Information
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Facility Surveillance Report
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Emerus McKinney
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Conducted on
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Dan Baas, RN CEN Nurse Manager
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Craig Ranch
SAFETY
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Are compressed gas cylinders strapped to the wall or otherwise secured in a non-tip base?
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Check "E" cylinders oxygen supply.
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Temperature logs signed off?
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Are electrical panels kept clear within 3 feet in front of breaker panels?
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Fire extinguisher inspection x 5 (documented on tags)
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Are sharps containers disposed of when 3/4 full?
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Eye wash station expiration date checked and verified to be in date?
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Are the hallways free and clear of stored items or obstructions?
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Is the patient nutrition refrigerator clean and defrosted?
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Is the patient microwave clean and in good working order?
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Are there space heaters present?
INFECTION CONTROL
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Every room, closet, and enclosure is inspected.
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Every drain is flushed with running water.
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Clean linen stored off ground.
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Clean linen properly store in clean utility room and covered and unwrapped from plastic.
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Clean linen stored separate from dirty linen.
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Clean "clean linen rack" monthly.
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Soiled linen stored in proper linen bags in soiled utility room.
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Any soiled bags leaking fluid(s).
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High cleaning done. This includes dusting of air conditioning ventilation openings, top of refrigerators, and tall equipment.
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Ceilings clear of staining.
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Hand washing posters posted.
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Report to local health department.
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I'VE fluids stored properly and "in date".
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Are there supplies stored under sinks.
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Other issues identified.
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Weekly cleaning log complete and placed in facility binder.
PHARMACY
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Control medications properly stored and log sheets signed and verified by pharmacist.
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Code cart medications checked for expiration date status and minimum quantity verified.
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All medications checked for expiration date.
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Medication refrigerator log checked and verified contents kept between 2-8 degrees Celsius daily.
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No food stored in medication refrigerator.
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Open multi dose medications correctly marked, dated, and properly stored.
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Only authorized medications and supplies are present.
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Medications are secured to include suture cart locked and not accessible to public.
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Poison control telephone number clearly posted.
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NO concentrated electrolytes are available in unit.
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Topical medications are kept separate from PO and I'VE medications.
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Flammable items stored properly.
LABORATORY
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Controls and supplies are not expired.
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Temperatures documented on LabDaq computer twice daily.
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Levy Jennings controls for CBC reviewed.
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Liquid controls for Piccolo completed.
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NO food or drink in lab area.
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No food or drink in lab refrigerator.
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Wave testing log in order.
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Send out computer logs reviewed.
OTHER
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Chart reviews completed.
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HVAC issues.
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Water supply issues
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Security related issues.
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Safety related issues.
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Sewer related issues.
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Life safety issues.
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Trash/waste/biohazard disposal issues.
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Other related issues.
QUARTERLY (MARCH, JUNE, SEPTEMBER, DECEMBER)
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Fire drill both shifts.
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Clinical alarms checked and documented.
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Hand washing data compiled for Infection Control meeting.
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Needle stick log given to Safety Committee for meeting.
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Medical gas system panels checked and operating.
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Area alarms functioning.
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Automatic pressure switches functioning.
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Shut off valves operational.
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Flexible connectors and valves functioning.
ANNUALLY. (REPORT IN JUNE)
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Local fire department approval of plan.
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Inspection of sprinkler system.
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Inspection of fire extinguishers.
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Inspection of back flow valve.
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Inspection of riser room.
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Policy and procedure review.
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Medical gas inspections.
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Service generator.
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Disaster exercise.
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Fit testing for all staff completed and in HR file at corporate.
ADDITIONAL NOTES OR COMMENTS
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Dan Baas, RN CEN Nurse Manager