Title Page
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Conducted on
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Prepared by
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Location
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Detailed Location
- GPU Common areas
- ***AT Bldg/TX Mall***
- GPU Food Service West Lake / Pod H
- 3N1 APU
- GPU Pod HMH
- HR / IT / Safety Offices / Rehab Offices /
- 1S1 FSU
- GPU Pod B
- Food Service East Lake-both levels
- 1N1 APU
- Security / PERT /Social Work / FSU Psychology Area / Med Staff Office
- GPU Pod D
- 2N1 APU
- FSU/APU/AT Bldg Yard Spaces/Sidewalks
- 2S1 FSU
- Educational Services
- GPU Pod E
- Dental Office 0N3 / Psychology Area
- 2N3 FSU
- GPU Lab
- Medical Records / SB / Accounting-includes patient funds /Admin / CNO /
- Pharmacy
- GPU OT and Rehab Areas
- ETRU
- 3S1 FSU
- 0N3 Offices / Central Supply / Housekeeping / Basement Corridor / QM
- ***1N3***New ward scheduled to open 1 Jul 20
- ***3N3***New ward scheduled to open 1 Jul 20
Medical Equipment (ME) EOC Inspection
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ME 1. Medical equipment is clean and in good repair?
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What is the likelihood to harm a patient / staff / Visitor?
- High: Could directly lead to harm without need for other significant circumstances or failures.--Likely
- Moderate: Could cause harm directly, but more likely to cause harm as a contributing factor in the presence of special circumstances or additional failures.--Possible
- Low: Undermines safety/quality or contributes to an unsafe environment, but very unlikely to directly contribute to harm.--Rare
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Is the problem…
- Widespread: issue is “pervasive at the organization” --Process failure/systemic failure --Majority of patients are/could be impacted
- Pattern: issue has potential to “impact more than a limited number of patients impacted” -- Process variation -- > or = 3 but less than 50% patients impacted
- Limited: issue is a “unique occurrence” -- Outlier -- Not representative of routine/regular practice
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ME 2. Preventive maintenance inspection stickers/tags:▪ Present and legible?▪ Within the required inspection interval?▪ Include date inspected and next inspection due date?
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What is the likelihood to harm a patient / staff / Visitor?
- High: Could directly lead to harm without need for other significant circumstances or failures.--Likely
- Moderate: Could cause harm directly, but more likely to cause harm as a contributing factor in the presence of special circumstances or additional failures.--Possible
- Low: Undermines safety/quality or contributes to an unsafe environment, but very unlikely to directly contribute to harm.--Rare
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Is the problem…
- Widespread: issue is “pervasive at the organization” --Process failure/systemic failure --Majority of patients are/could be impacted
- Pattern: issue has potential to “impact more than a limited number of patients impacted” -- Process variation -- > or = 3 but less than 50% patients impacted
- Limited: issue is a “unique occurrence” -- Outlier -- Not representative of routine/regular practice
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ME 3. Area staff are familiar with medical equipment inspection stickers/tags and can describe how they know if equipment is safe to use?
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What is the likelihood to harm a patient / staff / Visitor?
- High: Could directly lead to harm without need for other significant circumstances or failures.--Likely
- Moderate: Could cause harm directly, but more likely to cause harm as a contributing factor in the presence of special circumstances or additional failures.--Possible
- Low: Undermines safety/quality or contributes to an unsafe environment, but very unlikely to directly contribute to harm.--Rare
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Is the problem…
- Widespread: issue is “pervasive at the organization” --Process failure/systemic failure --Majority of patients are/could be impacted
- Pattern: issue has potential to “impact more than a limited number of patients impacted” -- Process variation -- > or = 3 but less than 50% patients impacted
- Limited: issue is a “unique occurrence” -- Outlier -- Not representative of routine/regular practice
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ME 4. Emergency resuscitation carts (code/crash carts):▪ Secured▪Plugged in to an emergency power source▪ Inspection & test logs documented & maintained current▪ Staff aware of proper inspection and testing procedures▪ Consumables supplies within expiration date ranges
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What is the likelihood to harm a patient / staff / Visitor?
- High: Could directly lead to harm without need for other significant circumstances or failures.--Likely
- Moderate: Could cause harm directly, but more likely to cause harm as a contributing factor in the presence of special circumstances or additional failures.--Possible
- Low: Undermines safety/quality or contributes to an unsafe environment, but very unlikely to directly contribute to harm.--Rare
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Is the problem…
- Widespread: issue is “pervasive at the organization” --Process failure/systemic failure --Majority of patients are/could be impacted
- Pattern: issue has potential to “impact more than a limited number of patients impacted” -- Process variation -- > or = 3 but less than 50% patients impacted
- Limited: issue is a “unique occurrence” -- Outlier -- Not representative of routine/regular practice
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ME 5. Staff can describe the steps to take in the event of medical equipment malfunction or failure?▪ Remove equipment from service ▪ Apply failure tag/label to equipment▪ Notify Supervisor / Central supply▪ Perform emergency clinical interventions as necessary
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What is the likelihood to harm a patient / staff / Visitor?
- High: Could directly lead to harm without need for other significant circumstances or failures.--Likely
- Moderate: Could cause harm directly, but more likely to cause harm as a contributing factor in the presence of special circumstances or additional failures.--Possible
- Low: Undermines safety/quality or contributes to an unsafe environment, but very unlikely to directly contribute to harm.--Rare
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Is the problem…
- Widespread: issue is “pervasive at the organization” --Process failure/systemic failure --Majority of patients are/could be impacted
- Pattern: issue has potential to “impact more than a limited number of patients impacted” -- Process variation -- > or = 3 but less than 50% patients impacted
- Limited: issue is a “unique occurrence” -- Outlier -- Not representative of routine/regular practice
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ME 6. Medical Equipment plugged into a red outlet while not in use? R- series Defib...IV Infusion Pumps...ECG Machines...Suction Machine...Patient Vital Signs machine
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What is the likelihood to harm a patient / staff / Visitor?
- High: Could directly lead to harm without need for other significant circumstances or failures.--Likely
- Moderate: Could cause harm directly, but more likely to cause harm as a contributing factor in the presence of special circumstances or additional failures.--Possible
- Low: Undermines safety/quality or contributes to an unsafe environment, but very unlikely to directly contribute to harm.--Rare
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Is the problem…
- Widespread: issue is “pervasive at the organization” --Process failure/systemic failure --Majority of patients are/could be impacted
- Pattern: issue has potential to “impact more than a limited number of patients impacted” -- Process variation -- > or = 3 but less than 50% patients impacted
- Limited: issue is a “unique occurrence” -- Outlier -- Not representative of routine/regular practice
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ME 7. Clean medical equipment is segregated from dirty and is properly stored according to facility policies and procedures?
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What is the likelihood to harm a patient / staff / Visitor?
- High: Could directly lead to harm without need for other significant circumstances or failures.--Likely
- Moderate: Could cause harm directly, but more likely to cause harm as a contributing factor in the presence of special circumstances or additional failures.--Possible
- Low: Undermines safety/quality or contributes to an unsafe environment, but very unlikely to directly contribute to harm.--Rare
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Is the problem…
- Widespread: issue is “pervasive at the organization” --Process failure/systemic failure --Majority of patients are/could be impacted
- Pattern: issue has potential to “impact more than a limited number of patients impacted” -- Process variation -- > or = 3 but less than 50% patients impacted
- Limited: issue is a “unique occurrence” -- Outlier -- Not representative of routine/regular practice
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ME 8. Do you have any additional comments? If so, please add them here.
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