Douglas Environment of Care Rounds

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

SAFETY MANAGEMENT/EMERGENCY MANAGEMENT/FIRE MANAGEMENT

• Red S.T.E.P manual posted for review by staff? <br>Responsible for correction: Department

  Yes

  No

  N/A

• Exit corridors, exits and smoke/fire barrier door unobstructed?<br>Responsible for correction: Department

  Yes

  No

  N/A

• Are corridors, exits and smoke/fire barrier doors unobstructed? <br>Responsible for correction: Department

  Yes

  No

  N/A

• Exit direction identified by a minimum of two lighted signs in corridors? Responsible for correction: Engineering

  Yes

  No

  N/A

• Are items temporarily staged in the corridor? Especially if they don't have wheels. <br>Responsible for correction: Department

  Yes

  No

  N/A

• Any doors found improperly held open by any means?<br>Responsible for correction: Department

  Yes

  No

  N/A

• Exit doors, soiled utility doors and smoke/fire containment doors close and latch properly?<br>Responsible for correction: Department and Engineering

  Yes

  No

  N/A

• Fire extinguishers unobstructed and within current monthly inspection date (one year)?<br>Responsible for correction: Department and Engineering

  Yes

  No

  N/A

• Are items temporarily stage in the corridor moved to one side only? Responsible for correction: Department

  Yes

  No

  N/A

• Are any items stored in the corridor? (Especially if they don't have wheels.) Responsible for correction: Department

  Yes

  No

  N/A

• Alarm pull stations marked and accessible?<br>Responsible for correction: Department and Engineering

  Yes

  No

  N/A

• Hazardous storage area is within guidelines? I.E. Chemicals properly labeled.<br>Responsible for correction: Department, Engineering, and EVS

  Yes

  No

  N/A

• Randomly selected staff members demonstrate proficiency in fire/safety, bomb threat, evacuation and oxygen shut-off procedures?<br>Responsible for correction: Department

  Yes

  No

  N/A

• Sprinkler heads and air vents are free of corrosion and dust?<br>Responsible for correction: Department, Engineering and EVS

  Yes

  No

  N/A

• Storage is no closer than 18 inches from sprinkler head/ceiling?<br>Responsible for correction: Department

  Yes

  No

  N/A

• No storage allowed on the floor or under the sink?<br>Responsible for correction: Department

  Yes

  No

  N/A

• All lighting is in working order, including emergency wall-mounted battery operated units?<br>Responsible for correction: Department and Engineering

  Yes

  No

  N/A

• Walking surfaces are free from debris, loose coverings and other trip hazards?<br>Responsible for correction: Department

  Yes

  No

  N/A

• Patient room furnishings or appointments free from defects? (Bed, rails, chairs, grab bars, etc.) Responsible for correction: Department

  Yes

  No

  N/A

• Nurse call devices operate in randomly chosen rooms? Responsible for correction: Department

  Yes

  No

  N/A

• Staff is aware of "RACE" and "PASS" procedures? Responsible for correction: Department

  Yes

  No

  N/A

• Staff is aware of the Telephone Number to report emergency situations or fire emergency? Responsible for correction: Department

  Yes

  No

  N/A

• Staff has knowledge of the EOC Committee and the Chairperson? Responsible for correction: Department

  Yes

  No

  N/A

HAZARDOUS MATERIALS AND WASTE MANAGEMENT

• Container for disposal of sharps available in area and less than 3/4 full? Responsible for correction: Department and EVS

  Yes

  No

  N/A

• Are bio-hazardous waste containers used correctly? Responsible for correction: Department

  Yes

  No

  N/A

• Are authorized containers/quantities of hazardous materials present and adequately stored? Responsible for correction: Department

  Yes

  No

  N/A

• MSDS match recorded chemical inventory list? Proper labeling of all containers? Responsible for correction: Department

  Yes

  No

  N/A

• Randomly chosen staff members demonstrate knowledge of hazardous materials handling and can locate appropriate MSDS and Right to Know policy? Responsible for correction: Department

  Yes

  No

  N/A

• Staff is proficient in spill recovery procedures? Responsible for correction: Department

  Yes

  No

  N/A

• Is a spill kit present in the area (if applicable)? Responsible for correction: Department

