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This PDF version (March 2015) of the Safety Risk Assessment Toolkit is part of The Center for Health Design open access Tools and Resources and is made available under the following Creative Commons License conditions.

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Cover A Safety Risk Assessment for Healthcare Facility Environments


Safety Risk Assessment (SRA) for healthcare facility environments

DISCLAIMERS: This tool is not intended to be a guarantee of a safe environment; the environment is one part of a safety solution that includes operational policies and procedures and behavior of people. It is intended for use with collaborative input of project and facility-based expertise. This tool is also not a comprehensive list of guideline requirements but provides a high-level overview of certain considerations and their relationship to safety. This toolkit has been created with support from the Agency for Healthcare Research and Quality (AHRQ) Grant R13HS021824 and the Facility Guidelines Institute (FGI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

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Let's Go! This toolkit has been created through a consenus process of experts in the safety risk areas. The Center for Health Design extends its gratitude to all the particpants and volunteers that supported content development and testing. The Center also thanks the three pilot sites who made their project teams available for testing : Barnes-Jewish Hospital, University of California Irvine Medical Center, and Memorial Sloane Kettering Cancer Center.

The Center for Health Design: 1850 Gateway Boulevard, Suite 1083; Concord, California 94520 USA; Phone: 925.521.9404; Fax: 925.521.9405

Copyright 2012-2015 The Center for Health Design. All Rights Reserved. The Excel version of this tool may only be used with an active Affiliate Plus membership with The Center for Health Design. This tool may not be used by, transferred to or copied to any other party. The legend may not be removed from the tool or accompanying materials. The user may not make derivative work, remixes, transform, or build upon or distribute the tool or accompanying materials. The authorized PDF version, accompanied by the Creative Commons License page, is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Volunteers 3 A Safety Risk Assessment for Healthcare Facility Environments


The Core Team1 Anjali Joseph, PhD, EDAC, former Director of Grants and Research Advisory Services, The Center for Health Design; Endowed Chair in Architecture+Health Design and Research, Assoc. Prof. of

Architecture, Clemson University2 Ellen Taylor, AIA, MBA, EDAC, Director of Research, The Center for Health Design

3 Xiaobo Quan, PhD, EDAC, Senior Research Associate, The Center for Health Design

4 Upali Nanda, PhD, Assoc. AIA, EDAC, former Research Consultant, The Center for Health Design; Vice President and Director of Research, HKS Inc. / Executive Director, CADRE

5 Catherine Ancheta, Project Manager, The Center for Health Design

6 Debra Levin, EDAC, President and CEO, The Center for Health Design

The many volunteers that made this toolkit possible include (listed alphabetically):

Advisory Council7 Doug Bonacum MBA, CSP, CPPS, VP, Quality, Safety, and Resource Management, Kaiser Permanente

8 Carol Corr, AIA, EDAC, LEED, Green Associate Design Manager, Facilities Planning and Design, National Facilities Services Kaiser Permanente

9 Terry Fairbanks, MD, MS, Director of the National Center for Human Factors Engineering in Healthcare, and Acting Director of the Simulation & Training Environment Laboratory (SiTEL), MedStar Institute for Innovation (MI2)

10 Ella Franklin, RN, CRC, EDAC, Director, Infection Prevention Research and Innovation, MedStar Institute for Innovation (MI2)

11 Tejas Gandhi, Chief Administrative Officer, The Medical Center of Central Georgia

12 John Kouletsis, AIA, EDAC, Vice President, Facilities Planning & Design, National Facilities Services, Kaiser Permanente

13 Jim Lussier, Founder & President, The Lussier Center

14 Eileen Malone, RN, MSN, MS, EDAC, Senior Partner, Mercury Healthcare Consulting, LLC (also a workgroup leader)

15 Chris McCarthy, MPH, MBA, Director, Innovation Learning Network

16 John Reiling, PhD, MBA, MHA, President & CEO, Safe by Design / Adjunct Professor, University of Minnesota, University of St. Thomas

