exit doors are not blocked and clear of clutter

  Yes

  No

  N/A

  Not Reviewed

• Hallways clear with all equipment parked on one side or in alcoves

  Yes

  No

  N/A

  Not Reviewed

• Fire rated doors must latch & close properly

  Yes

  No

  N/A

  Not Reviewed

• No flammable items on fire rated doors

  Yes

  No

  N/A

  Not Reviewed

• Nothing in front of medical gas valves, fire extinguishers or pull stations

  Yes

  No

  N/A

  Not Reviewed

• Nothing stored under sinks throughout unit

  Yes

  No

  N/A

  Not Reviewed

• No doorstops used or doors propped open

  Yes

  No

  N/A

  Not Reviewed

• No overfilled sharps containers throughout the unit (replace when ¾ full)

  Yes

  No

  N/A

  Not Reviewed

• Patient Health Information protected from public view. I.e., Pt information (white board, WOWs & Chart) secured to ensure privacy

  Yes

  No

  N/A

  Not Reviewed

• No food or beverages in patient care areas, nurses' stations, and staff work areas.

  Yes

  No

  N/A

  Not Reviewed

• All Pt. equipment labeled with clinical engineering sticker & current PMs

  Yes

  No

  N/A

  Not Reviewed

• Overall cleanliness of unit (floors, walls, clutter, dust)

  Yes

  No

  N/A

  Not Reviewed

• No unattended meds on Pyxis, WOWs, or throughout the unit

  Yes

  No

  N/A

  Not Reviewed

• All insulin or multi-use vials are dated w/discard date in 28 days

  Yes

  No

  N/A

  Not Reviewed

• Med Room: Med Room locked with access for authorized personnel only

  Yes

  No

  N/A

  Not Reviewed

• Med Room: Med Prep areas are clean, uncluttered and separated from other areas

  Yes

  No

  N/A

  Not Reviewed

• Individual pill cutters are clean and free of medication residue, plastic sleeves are available

  Yes

  No

  N/A

  Not Reviewed

• Multi-use pill cutters are clean and free of medication residue, plastic sleeves are available

  Yes

  No

  N/A

  Not Reviewed

• Multi-dose Insulin and Tuberculin vials are: dated when opened with last date they can be used (28 days); no expired vials in use; no vials stored on counter

  Yes

  No

  N/A

  Not Reviewed

• All tubed meds put away in a secure place; not accessible to unauthorized persons

  Yes

  No

  N/A

  Not Reviewed

• Medication refrigerator and freezer temperatures logged and documented daily

  Yes

  No

  N/A

  Not Reviewed

• Med Room checked for expired medications and supplies

  Yes

  No

  N/A

  Not Reviewed

Waived Testing and Infection Control Practices:

• All employees wearing universal COVID mask, covering mouth and nose

  Yes

  No

  N/A

  Not Reviewed

• All employees have been screened according to COVID employee screening guidelines

  Yes

  No

  N/A

  Not Reviewed

• Infection Prevention: Contact Precaution sign posted and isolation cart placed outside of room

  Yes

  No

  N/A

  Not Reviewed

• Airborne isolation room doors closed

  Yes

  No

  N/A

  Not Reviewed

• Waived Testing: Glucometer cleaned. Controls and Strips dated w/date opened/expiration date: Toss after 90 calendar days

  Yes

  No

  N/A

  Not Reviewed

• Hand sanitizer or alternative readily available for staff

  Yes

  No

  N/A

  Not Reviewed

• No open Sani-Cloth containers

  Yes

  No

  N/A

  Not Reviewed

• Hand hygiene performed when staff entering & exiting patient rooms

  Yes

  No

  N/A

  Not Reviewed

• No gloves and booties or PPE that have been used in patient care in hallways or public areas

  Yes

  No

  N/A

  Not Reviewed

Nutrition Rooms

• Nutrition Room: Patient food must be labeled with Pt. name and date.

