1. RHQN Members Conference Call September, 2012 Semi-Annual DOH Survey Update The Environment of Care Randy Benson Executive Director Rural Healthcare Quality Network

2. Semi-Annual DOH Survey Update The Environment of Care ELECTRICAL WIRING AND EQUIPMENT CORRIDOR DOORS FIRE SPRINKLER TESTING AND MAINTENANCE FIRE EXTINGUISHERS HAZARDOUS AREAS TYPES OF CONSTRUCTION SPACE HEATERS SOILED LINEN AND TRASH RECEPTACLES HANDLING/DISPOSAL OF CARCINOGENS MANAGEMENT OF HUMAN RESOURCES

3. Semi-Annual DOH Survey Update The Environment of Care ELECTRICAL WIRING AND EQUIPMENT ◦ Misuse of extension cords, i.e., using extension cords in place of permanent wiring ◦ Daisy chains or piggy-backed power cords ◦ Obstructed electrical panels ◦ Mislabeled or un-labeled electrical circuit boxes ◦ Outlets that were not Ground Fault Circuit Interrupter (GFCI) approved ◦ Portable space heaters ◦ Open junction boxes

4. Semi-Annual DOH Survey Update The Environment of Care CORRIDOR DOORS ◦ Doors that did not close and/or latch ◦ Doors purposely blocked from closing with wedges and/or doorstops ◦ Penetrations in the door compromising the smoke resistance of the door

5. Semi-Annual DOH Survey Update The Environment of Care FIRE SPRINKLER TESTING AND MAINTENANCE ◦ Overdue tests/inspections ◦ Missing escutcheon plates/escutcheon rings ◦ Painted sprinkler heads ◦ Obstructed sprinkler heads ◦ Areas with no sprinkler protection ◦ Damaged or otherwise compromised sprinkler heads

6. Semi-Annual DOH Survey Update The Environment of Care FIRE EXTINGUISHERS ◦ Failed to assure fire extinguishers are properly maintained. This potentially delays a quick response to contain a fire from spreading, exposing residents to fire in the environment ◦ No documentation of the portable fire extinguishers being inspected monthly for the past 12 months

7. Semi-Annual DOH Survey Update The Environment of Care HAZARDOUS AREAS ◦ Lacking one-hour fire-rated construction ◦ Improper fire rating on doors ◦ When sprinklered, must have smoke resistive partitions and doors ◦ Doors must be self-closing ◦ Plates on doors shall be nonrated or field applied protective plates that do not exceed 48 inches from the bottom of the door

8. Semi-Annual DOH Survey Update The Environment of Care TYPES OF CONSTRUCTION ◦ Construction does not meet the requirements of the 2000 Life Safety code or the standards adopted with the 2000 Life Safety Code. This is especially common if exceptions were made during the plan review process and the facility does not have the approved plans and documents at the facility.

9. Semi-Annual DOH Survey Update The Environment of Care SPACE HEATERS ◦ Space heaters are prohibited  Portable space heating devices shall be prohibited in all health care occupancies except it shall to be used in non-sleeping staff and employee areas where the heating elements of such devices do not exceed 212°F. 18.7.8, 19.7.8

10. Semi-Annual DOH Survey Update The Environment of Care SOILED LINEN AND TRASH RECEPTACLES ◦ Soiled linen or trash collection receptacles are too large  Soiled linen or trash collection receptacles shall not exceed 32 gal (121 L) in capacity. The average density of container capacity in a room or space shall not exceed.5 gal/ft 2 (20.4L/m 2 ). A capacity of 32 gal (121 L) shall not be exceeded within any 64-ft 2 (5.9m 2 ) area. Mobile soiled linen or trash collection receptacles with capacities greater than 32 gal (121 L) shall be located in a room protected as a hazardous area when not attended. 18.7.5.5, 19.7.5.5

11. Semi-Annual DOH Survey Update The Environment of Care CARCINOGEN HANDLING/DISPOSAL ◦ Cold Sterilants (e.g. Metricide, Rapicide, Cidex, Cidex OPA ◦ Failure to Document Competency of Staff (Mixing, Handling, Disposing of Cold Sterilants) ◦ Failure to Document Testing of Solution At Each Use ◦ Solution Testing Strips Out of Date ◦ Failure to Have Scope/Probe Cleaning Area Properly Ventilated ◦ Failure to Properly Neutralize Cold Sterilant Before Disposal

12. Semi-Annual DOH Survey Update The Environment of Care HUMAN RESOURCES MANAGEMENT ◦ Hospitals Must: Assure Qualified Staff Available To Operate Each Department, Including a Process for Competency, Skill Assessment and Development (WAC 246-320-156 (3)  Failure to properly document orientation (including job specific orientation)  Failure to document generic and department specific safety training  Failure to document job specific skills and knowledge.  Failure to proactively assess job skills and knowledge in all departments  Failure to document skills development

13. Semi-Annual DOH Survey Update The Environment of Care QUESTIONS?

14. Semi-Annual DOH Survey Update The Environment of Care Randy Benson Executive Director Rural Healthcare Quality Network randyb@wsha.org 206 577-1821