Joint Commission Mock Survey Tool

Information

ENVIRONMENT OF CARE

No items stored under sinks?
Equipment / Furniture: * No broken equipment or furniture stored on the patient care units. * Coverings are intact - no rips or repairs needed.
Potential safety hazards: Housekeeping & Maintenance carts & buckets are attended and locked. All fluids are labeled.
Laundry and trash chute accesses are locked.
Hazardous rooms are locked: EVS closets, supply closets, mechanical rooms and electrical panels.
Hazardous chemicals and flammable agents are labeled and stored properly.
Eyewash stations: Inspection tags are present and up to date.
Refrigerators: Contain only those items designed for that refrigerator (specimen, medications or patient food)
Refrigerators: If manually monitored, logs are complete. Both manual and temp track-documentation is present for actions taken to correct out of range temps.
Blanket, item warmers: Set to maintain temp of 130. Necessary logs completed including actions taken to out of range temperature readings.
Electrical safety: Use of hospital grade power strips, plugs & receptacles in good condition.
No outer shipping carton boxes in patient care areas.
No expired items.
Preventative Maintenance: * Equipment checked with up to date bio-med sticker.
Central Alarm Monitor: * Logs accurate and complete.

Confidential Patient Information: Cannot be overheard or seen by unauthorized persons: * Computer terminals signed off when not in use. * Patient information is not discussed in public areas. * Labels and PHI are obliterated before discarding in the trash.
No clipboards displayed as sign-in sheets when multiple patient names on the list.
If fax machine is in public area, patient information is quickly removed.

Appropriate storage of boxes and pt care items: * Not directly on floor. * 18" clearance from sprinkler head. * Boxes stored on shelves close to floor must have solid bottom and high enough to not incur water damage from mopping. * Volume of combustible material is not stored in large quantity as to create a fire hazard.
Oxygen or other combustible compressed gas cylinders are stored properly: * Secured in floor stand, carrier or secured to the wall by a mount. (not laying on the floor or against wall) * Limited to 12 E-cylinders per smoke compartment. * Greater than 12 stored in a secured room.
Fire exits and hallways are cleared: * Egress corridors must have 8ft clearance. * Equipment in corridors must be actively accessed to be in use.
Fire alarm pull stations, fire extinguishers, medical gas shutoff valves are not blocked.
Fire extinguishers have been inspected monthly.
Maximum of 2-32 gallon trash cans in a 10x10 room. (unless fire rated)
Fire doors are not blocked or propped and when closed there is positive latching.
Exit signs are illuminated.
Evacuation route posted & current.
Everyone has ID badges and worn appropriately: * Staff and Visitors
Ceiling tiles are in place, no cracks, holes, misaligned or visible stains.
Floors, ceilings, walls, and other surfaces intact and free from holes.
Nurse call lights working.

Are there any alarms sounding that staff is not attending to in a timely manner.

Food and drink in designated areas: * No evidence of it in patient rooms/area, perches, hazardous chemical storage area, laboratory specimen area.
Hand Hygiene Products: * No empty alcohol gel bottles * No empty soap or paper towels * No unapproved lotions
PPE: * Readily available * Clearly marked * Worn correctly
Patient food & drinks: No expired items.
Biohazard Waste: * Discard in Red Bags with a biohazard symbol * Not overfilled * Covered when transported
Soiled Linen: Properly stored and not overfilled.
Separation of clean vs. dirty supplies & equipment: * Clearly marked * Clean items if stored in soiled utility are covered & clearly marked
Patient care supplies: * Not expired, damaged, soiled.
Linen and Linen Carts: Covered and carts have solid bottoms.
Sharps Waste: * Placed in puncture resistant sharps container. * Disposed of when 3/4 full or "full" indicator * Mounted appropriately
General Cleanliness: * Observe surfaces for high dust & residue, floors, stairwells, nutritional area, med prep areas, pt rooms & bathrooms * No blood or bodily fluids
Air vents: Clean
All items in PT care area that are not disposable are able to be wiped down.
Curtains, drapes or blinds clean.
Negative and Positive air flow rooms function appropriately.
Ice machines clean.
Water fountains clean and functioning.

Medication rooms are clean and uncluttered.
Laminar flow hood is used for IV admixture when appropriate.
Visual inspection of medication containers: No Issues.
Area free of distractions.
Medication is appropriately labeled. * Expiration dates, directions, etc..
All medications, needles and syringes are secured in locked cabinet or locked room or under constant surveillance.
Controlled substances stored to prevent diversion.
Medications stored appropriately to maintain stability.
Medications, formula, & solutions not expired beyond expiration date.
Opened multi-dose vials dated and initialed. Not expired.
Code Carts: * Locked and marked with then first drug to expire. * Checked per policy. * Include defibrillator check. * Extra locks kept secured. * All supplies & drugs that are on the inventory list are on the cart. *. Cart is clean. *. O2 tank is >1/2 full
Syringes are labeled when in use.
Medication refrigerator: Only contain medications for current patients.
Patient Bedside: *. IV tubing is labeled per policy. *. Medication is secured and labeled. *. All solutions are labeled at the bedside.
Medication Carts: Doors and drawers are locked.