Workgroup Leaders17 Maggie Calkins PhD, President & Board Chair, IDEAS Institute / Elliot Professor in Health Care Design, Kent State University, College of Architecture and Environmental Design

18 Linda Dickey, RN, MPH, CIC, Director, Epidemiology & Infection Prevention, UC Irvine Health

19 Mary Matz, MSPH, CPE, CSPHP, Consultant, Patient Care Ergonomics, Patient Care Ergonomic Solutions, LLC

20 Kelsey McCoskey, MS OTR/L, CPE, CSPHP, Ergonomist, Occupational Therapist, US Army Public Health Command

21 Mardelle Shepley, FAIA, EDAC, LEED AP, Professor - Design + Environmental Analysis, Cornell University College of Human Ecology

22 Tony York, CPP, CHPA, Chief Operating Officer, HSS

Subject Matter Experts and Pilot Test Participants23 The Barnes-Jewish Hospital team in St. Louis, MO

24 The University of California Irvine Medical Center team in Irvine, CA

25 The Memorial Sloan Kettering Cancer Center team in New York, NY

Home



Home

26 Carmen Adams DNSc, RNC, Strategic Leader, Quality, Kaiser Permanente

27 David Allison FAIA, ACHA, Professor/Director, Graduate Studies in Architecture + Health Clemson University

28 Helen Archer-Duste RN, MS, Executive Director, Workplace Safety and Care Experience Kaiser Permanente

29 Angelene Baldi, AIA, EDAC, LEED GA, Planning Manager for Facilities Planning and Design, Kaiser Permanente

30 Sue Barnes RN, CIC, Infection Prevention and Control Quality and Safety Department, Kaiser Permanente

31 Donna Bohannon R. Ph., CPPS Scientific Liason, U.S. Pharmacopeial Convention

32 Doug Bonacum MBA, CSP, CPPS, VP, Quality, Safety, and Resource Management, Kaiser Permanente

33 Sheila Bosch PhD, LEED AP, EDAC Director of Research, Gresham, Smith & Partners

34 Barbara Braun PhD, Associate Director, Department of Health Services Research, Division of Healthcare Quality Evaluation, The Joint Commission

35 Rosalyn Cama FASID, EDAC President CAMA, Inc.

36 Pascale Carayon, PhD, Procter & Gamble Bascom Professor in Total Quality Department of Industrial and Systems, Engineering, Director of the Center for Quality and Productivity Improvement University of Wisconsin-Madison

37 Satyan Chari, BOT, Grad Cert Occ Thy, M Sc Occ Thy, Program Coordinator - Falls Risk/OHMR, Research Fellow, Royal Brisbane and Women's Hospital,Queensland Health

