Environment Of Care Rounding (clinics)

Audit Form

Environment Of Care Rounding (clinics)

Environment of Care rounding is an interdisciplinary team approach (facilities, IP, Quality, Compliance) to keeping the environment we work in safe and efficient. It is completed to ensure compliance with Joint Commission standards (LS03.03.01 EP1-8, EC 02.05.05 EP3, IC 02.02.01EP3, etc), NFPA codes, Life Safety Codes, and OSHA standards and regulations.

Required

Observed Date

Surveyed Site

Fire Safety

Are exit doors and stairwells clear?

Are exit paths outside the building free and clear from clutter/obstructions?

Are exit doors clearly marked EXIT and illuminated?

Do fire doors latch properly?

Are corridors and passageways free of obstruction?

Are pull stations and fire extinguishers unobstructed?

Are fire extinguisher monthly inspections up-to-date?

Are alcohol-based hand rubs stored and handled in accordance with NFPA standards?

Are fire doors not propped/held open and free from items that will keep them from closing freely?

Are hazardous room doors storage rooms, soiled utility rooms not propped/held open and free from items that will keep them from closing freely?

Hazardous room sprinkler heads are not missing escutcheons or have gaps around escutcheons?

Corridor sprinkler heads are not missing escutcheons or have gaps around escutcheons?

Other areas patient rooms sprinkler heads are not missing escutcheons or have gaps around escutcheons?Checklist Field

Sprinkler heads are free from corrosion, paint, dust, grease and foreign objects?

Is there 18 inches or more of open space maintained below the sprinkler deflector to the top of storage?

Safety Management

Are hand rails solidly mounted ,not loose?

Is location free from trip hazards?

Are walls free from paint or repair needs?

Are cables or wires not exposed?

Are ceiling tiles clean, stain free, and in good condition?

Are compressed gas cylinders stored and secured properly?

Are oxygen cylinders stored correctly?

Are the total number of oxygen tanks within the allowable limits?

Utilities

Are items stored at least 36" from electrical panels?

Are electric panels properly secured or locked?

Are electric panel switch labels accurate and are all spares in the off position?

Are all mechanical and electrical rooms clean and have no storage?

Do sterile storage, medication rooms, and other clean/sterile areas have positive air pressure to the corridor/adjacent areas?

Do soiled utility, trash, hazardous waste, and other dirty rooms have negative air pressure to the corridor/adjacent areas?

Infection Control

All clean supplies stored off of the floor?

Are supplies within expiration dates ,Random checks?

Is clean linen covered?

Is clean linen kept separate from the dirty linen disposal?

Are medication refrigerator logs maintained and up-to-date and Are temperatures within range?

Are medicines and food stored in separate refrigerators?

Ice machines are clean

The only items stored under sinks are items allowed by policy?

Return and supply air diffusers are free from dust

Countertops in good repair with no chips or missing laminate

Furniture is in good repair and not dirty or soiled

Clean utility rooms contain only clean/sterile items

Soiled utility rooms contain contaminated/soiled items only

Hazardous Materials and Waste

Is medical waste kept in red biohazard bags or containers?

Are sharps containers securely mounted and not overfilled?

Are secondary chemical containers properly labeled with product name, hazard warnings, and manufacturer?

Are spill kits in place where needed?

Are chemicals stored separately from patient contact or other clean items?

Is personal protective equipment available at chemical mixing stations?

Are eyewash stations and showers inspections documented weekly, or in accordance with policy?

Are eyewash stations properly plumbed and temperature controlled?

Are signs available indicating location of eyewash stations?

Is the written Hazardous Chemical Inventory complete, up-to-date, and readily available?

Are Safety Data Sheets (SDS) readily accessible to staff?

Security

Are personal items of staff and medical staff properly secured?

Are all employees wearing their ID badges in plain view?

Confidential patient information is secure and HIPAA practices are followed

Are all sensitive areas properly secured, mechanical and electrical rooms locked

Medical Equipment

Does equipment not have any exposed wires?

Are all high-risk medical equipment inspection tags current AED?

Are all non-high-risk medical equipment inspection tags current?

Is defective equipment tagged and removed from service?

Does the equipment's cleanliness, paint, wiring, and covers appear satisfactory?

Staff Knowledge

Can staff locate the Emergency Operations Plan either on-line or hard copy

Staff can explain job role/tasks for external emergencies

Staff can explain evacuation procedure

Who is the Safety Officer?

Where is the nearest fire extinguisher?

What is the procedure for using a fire extinguisher?

Where is the nearest fire pull station?

Staff know how to report defective medical equipment

Staff know how to report defective non-medical equipment

Staff know how to report overfull sharps containers

Staff know how to access policies and procedures

Staff know how to access SDS and understand how to use them

Staff know how to report a chemical spill

Staff know how to report a security emergency

Staff know how to report a safety concern

Required License Displayed

Is the CLIA license displayed and within expiration date

Are the Dental licenses displayed?

Action Itmes

List Work Orders Created

Do not enter protected health information (PHI)

Additional Information

Do not enter protected health information (PHI)

Environment Of Care Rounding (clinics)

Table of Contents

Audit Form

Environment Of Care Rounding (clinics)

Environment Of Care Rounding (clinics) Checklist