  Yes

  No

  N/A

• Are oxygen/compressed gases properly secured and in the correct transporting device? Responsible for correction: Department

  Yes

  No

  N/A

MEDICAL EQUIPMENT MANAGEMENT AND MISCELLANEOUS INFORMATION

• Any equipment stickers out of date? Responsible for correction: Department and Biomed

  Yes

  No

  N/A

• Any PM stickers missing? Responsible for correction: Department and Biomed

  Yes

  No

  N/A

• Any defibrillators tested or checked IAW current procedures or practice? Responsible for correction: Department and Biomen

  Yes

  No

  N/A

• Use of portable heaters and warming plates are prohibited? Responsible for correction: Department

  Yes

  No

  N/A

• Staff is aware of repair, replacement, reporting and medical intervention procedures involving any equipment used in their area? Responsible for correction: Department

  Yes

  No

  N/A

UTILITY SYSTEMS MANAGEMENT AND ELECTRICAL SAFETY

• Switches and plug receptacles are in good working order with protective plates in place? Responsible for correction: Engineering

  Yes

  No

  N/A

• Plugs and cords on approved electrical equipment in good repair? Responsible for correction: Department and Engineering

  Yes

  No

  N/A

• Is extension cord use limited to only hospital approved devices? Responsible for correction: Department

  Yes

  No

  N/A

• Are multi-plug strips properly mounted? Responsible for correction: Department, Engineering and IT

  Yes

  No

  N/A

• Electrical closets are free from dust accumulation or improperly stored items? Responsible for correction: Engineering and EVS

  Yes

  No

  N/A

• Staff has knowledge of and the location of "red" emergency outlets in their area? Responsible for correction: Department

  Yes

  No

  N/A

• Mechanical areas free of combustible storage and free of obstruction to access to electrical panels? Responsible for correction: Engineering

  Yes

  No

  N/A

• Lighting and other mechanical items functional and in working order? Responsible for correction: Engineering

  Yes

  No

  N/A

HOUSEKEEPING ISSUES

• Are high and horizontal surfaces clean? Responsible for correction: EVS

  Yes

  No

  N/A

• Any cleaning supplies or carts left unattended? Responsible for correction: EVS

  Yes

  No

  N/A

• Is the EVS closed locked? Responsible for correction: EVS

  Yes

  No

  N/A

• Are all cleaning supplies properly labeled? Responsible for correction: EVS

  Yes

  No

  N/A

• Any excessive trash or soiled linen anywhere? Responsible for correction: EVS

  Yes

  No

  N/A

• Clean around dumpster areas? All lids closed and in good condition? Responsible for correction: EVS<br>

  Yes

  No

  N/A

• Clean Linen carts covered? Responsible for correction: EVS

  Yes

  No

  N/A

• Any storage on top of clean linen carts? Responsible for correction: EVS

  Yes

  No

  N/A

• Any signs of insects or rodents? Responsible for correction: Department and EVS

  Yes

  No

  N/A

• Any broken or stained ceiling tiles? Responsible for correction: Department and Engineering

  Yes

  No

  N/A

• All furniture or room fixtures are clean and in good repair? Responsible for correction: Department, Engineering and EVS

  Yes

  No

  N/A

MISCELLANEOUS INFORMATION

• REFRIGERATORS:

• Are refrigerators clean inside and out? Responsible for correction: Department and EVS

  Yes

  No

  N/A

• Are refrigerator temperature posted? Responsible for correction: Department

  Yes

  No

  N/A

• MEDICATION CARTS:

• Are medication carts locked and secured? Responsible for correction: Department and Pharmacy

  Yes

  No

  N/A

• Is the Medication Room door locked? Responsible for correction: Department and Pharmacy

  Yes

  No

  N/A

• SECURITY OF PERSONAL ITEMS:

• Staff and/or patient valuables left out unsecured? Responsible for correction: Department

  Yes

  No

  N/A

• ID Badges are present on each staff member? Responsible for correction: Department

  Yes

  No

  N/A

• Is PPE readily available? Responsible for correction: Department

  Yes

  No

  N/A

• Was appropriate hand hygiene practice observed? Responsible for correction: Department

  Yes

  No

  N/A

• OTHER ITEMS AS NEEDED:

• ANY OTHER ITEMS OBSERVED DURING ROUNDS: