Information

  • Facility Surveillance Report

  • Emerus McKinney

  • Conducted on

  • Dan Baas, RN CEN Nurse Manager

  • Add signature

  • Craig Ranch

SAFETY

  • Are compressed gas cylinders strapped to the wall or otherwise secured in a non-tip base?

  • Check "E" cylinders oxygen supply.

  • Temperature logs signed off?

  • Are electrical panels kept clear within 3 feet in front of breaker panels?

  • Add media

  • Fire extinguisher inspection x 5 (documented on tags)

  • Are sharps containers disposed of when 3/4 full?

  • Eye wash station expiration date checked and verified to be in date?

  • Are the hallways free and clear of stored items or obstructions?

  • Is the patient nutrition refrigerator clean and defrosted?

  • Is the patient microwave clean and in good working order?

  • Are there space heaters present?

INFECTION CONTROL

  • Every room, closet, and enclosure is inspected.

  • Every drain is flushed with running water.

  • Clean linen stored off ground.

  • Clean linen properly store in clean utility room and covered and unwrapped from plastic.

  • Clean linen stored separate from dirty linen.

  • Clean "clean linen rack" monthly.

  • Soiled linen stored in proper linen bags in soiled utility room.

  • Any soiled bags leaking fluid(s).

  • High cleaning done. This includes dusting of air conditioning ventilation openings, top of refrigerators, and tall equipment.

  • Ceilings clear of staining.

  • Hand washing posters posted.

  • Report to local health department.

  • I'VE fluids stored properly and "in date".

  • Are there supplies stored under sinks.

  • Other issues identified.

  • Weekly cleaning log complete and placed in facility binder.

PHARMACY

  • Control medications properly stored and log sheets signed and verified by pharmacist.

  • Code cart medications checked for expiration date status and minimum quantity verified.

  • All medications checked for expiration date.

  • Medication refrigerator log checked and verified contents kept between 2-8 degrees Celsius daily.

  • No food stored in medication refrigerator.

  • Open multi dose medications correctly marked, dated, and properly stored.

  • Only authorized medications and supplies are present.

  • Medications are secured to include suture cart locked and not accessible to public.

  • Poison control telephone number clearly posted.

  • NO concentrated electrolytes are available in unit.

  • Topical medications are kept separate from PO and I'VE medications.

  • Flammable items stored properly.

LABORATORY

  • Controls and supplies are not expired.

  • Temperatures documented on LabDaq computer twice daily.

  • Levy Jennings controls for CBC reviewed.

  • Liquid controls for Piccolo completed.

  • NO food or drink in lab area.

  • No food or drink in lab refrigerator.

  • Wave testing log in order.

  • Send out computer logs reviewed.

OTHER

  • Chart reviews completed.

  • HVAC issues.

  • Water supply issues

  • Security related issues.

  • Safety related issues.

  • Sewer related issues.

  • Life safety issues.

  • Trash/waste/biohazard disposal issues.

  • Other related issues.

QUARTERLY (MARCH, JUNE, SEPTEMBER, DECEMBER)

  • Fire drill both shifts.

  • Clinical alarms checked and documented.

  • Hand washing data compiled for Infection Control meeting.

  • Needle stick log given to Safety Committee for meeting.

  • Medical gas system panels checked and operating.

  • Area alarms functioning.

  • Automatic pressure switches functioning.

  • Shut off valves operational.

  • Flexible connectors and valves functioning.

ANNUALLY. (REPORT IN JUNE)

  • Local fire department approval of plan.

  • Inspection of sprinkler system.

  • Inspection of fire extinguishers.

  • Inspection of back flow valve.

  • Inspection of riser room.

  • Policy and procedure review.

  • Medical gas inspections.

  • Service generator.

  • Disaster exercise.

  • Fit testing for all staff completed and in HR file at corporate.

ADDITIONAL NOTES OR COMMENTS

  • Dan Baas, RN CEN Nurse Manager

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