38 Young-Seon Choi, PhD, March, Assistant Professor Department of Architecture, Kyungil University, South Korea

39 Eileen Costantinou, RN, MSN, BC, Practice Specialist, Senior Coordinator, Barnes-Jewish Hospital

40 Tom Davis, Director of Facilities Management & Security, University of Colorado Hospital

41 Marie DePerio, Medical Officer, CDC/NIOSH

42 Lena Deter, RN, MPH, CSPHP, Clinical Specialist in Patient Safety, DELHEC LLC

43 Anthony Donaldson, CSPHP, National Environmental, Health and Safety Senior Staff Manager, Kaiser Permanente

44 Lori Dowling, President, ECORE Commercial Flooring

45 Jan Ehrenwerth, MD, Professor of Anesthesiology; Director, Vascular Yale University School of Medicine

46 Doug Erickson, FASHE, CHFM, HFDP, CHC, CEO, Facilities Guidelines Institute

47 Bill Felkey, BA, MS, Professor Emeritus, Auburn University

48 John Fishbeck, Associate Project Director, The Joint Commission

49 June Fisher, MD, Director, TDICT Project, Trauma Foundation/NIOSH

50 Guy Fragala, PhD, PE Senior Advisor for Ergonomics, Patient Safety Center of Inquiry

51 Susan Gallagher, RN, Bariatric Expert, Independent Consultant

52 John Grout, PhD, Dean, Campbell School of Business, Berry College

53 Ed Hall, MS, CSP, Chief Operating Officer, The Stanford University Medical Network Risk Authority

54 Kendall Hall, MD, MS, Scientific Director, MedStar SiTEL, MedStar Health

55 D. Kirk Hamilton, FAIA, FACHA, EDAC, Professor of Architecture, Texas A&M University

56 Eve Hanna, MD, MPH, Occupational Health Physician, James A Haley Veteran’s Hospital

57 Daniel Hartley, Ed.D., Epidemiologist, NIOSH Workplace Violence Prevention Coordinator, NIOSH



Home

58 William Heath, RPh, MBA, FAPhA, Col (retired), Consultant to USP, APhA, ASHP, Heath Healthcare Consulting, Inc., U.S. ARMY

59 Dennis Hemphill, CPP, System VP - Safety, Security, Emergency Management, Dignity Health

60 Prof. Sue Hignett, PhD, Professor of Healthcare Ergonomics & Patient Safety, Postgraduate Programme Director for Ergonomics & Human Factors, Chair of Education & Training Panel, Chartered Institute of Ergonomics & Human Factors, Loughborough University

61 Robert Hody Asst. Director, Lean Sigma Deployment Johns Hopkins Medicine

62 Vicky Hogue, RN, MSN, CCRN, EDAC, VP Patient Services/CNO, Wellstar Paulding Hospital

63 Daniel Horan, INCE, LEED AP BD+C, Senior Consultant, Cavanaugh Tocci Associates, Inc.

64 Kimberly Hudson, RN, MSN, Safe Patient Handling Coordinator, Marion VAMC

65 Robert Hunn, MBA, CHFM, CHSP, LEED AP BD&C, EDAC, Director of EH&S, University of Kansas Hospital

66 Jim Hunt, AIA, NCARB, President, Behavioral Health Facility Consulting

67 Tamara James, CPE, Ergonomics Director, Duke University and Health System

68 Mandy Kachur, PE, INCE Board Certified Principal Consultant, Soundscape Engineering LLC

69 Hanneke Knibbe MSc, RPT Owner, LOCOmotion

70 Joe Kucharz, Director, Healthcare Real Estate, Navigant

71 Don MacAlister, CHPA, Vice President, Paladin Security

72 Jennifer MacDaniel, Project Principal, Innovations Group, Kaiser Permanente

73 Kathy Maher, RN, MSN, Manager, Employee Health Services, UW Medicine Harborview Medical Center

74 Jain Malkin, CID, AAHID, EDAC, President, JAIN MALKIN INC.

75 Larry Mallak, PhD, Professor, Western Michigan University

76 Kirsten Martin, RN, MBA, CHE, Consultant, Planning & Development, St. Michael's Hospital

77 Marie Martin, PhD, Industrial Hygienist (SPHM Facility Coordinator), VA North Texas Health Care System

78 Susan McCrone, PhD, RN, Professor and Coordinator. CDC/NIOSH

79 Kate McPhaul, PhD, MPH, RN, Deputy Chief Consultant, Occupational Health (10P3D) Office of Public Health, Veterans Health Administration

80 David Meek, RN, MA, BSN, BEd, CEN, CLNC, CEM Founder, The National Institute for Elopement Prevention & Resolution

81 Bart Miller, CHFM, CHC, CHSP, CHEP, SASHE, Director of Construction/Plant Operations/Bio-Medical Services, St. Mary Medical Center

82 Peter Mills, PhD, MS, Director, VA National Center for Patient Safety Field Office, Veterans Affairs Medical Center / Adjunct Associate Professor of Psychiatry, The Geisel School of Medicine at

