Spectrum Health BR/RC Safety Engagement Rounds

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General safety

• Staff knowledgeable about Bee Ready Survey Guide

  Yes

  No

  N/A

• Staff knowledgeable about NOSG's

  Yes

  No

  N/A

• United staff observed Washing In/Out

  Yes

  No

  N/A

• Staff observed not blocking fire extinguishers

  Yes

  No

  N/A

• MD, nursing, ancillary staff maintains confidentiality of patient information

  Yes

  No

  N/A

• ES staff knowledgeable about chemical safety

  Yes

  No

  N/A

• ES knowledgeable about their role in infection control

  Yes

  No

  N/A

National Patient Safety Goals

• Can you list the 2 patient identifiers used at SH

  Yes

  No

  N/A

• Can you explain how correct patient gets blood

  Yes

  No

  N/A

• Within what timeframe are critical test results communicated

  Yes

  No

  N/A

• Can you explain how medications in syringes/basins/cups are labeled

  Yes

  No

  N/A

• Can you explain how anticoagulant administration is kept safe

  Yes

  No

  N/A

• Can you explain when & how med reconciliation is completed

  Yes

  No

  N/A

• Can you explain how to keep patients fire from infection prior to giving care

  Yes

  No

  N/A

• Can you explain SH guidelines for preventing resistive organism infections

  Yes

  No

  N/A

• Can you e plain SH guidelines for preventing central line infections

  Yes

  No

  N/A

• Can you explain SH guidelines on preventing post operative surgical infections

  Yes

  No

  N/A

• Can you explain SH guidelines for preventing UTI's from catheters

  Yes

  No

  N/A

• Can you explain how the correct surgery on the correct patient is confirmed

  Yes

  No

  N/A

• Can you explain how the correct place on the patients body is marked for surgery

  Yes

  No

  N/A

• Can you explain how surgery is confirmed to prevent mistakes prior to the surgery

  Yes

  No

  N/A

Life Safety

• Can you explain your role if a disaster causes an influx of patients

  Yes

  No

  N/A

• Can you explain how to report a safety related issue

  Yes

  No

  N/A

• Can you explain your role in a fire event

  Yes

  No

  N/A

• Can you tell me where the fire extinguisher is

  Yes

  No

  N/A

• Can you explAin PASSAGE fire extinguishing technique

  Yes

  No

  N/A

• Can you explain the SAVE acronym

  Yes

  No

  N/A

• Can you explain to me where the fire alarm pull stations are

  Yes

  No

  N/A

• Can you explain your role when a disaster is paged

  Yes

  No

  N/A

• Can you explain how/where to find the SDS information

  Yes

  No

  N/A

• Can you explain the policy on coming to work sick

  Yes

  No

  N/A

• Can you explain how to take care of malfunctioning equipment

  Yes

  No

  N/A

• Can you tell me who can shut off O2 valves in an emergency

  Yes

  No

  N/A

Additional Comments

• Additional Comments

• Surveyor's Signature

  Sign