Environment of Care Rounds Date 2022-05-25 Can staff identify a physical risk? Yes Location/ Hazard Description -- Action/Recommendation- Improvement -- Can staff describe methods to correct/ report the physical risk identified? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can staff demonstrate actions to take in the event of a facility related incident? -- Location/ Hazard Description -- Action/Recommendation- Improvement Page 1 of 47 Environment of Care Rounds -- Does staff know the smoking policy? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are stretchers and wheelchairs in good repair? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is clean linen kept covered and in a separate room from dirty linen? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Page 2 of 47 Environment of Care Rounds Are ceiling tiles free of stains? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are mechanical and electrical rooms clean, neat, and free of storage items (cardboard boxes, etc.)? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are floors clean and suitable for patient care? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Page 3 of 47 Environment of Care Rounds Are cabinets under sinks free of storage? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are walls painted and in good repair? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are soap and hand towel dispensers filled? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are mattresses free of tears? Page 4 of 47 Environment of Care Rounds -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are light fixtures free of insects and dirt? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are rooms being used as intended? (not storage) -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is furniture clean, undamaged, and with no visible hazards? -- Page 5 of 47 Environment of Care Rounds Location/ Hazard Description -- Action/Recommendation- Improvement -- Are bathroom grab bars in good repair and call pendants hanging unobstructed to within 4 inches but off of the floor? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are floor coverings clean and without trip hazards? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are exterior walkways/parking areas free of trip hazards? -- Page 6 of 47 Environment of Care Rounds Location/ Hazard Description -- Action/Recommendation- Improvement -- Is there sufficient ADA parking with unobstructed access? No Location/ Hazard Description -- Action/Recommendation- Improvement -- Are traffic views are unobstructed? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Does evidence show that the smoking policy being adhered to? -- Location/ Hazard Description Page 7 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Are supplies within expiration dates? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are cardboard boxes being stored off of the floor? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is there no visible trash or garbage around the exterior? -- Location/ Hazard Description -- Page 8 of 47 Environment of Care Rounds Action/Recommendation- Improvement -- Are temp logs (Nutrition and Meds) in place and documented correctly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are medication carts/refrigerators properly locked? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Garbage contained in bags, not overfilled? -- Location/ Hazard Description -- Action/Recommendation- Improvement Page 9 of 47 Environment of Care Rounds -- Soiled linens contained in bags, not overfilled? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are free-standing shelves secured to wall to prevent toppling in event of earthquake? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are drawers/ cupboards closed to prevent injury? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Page 10 of 47 Environment of Care Rounds Do (2) employees know how to report a safety incident? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are employees properly identified? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are reps and LIP�s properly identified? -- All entrances can be secured and locked? -- Location/ Hazard Description -- Action/Recommendation- Improvement Page 11 of 47 Environment of Care Rounds -- Is there is adequate exterior lighting at night? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are protective measures in place for security-sensitive areas such as IT and Med rooms? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are roof accesses locked? Yes Page 12 of 47 Environment of Care Rounds Location/ Hazard Description -- Action/Recommendation- Improvement -- Are employee and patient valuables visibly secure? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is all Patient Health Information (PHI) hidden from view? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees explain the procedure to get help in the event of a security emergency? -- Page 13 of 47 Environment of Care Rounds Location/ Hazard Description -- Action/Recommendation- Improvement -- Is the facility panic button operational? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is appropriate PPE available for employees? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is PPE being worn appropriately? -- Location/ Hazard Description Page 14 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Can employees (2) demonstrate knowledge of correct sequence for donning and doffing PPE? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are hazardous chemicals properly stored? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are spill kit(s) available for hazardous chemicals on hand? -- Location/ Hazard Description Page 15 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Is the SDS binder updated and readily accessible for employees? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of both locations of SDS/MSDS sheets? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of location first aid procedures for a chemical on an SDS/MSDS sheet? (section 4) -- Location/ Hazard Description Page 16 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of location PPE required for a chemical on an SDS/MSDS sheet? (section 8) -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of proper storage of a chemical on an SDS/ MSDS sheet? (section 7) -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of emergency procedures for accidental release of a chemical on an SDS/MSDS sheet? (section 6) -- Page 17 of 47 Environment of Care Rounds Location/ Hazard Description -- Action/Recommendation- Improvement -- Are hazardous materials being stored correctly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees locate nearest eyewash station? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of eyewash station use? -- Location/ Hazard Description Page 18 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Are eyewash stations being tested weekly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of spill kit location? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are spill kits properly located with signage? -- Location/ Hazard Description -- Page 19 of 47 Environment of Care Rounds Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of use of the spill kit? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are sharps containers readily available and less than � full? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are sharps containers secured? -- Location/ Hazard Description -- Action/Recommendation- Improvement Page 20 of 47 Environment of Care Rounds -- Is normal and biohazardous waste segregated correctly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is hazardous waste properly and securely stored? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are radiation protective aprons and collars hung correctly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Page 21 of 47 Environment of Care Rounds Are radiation protective aprons and collars in good repair? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are cleaning chemicals labeled correctly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Do (2) employees know their role in a disaster? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Evacuation routes are posted and oriented correctly? Page 22 of 47 Environment of Care Rounds -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of primary rally point? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge pf location and reason for using secondary rally point? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate location of fire wall/doors? Page 23 of 47 Environment of Care Rounds -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees explain how to conduct a horizontal evacuation? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees demonstrate knowledge of evacuation point? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Clearly and correctly marked? -- Page 24 of 47 Environment of Care Rounds Unlocked from inside? -- Clear of debris and equipment? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Fire Extinguisher inspections current? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is extinguisher accessible (not blocked)? -- Location/ Hazard Description -- Action/Recommendation- Improvement Page 25 of 47 Environment of Care Rounds -- Are floors and walls free from holes? Clean and dry? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are fire doors undamaged? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Do all fire doors operate as required? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Page 26 of 47 Environment of Care Rounds Are fire doors propped open? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are combustible materials stored properly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Do (2) employees know location of nearest fire alarm pull station? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Spot check smoke/ fire barrier. Are there penetrations? Page 27 of 47 Environment of Care Rounds -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Does staff know fire plan? RACER -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Do (2) employees know location of nearest fire extinguisher? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can staff demonstrate the use of a fire extinguisher? PASS -- Page 28 of 47 Environment of Care Rounds Location/ Hazard Description -- Action/Recommendation- Improvement -- Spot check (3) pieces of equipment for ID tags and current PM label? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is all defective equipment labeled as such? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Does equipment appear to be clean and stored correctly? -- Location/ Hazard Description Page 29 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Are crash cart logs documented correctly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are medical equipment consumables within expiration dates (defibrillator pads, AED batteries, etc.)? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees explain emergency procedures for life support equipment failures? -- Location/ Hazard Description Page 30 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Are all equipment cords 3 pronged and not frayed? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Can (2) employees can locate and explain MIFU for one piece of equipment? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are electrical panels are locked (public area) and not being blocked (all areas)? -- Location/ Hazard Description -- Page 31 of 47 Environment of Care Rounds Action/Recommendation- Improvement -- Are electrical rooms locked to prevent public access? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are electrical panels unblocked? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are med gas shutoff valves unblocked? -- Location/ Hazard Description -- Action/Recommendation- Improvement Page 32 of 47 Environment of Care Rounds -- Do (2) employees know where the med gas shutoff valves are and who is authorized to shut off medical gas valves? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Humidity/ temperature logs are being correctly documented? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are there less than 12 e-cylinders (300 cu/ft. oxygen) stored in a smoke compartment? -- Location/ Hazard Description -- Action/Recommendation- Improvement Page 33 of 47 Environment of Care Rounds -- Are empty and full cylinders segregated and properly labeled as such? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are cylinders individually secured by chain or stands? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Do emergency receptacles/covers have distinctive markings or color, i.e red? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Page 34 of 47 Environment of Care Rounds Are electrical panel schedules accurate and legible? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are power strips compliant (green dot)? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Do all rooms have tamper resistant receptacles? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is all recent 'above ceiling' work free of unsealed penetrations? Page 35 of 47 Environment of Care Rounds -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are items stored 18 inches away from sprinkler heads? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are exit signs illuminated? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are fire extinguishers are checked monthly and not blocked? -- Page 36 of 47 Environment of Care Rounds Location/ Hazard Description -- Action/Recommendation- Improvement -- Are corridors, exits, and doors free from obstruction? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are all combustibles (trash, linen, etc.) stores in a 1 hour rated room? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are all doors free from being propped, wedged, or blocked open? -- Location/ Hazard Description Page 37 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Are alcohol based hand rub (ABHR) installed correctly (1 inch from electrical, with drip tray, and less than 10 gallons in the center)? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are exit stairwells free of obstructions and unsealed penetrations? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are doors in good repair, close, latch properly? -- Location/ Hazard Description Page 38 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Do sprinkler heads have escutcheons and are free of lint build up? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Do privacy curtains have at least 18 inches of mesh at the top? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are all areas free of portable space heaters? -- Location/ Hazard Description -- Page 39 of 47 Environment of Care Rounds Action/Recommendation- Improvement -- Do (2) employees know what to do in case of a fire? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Daily logs completed for temperatures -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Only medication stored in medication refrigerator -- Location/ Hazard Description -- Action/Recommendation- Improvement Page 40 of 47 Environment of Care Rounds -- No outdated IV solutions or medications -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Open vials dated and timed as per policy -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Medication carts clean and organized -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Page 41 of 47 Environment of Care Rounds Are look alike/sound alike medications properly identified? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are high alert medications properly identified? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are appropriate solutions available for soaking? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are appropriate containers available? Page 42 of 47 Environment of Care Rounds -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are containers clean, covered, labeled as required? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are Instruments/devices being processed correctly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Is QA program for glutaraldehyde being followed? -- Page 43 of 47 Environment of Care Rounds Location/ Hazard Description -- Action/Recommendation- Improvement -- Are sterilizers clean? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are sterilizers functioning properly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are sterilizer preventive maintenance records available? -- Location/ Hazard Description Page 44 of 47 Environment of Care Rounds -- Action/Recommendation- Improvement -- Are sterilization parameters maintained? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are chemical/Biological monitors used as per policy? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are sterilization records/documentation complete? -- Location/ Hazard Description -- Page 45 of 47 Environment of Care Rounds Action/Recommendation- Improvement -- Are safety needle devices available, used by staff, and disposed of properly? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are Standard precautions followed by staff? (Observed and knowledge indicated when asked) -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Do (2) employees know procedures for needlestick? -- Location/ Hazard Description -- Page 46 of 47 Environment of Care Rounds Action/Recommendation- Improvement -- Rooms maintain positive/ negative pressure? (indicate which) -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Are rooms cleaned appropriately after use? -- Location/ Hazard Description -- Action/Recommendation- Improvement -- Comments -- Page 47 of 47