  Yes

  No

  N/A

  Not Reviewed

• Nutrition Room: No staff food to be stored in patient refrigerator

  Yes

  No

  N/A

  Not Reviewed

• Nutrition Room: Refrigerator temp checked daily & documented daily by dietary services

  Yes

  No

  N/A

  Not Reviewed

Soiled (Dirty) Utility Room

• S: Doors closed

  Yes

  No

  N/A

  Not Reviewed

• S: No clean supplies or clean equipment stored in the soiled utility room

  Yes

  No

  N/A

  Not Reviewed

• S: No storage of patient personal belongings

  Yes

  No

  N/A

  Not Reviewed

• S: Floors are clutter free, allowing access to sink, hopper, and door

  Yes

  No

  N/A

  Not Reviewed

• S: Counters are soil/cutter free

  Yes

  No

  N/A

  Not Reviewed

• S: Approved enzymatic gel/ instrument cleaning supplies in room (if applicable)

  Yes

  No

  N/A

  Not Reviewed

• S: Instruments are wet (sprayed) and in open position (if applicable)

  Yes

  No

  N/A

  Not Reviewed

• S: Garbage cans with lids

  Yes

  No

  N/A

  Not Reviewed

• S: Hazardous waste containers are closed/covered and labeled with biohazard sticker on lid and 3 sides of container

  Yes

  No

  N/A

  Not Reviewed

• S: Equipment requiring cleaning or services must be clearly marked

  Yes

  No

  N/A

  Not Reviewed

• S: Sharps containers below the fill line (replace when 3/4 full)

  Yes

  No

  N/A

  Not Reviewed

• S: All storage no higher than 18 inches from sprinkler heads

  Yes

  No

  N/A

  Not Reviewed

Clean Utility Room

• Doors are locked at all times (authorized personnel only)

  Yes

  No

  N/A

  Not Reviewed

• No dirty items in room

  Yes

  No

  N/A

  Not Reviewed

• Clean transport containers with biohazard label in room (stainless steel, cardboard or red - if applicable)

  Yes

  No

  N/A

  Not Reviewed

• No storage of staff or patient person belongings

  Yes

  No

  N/A

  Not Reviewed

• C: Linen carts must be covered and have solid bottoms throughout the unit

  Yes

  No

  N/A

  Not Reviewed

• C: No bags, boxes, or supplies stored on the floor. Must be on pallets or wire shelving with solid bottom

  Yes

  No

  N/A

  Not Reviewed

• C: No corrugated shipping boxes. Remove immediately

  Yes

  No

  N/A

  Not Reviewed

• C: Check for expired medications and or supplies throughout the unit

  Yes

  No

  N/A

  Not Reviewed

• C: No supplies stored within 18 inches from the bottom of the sprinkler head

  Yes

  No

  N/A

  Not Reviewed

• C: O2 tanks are stored upright in the holder. Full >2000 PSI and empty O2 tanks are segregated between FULL AND EMPTY with signage

  Yes

  No

  N/A

  Not Reviewed

Perioperative and Procedure Rooms

• Timeouts are performed for all required invasive procedures; total team participation with active pause

  Yes

  No

  N/A

  Not Reviewed

• Required PPE is worn by all staff in procedure rooms / ORs

  Yes

  No

  N/A

  Not Reviewed

• Medications are labeled when removed from the original manufacturer container

  Yes

  No

  N/A

  Not Reviewed

• All PPE except head coverings (e.g. bonnets, skull caps) removed when going outside procedural areas - no booties in hall, gloves are removed upon exit

  Yes

  No

  N/A

  Not Reviewed

• General cleanliness; no extra linen / supplies out in the open. Linen is covered.

  Yes

  No

  N/A

  Not Reviewed

• All syringes/medications/specimens must be secured and attended by authorized individuals

  Yes

  No

  N/A

  Not Reviewed