August 2016 Environment of Care Report

Environment of Care Meeting Summary – August 10, 2016 

Equipment Management:

    • Recall notices have been uploaded to the Public Recall folder and forwarded to department managers.
    • TLC Safety Report-100% Class I and 99.5% Class II preventative maintenance has been completed. There were 0 patient incidents, 2 user errors and 1 misuse.  There were 4 preventative maintenance failures.

General Safety Issues:

    • Employee incidents were reviewed for the 2nd quarter – one needlestick in the ED, no equipment issues.
    • There were 3 inpatient falls with no injuries, 1 ED fall and one in outpatient Imaging.

Performance Improvement Plan:

    • Annual Departmental Safety Review has been distributed to departments..       Hazardous waste & cleaning product inventory of all departments is being included in the Safety review.  Committee will review overall results at the November meeting.
       

Infection Prevention & Control:

    • There were 4 Construction permits were issued in the 2nd quarter – Call Center/Nurses station, re-carpeting project, Sound wall in Social services/ IT Office Plumbing project.
    • Reviewing Biohazard/Sharps container vendor and pricing looking at Stericycle.
    • RFP’s are being sent out for laundry service vendors.
    • The Hand Hygiene policy and procedure is being updated to better define artificial nails and polish in the workplace.
    • Mark presented an update on the use of corrugated boxes and the plan to go cardboard free throughout the facility except in Materials Management as an Infection Control precaution.

Hazardous Materials & Waste:
Nothing to report at this time.

Hazard Surveillance:  
Nothing to report for the 2nd quarter.
Emergency Preparedness:  

    • Emergency Code flip charts have been updated & distributed to all departments – well received by staff.
    • The Run/Hide/Fight video assignment has been completed by all departments.
    • Discussion on Active Shooter exercise/Drill. The Emergency Preparedness committee will be putting together a plan for all facilities.
    • 3M PAPR suits are being relocated due to the current ambulance garage being torn down during the expansion.
    • The 2016 Hazard Vulnerability Analysis was reviewed by the EOC Committee for each facility. Environment of Care members were all in agreement with the results.  Results will be documented in the Emergency Operations Plan.
    • The six Environment of Management plans have been reviewed by the EOC committee. They will be presented to the FLHS Board at the August Board Meeting for approval along with a summary of updates and changes to the plans.

Security:

    • Violence Prevention Committee update-Panic button solution has been deployed at both Pine City Clinic 7/21/16 & Hinckley Clinic 8/8/16. Training was conducted with the Pine County Sheriff’s Office and staff.
       

Education:    

    • 2016 OLE online training update
  • Violence Prevention – approximately 20 staff still need education
  • Safety Storm Alpha:  64% completed
  • Safety Storm Beta:  61% completed
  • Safety Storm Gamma:  63% completed
  • Legal Compliance:  75% completed
  • HIPAA:  72% completed
    • ICRA (Infection Control Risk Assessment) Training conducted on 6/24/16.

Fire Safety

    • All Fire Drills have been completed for the 2nd quarter.

Utility Management:

    • Relocation of the electrical power feeds & fiber optic lines are underway for the expansion project. There will be a scheduled 3-6 hours Hospital only power outage – with generator use in the fall when the chiller is not in use.
       

Other:

    • Discussion on internal Temp Track testing “after hours”. Mark will set up a meeting to develop an response action plan.  He will report back at the November meeting.
    • Discussion was held on weight limits on boxes being transferred to other satellite clinics.