Patient Safety Leadership Rounds

• Mock Survey 2

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Documentation

• Is all patient documentation filed according to RFDS procedure ? - (Leader conducting the round is to ask Admin staff)

  Yes

  No

  N/A

• Has all patient care documentation been provided to administration staff for data entry been complete? - (Leader conducting the round is to ask Admin staff)

  Yes

  No

  N/A

• Have all patient identifiers been completed on paperwork?- (Leader conducting the round is to ask Admin staff)

  Yes

  No

  N/A

• Have all CQIs been reviewed? (Leader to ask Nurse Mgr)

  Yes

  No

  N/A

Infection Prevention

• Are all environmental cleaning checklists completed? - (Leader conducting the round is to view)

  Yes

  No

  N/A

• Are sharps containers available for all episodes of care?

  Yes

  No

  N/A

• Are all sharps containers currently in use less than 3/4 full? - (Leader conducting the round is to view)

  Yes

  No

  N/A

• Are all sharps containers out of the reach of children?

  Yes

  No

  N/A

• Is PPE fully restocked and available for patient care episodes? - (Leader is to check)

  Yes

  No

  N/A

• The FIRST Occupational Exposure poster is on display

• Do all staff have an occupational exposure lanyard card?- (Leader conducting the round is to ask staff)

  Yes

  No

  N/A

• If no, one has been provided

Medications

• The medication store room is locked - (Leader conducting the round is to check)

• All expired controlled drugs have been sent for destruction? - (Leader is to check)

  Yes

  No

  N/A

• Have the controlled drug packs been checked and restocked each shift? - (Leader conducting the round is to check)

  Yes

  No

  N/A

• The controlled drug safe is locked - (Leader conducting the round is to check)

Handover

• Do all clinical staff available at the time of this round have an ISBAR lanyard card?- (Leader conducting the round is to ask)

  Yes

  No

  N/A

• If no, one has been provided

• Can clinical staff in the area explain ISBAR to you and how they use it in handover and other clinical situations? - (Leader conducting the round is to ask)

  Yes

  No

  N/A

• If no, they have been provided with a copy of the clinical handover procedure.

Blood Management

• Can staff find the procedure and the informed consent for blood and blood products form? (Leader to ask staff to demonstrate)

  Yes

  No

  N/A

Pressure Injury Prevention

• Do all stretchers have a derma saver cover in place? - (Leader conducting the round is to check)

  Yes

  No

  N/A

• Are the air mattress overlays available and in good working order? - (Leader conducting the round is to ask staff)

  Yes

  No

  N/A

Escalation of care

Falls Prevention

• Can clinical staff in the area clearly articulate the RFDS escalation process? - (Leader conducting the round is to ask staff)

  Yes

  No

  N/A

• If clinical staff have used the escalation pathway, was a clinical incident lodged?

• Are all clinical staff familiar with the RFDS Falls Prevention Procedure? - (Leader conducting the round is to ask staff)

  Yes

  No

  N/A

• Have any staff been tasked to a bariatric patient without a TAS aircraft recently? - (Leader conducting the round is to ask staff)

  Yes

  No

  N/A

• If yes, a clinical incident report has been lodged

Staff concerns regarding patient safety i.e. inadequate, broken, or lack of equipment, failing processes/systems, missing processes/systems? - (Leader conducting the round is to ask staff)

• Staff concerns -

• Add photos of any problems or other concerns

  Media

• Leader Signature

  Sign