IHE Clinical Environment Of Care Rounds

• Document No.

• This is your Clinical EOC Report. Please respond within 15 days with corrections. Thank you: Scott S. Tulane 405-657-3131

• Department Surveyed:

• Conducted on

  Date

• Prepared by:

• INTEGRIS Health Edmond 4801 Integris Parkway Edmond, Oklahoma 73034
  Address

• Personnel: Troy Branstetter, Scott S. Tulane, Patti Newberry

GENERAL SAFETY

• Hallways and stairs are free of obstructions?

  Compliant

  Non-Compliant

  N/A

• Elevator doors open / close properly

  Compliant

  Non-Compliant

  N/A

• Walls and ceilings are free of major damage and stains?

  Compliant

  Non-Compliant

  N/A

• Floors have no damaged carpet or tile, slippery spots, or tripping hazards

  Compliant

  Non-Compliant

  N/A

• Ventilation grills are clean and unobstructed?

  Compliant

  Non-Compliant

  N/A

• Handrails are present and secure in patient rooms, bathrooms, and stairwells

  Compliant

  Non-Compliant

  N/A

• Comments:

FIRE SAFETY

• All fire extinguishers have been inspected monthly

  Compliant

  Non-Compliant

  N/A

• Fire extinguishers / pull stations are easily accessible?

  Compliant

  Non-Compliant

  N/A

• Are EXIT signs illumination working and unobstructed?

  Compliant

  Non-Compliant

  N/A

• Self-closing doors are not obstructed or held open with wedges, chairs, etc.?

  Compliant

  Non-Compliant

  N/A

• When fire doors are allowed to close, they close all the way and latch shut?

  Compliant

  Non-Compliant

  N/A

• Comments:

GAS / ELECTRICAL SAFETY

• Only hospital approved extension cords are in use and are not trip hazards or untidy?

  Compliant

  Non-Compliant

  N/A

• The outside of equipment and power cords and plugs have no visible damage?

  Compliant

  Non-Compliant

  N/A

• Utility panels are free from obstructions?

  Compliant

  Non-Compliant

  N/A

• Electrical outlets are free from damage

  Compliant

  Non-Compliant

  N/A

• Medical equipment is properly tagged , PM's have been conducted within the last 12 months?

  Compliant

  Non-Compliant

  N/A

• Gas valves and panels are properly labeled and functioning?

  Compliant

  Non-Compliant

  N/A

• Comments:

STORAGE

• Equipment is stored and stacked properly with 18 inches of clearance below the sprinkler heads?

  Compliant

  Non-Compliant

  N/A

• Boxes or supplies are kept at least 6 inches off of the floor?

  Compliant

  Non-Compliant

  N/A

• Gas cylinders are secured in carts, stands, or chained to the wall

  Compliant

  Non-Compliant

  N/A

• Comments:

SECURITY

• Electrical closets and hazardous areas are kept locked?

  Compliant

  Non-Compliant

  N/A

• Personal items (purses, wallets, keys, etc.) are stored out of sight?

  Compliant

  Non-Compliant

  N/A

• Doors with extra security devices, such as card readers and key pads, are always allowed to close and lock?

  Compliant

  Non-Compliant

  N/A

• Employees are wearing photo ID's (face forward)?

  Compliant

  Non-Compliant

  N/A

• Comments:

INFECTION CONTROL

• Isolation rooms are properly labeled, functioning, and supplies are readily available outside the door?

  Compliant

  Non-Compliant

  N/A

• Department is clean and dust free?

  Compliant

  Non-Compliant

  N/A

• Are needle / sharp containers less than 2/3rd full and secured to the wall, cabinet, or cart?

  Compliant

  Non-Compliant

  N/A

• Waste containers are available to separate general waste from infectious waste?

  Compliant

  Non-Compliant

  N/A

• Evidence of hand hygiene in ( ) # of employees out of ( ) # observed?

  Compliant

  Non-Compliant

  N/A

• Refrigerator clean and all contents within manufactures expiration date?

  Compliant

  Non-Compliant

  N/A

• Microwave oven is clean

  Compliant

  Non-Compliant

  N/A

• Personal Protective Equipment is readily available where appropriate?

  Compliant

  Non-Compliant

  N/A

• No evidence of storage under the sinks

  Compliant

  Non-Compliant

  N/A

• Comments:

COMMENTS

• Comments:

PHOTOS

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  Media

SIGNATURE

• Signature:

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