ADOPT-A-FLOOR PROGRAM

Instructions

  • Develop a group of managers who will participate in the program.
  • Each manager is assigned a certain area of the facility—but not their own area.
  • Prior to starting, conduct an educational program to educate the Adopt-A-Floor managers about what to look for, how to correct issues, and how to educate other hospital personnel.
  • Start with a check list (see below) of some of the most common items, and make sure the team understands what each item is. Have them ask questions prior to going out in the field for their appointed rounds.
  • Have the teams record their findings on the Adopt-A-Floor Work Order Tool.
  • Have the Adopt-A-Floor managers submit the report below to the proper safety committee.
  • Schedule monthly meetings to go over findings and answer any questions the team may have.
  • Document progress on the Adopt-A-Floor Work Order (W/O) Tool. All work orders are entered into the W/O system by priority, by responsible department to correct, and then closed out. The report documents total W/Os in priority categories, with percentage of completions for each priority, each department or service.
  • By having a program like this in place, you can identify where the problem areas are and focus on a plan of correction for deficient areas or staff. This can be an educational opportunity for deficient areas and staff.

ADOPT-A-FLOOR PROGRAM

Items to Inspect

Defibrillators are checked accordingly to policy

Medication refrigerators are checked

Corridor is free of clutter (nothing stored in corridors other than in-use equipment)

Hazardous waste containers have proper waste in the proper containers (see Safety & I.C. for exact details and comply with signs in soiled utility rooms).

Sharp containers are not overfilled

Lead aprons are inspected and in good shape

No viewable medical records

Patient bed and stretcher mattresses are not torn or soiled

Patient care furniture is not torn or broken

Areas with sprinklers have a clearance under head of a minimum of 18"

Door latches are not taped or stuffed with paper keeping the door from latching

Linen chute doors not taped over the latches, or door being held open from latching

Soiled Utility rooms doors closed and latched. Soiled equipment tagged; No clean equipment stored in soiled utility room

Check medical equipment for expired P.M. stickers or missing P.M. stickers

Check for doors being propped open (by wedges, garbage cans, etc.)

No oversized containers that are not in a protected hazardous area (>32 gallons) this includes garbage cans, soiled linen hampers, construction and demolition debris bins, and recycle containers

Environmental Services closets clean and tidy with Safety Data Sheets (SDS) available

Check all storage rooms for proper storage and that the room is approved for storage

Check for stained ceiling tiles

Check for broken floor tiles

Medication rooms locked

Sharps secured as per policy

No expired supplies in Material Management store rooms; clean utility rooms, sterile supply rooms, and medication rooms.

Monitor hand washing compliance

Windows are closed in special care environments and all Central HVAC locations

Page # ____ of _____

2015 Adopt - A - Floor Program

Surveyor's Report Form

Surveyor: ______Date:______

Telephone #: ______Fax #______

SURVEY LOCATION: Bld: ______Floor: ______Ward/Wing:-______

FINDINGS

Please use one line per item/issue to be reported

LOG # / DATE / ROOM# / ITEM # / DESCRIPTION OF ITEM / ISSUE

SEND COMPLETED REPORT TO: ______

ADOPT A FLOOR SCHEDULED MEETING

2015

The meetings listed below will be held @ ___ In the event of a venue change, you will be advised via email.

So that your reports are recorded promptly, please submit reports on a timely basis. Thank you.