EMCM Tracer Rounds

• Document No.

• Unit / department

• Conducted on

  Date

• Prepared by

• Personnel

Environmental

• There is no equipment / other objects in corridor for more than 30 minutes?

  Yes

  No

  N/A

• All objects that are in the corridor are on the same side?

  Yes

  No

  N/A

• Does the EVS staff know the "kill time" for the solution they are using? (Time surface must remain wet)

  Yes

  No

  N/A

• There were no soiled, wet, or damages surfaces? (Rodents)

  Yes

  No

  N/A

• No staff food in the patient refrigerator?

  Yes

  No

  N/A

• The inside of the refrigerator is clean?

  Yes

  No

  N/A

• Do all patient medication and nutrition refrigerators have 100% completed temperature logs?

  Yes

  No

  N/A

• There are no soiled or wet ceiling tiles?

  Yes

  No

  N/A

• Are all EVS closets neat and "uncluttered" with the door closed?<br>

  Yes

  No

  N/A

• Are Utility room doors closed?

  Yes

  No

  N/A

• Is the floor free of door wedges?<br>

  Yes

  No

  N/A

• Do all fire extinguishers have monthly checks?

  Yes

  No

  N/A

• For all months?<br>

  Yes

  No

  N/A

• Are all linen carts covered?

  Yes

  No

  N/A

• If EVS staff is pouring chemicals, are they wearing eye protection?

  Yes

  No

  N/A

• Comments:

Performance

• Staff that are observed. Did they wash in / wash out?

  Yes

  No

  N/A

• Are there any employees with artificial nails or nails longer than 1/4 inch or chipped?

  Yes

  No

  N/A

• Observe that patients are being identified with 2 patient identifiers when a nurse administers a medication.

  Yes

  No

  N/A

• Locate an isolation patient and observe if it is being adhered too by staff, physicians and visitors as available?<br>

  Yes

  No

  N/A

• Did staff know how to test the defibrillator?

  Yes

  No

  N/A

• Are all oxygen tanks in proper holders?

  Yes

  No

  N/A

• Were staff able to explain RACE and PASS?

  Yes

  No

  N/A

• Did the multidose vials have a "do not use beyond (date)"?

  Yes

  No

  N/A

• Were all staff wearing name badges?

  Yes

  No

  N/A

• Did staff identify themselves when they entered a patient room?

  Yes

  No

  N/A

• Comments:

Medical Records Review:

• Are all paper chart documents labeled with appropriate patient information?

  Yes

  No

  N/A

• Is each entry dated, timed, and signed? Including consents.

  Yes

  No

  N/A

• Is the care plan complete and updated?<br>

  Yes

  No

  N/A

• If patient was medicated for pain, is reassessment documented?<br>

  Yes

  No

  N/A

• Did patient receive appropriately ordered medication for the level of pain s/he described (mild, moderate, severe)?

  Yes

  No

  N/A

• If patient is in isolation, is there documentation that the patient/family has been educated?

  Yes

  No

  N/A

• Was a history and physical completed within 24 hours of admission?

  Yes

  No

  N/A

• If it was performed prior to admission and patient had surgery/invasive procedure, is the history and physical updated!

  Yes

  No

  N/A

• If patient is documented to be at risk for fall, see if patient has yellow bracelet and stars at the door?

  Yes

  No

  N/A

• Are home/current medications listed in chart?<br>

  Yes

  No

  N/A

• Are there any "Do not use" abbreviations on handwritten documentation?

  Yes

  No

  N/A

• Comments:

Staff Interviews:

• Was the staff able to explain the hand off process used at EMCM?

  Yes

  No

  N/A

• Was the staff able to describe the process for managing critical values?

  Yes

  No

  N/A

• Was the staff able to describe PI initiatives with which their unit has been involved?

  Yes

  No

  N/A

• Enter a description:

• Does the staff know what a CODE RED is and what their role is?

  Yes

  No

  N/A

• Does the staff know what a CODE PINK is and what their role during the code?

  Yes

  No

  N/A

• Does the staff know where the nearest fire extinguisher is?

  Yes

  No

  N/A

• Pull station?

  Yes

  No

  N/A

• Does the staff know what the MSDS is?

  Yes

  No

  N/A

• How to locate and access the MSDS information?

  Yes

  No

  N/A

• Comments:

  Yes

  No

  N/A

Staff Narrative:

• What was working well today?

• Are there any specific areas that need attention and why?

• Are there any areas that should be recognized and what makes them notable?

• Did you receive any negative feedback from patients, visitors, employees or physicians? If so, how do you plan to address and resolve the issues?

• Is there anything we can do better?

Quarterly Focus

• Was a specific task being performed? ( I.e. equipment cleaning, chemical disposal, etc)?

  Yes

  No

  N/A

• Comments:

• Did you identify anything that could affect the patient experience (I.e. wash in / wash out, staff fingernails, wearing. Name badges, clutter in hallways, etc.)?

• Do you have any recommendations to morose the issues you identified?