83 Richard Moeller, PE, FASHE, HFDP, LEED AP, CHC, Principal, Mazzetti

84 Patricia Morrill, PMP, EDAC, President, PM Healthcare Consulting, LLC

85 Ellen Murphy, MS, JD, FAAN, Professor Emerita, University of Wisconsin

86 Mahiyar Nasarwanji, PhD, Post-doctoral Research Fellow, Armstrong Institute for Patient Safety and Quality

87 Samira Pasha, PhD, EDAC, LEED AP BD+C, Senior Designer, RTKL

88 Erin Peavey, LEED AP BC+D, EDAC, Researcher + Medical Planner, HOK

89 Catherine Porzio, AIA, Associate, HKS Inc.



Home

90 Dana Ragouzeos, Design Research Lead, Innovation Consultancy

91 Marilyn Ridenour, BSN, MBA, MPH, Nurse Epidemiologist, CDC/NIOSH

92 Sheila Ruder, AIA, ACHA, EDAC, LEED AP, Lean Six Sigma CE, Vice President HKS Inc.

93 Abelardo Ruiz, Innovations Group, Kaiser Permanente - Facilities Planning & Design

94 Richard Schleckser, MS, ARM, NEBOSH, CMIOSH, CSPHP, Sr. Service Director, Liberty Mutual Insurance

95 Jonas Shultz, MSc, Human Factors Lead, Health Quality Council of Alberta

96 David Sine, CSP, ARM, Chief Risk Officer, Department of Veterans Affairs

97 Brian Smith, Six Sigma Black Belt, Healthcare Consultant

98 Ron Smith, AIA, ACHA, ACHE, EDAC, President & CEO, Design At The Intersection, LLC

99 Tom Smith, CHPA, CPP, President, Healthcare Security Consultants, Inc.

100 Elizabeth Stanberry, PharmD, Chief of Pharmacy, VA New Jersey Health Care System

101 Erica Stewart, CIH, HEM, National Environmental, Health and Safety, Principal Consultant, Kaiser Permanente

102 Andrew Streifel, MPH, REHS, Hospital Environmental Specialist, University of Minnesota

103 Dana Swenson, Senior Vice President, Umass Memorial Medical Center

104 Terry Thurston, RN, BSN, MBA, Director, Healthcare Operations Planning, BSA LifeStructures

105 Rein Tideiksaar, PhD, PA-C, President, Fallprevent, LLC

106 Kevin Tuohey, Executive Director - Research Compliance, Boston University & Boston Medical Center

107 David Uhaze, RA, Chief - Bureau of Construction Project Review, State of NJ Department of Community Affairs

108 Susan Wagner-Debusman, RN, Employee Health Program Manager, Kaiser Permanente

109 Thomas Wallen, AIA, ACHA, Vice President, Healthcare Performance Partners, Inc.

110 Frank Weinberg, Corporate Assistant Vice President of Facilities, MedStar Health, Inc.

111 Salley Whitman, MHA, Director of Operations, NXT Health

112 Lynn Willis, MHA, MHA, Regulatory Compliance Programs Manager, UC Irvine Medical Center

113 Laurie Wolf, MS, CPE, Performance Improvement Engineer, Barnes-Jewish Hospital

and Additional Staff from The Center for Health DesignAlison Berger, Project Manager

Anna Gasparini, Office Manager

Carolyn Glaser, MA, EDAC, Director of Operations

Donna Deckard, BSN, MPA, EDAC, Director of Strategic Projects

Linda P. Franklin, Senior Marketing Communications Manager

Shannon Roecklein, Project Manager

Home 7 A Safety Risk Assessment for Healthcare Facility Environments


It may seem overly simple to indicate a list of safety features that can improve safety, but patient safety begins with an awareness of safety features maintained within the facility. Poorly designed and operated healthcare environments contribute to adverse events and subsequent patient harm, such as healthcare associated infections, medication errors and patient falls.

The goal of this tool is to provide guidance to consider the underlying (latent) conditions that can lead to harm. This tool supports the requirement for a safety risk assessment (SRA) found in the 2104 FGI Guidelines for Design and Construction of Hospitals and Outpatient Facilities.

A large and growing body of evidence indicates that the physical environment impacts patient and staff safety, as well as stress and satisfaction; staff effectiveness; and organizational resource outcomes in hospitals and other healthcare settings. Facility replacement and renovation projects provide an opportunity to identify and mitigate or eliminate built environment latent conditions that lead to active failures impacting patient safety.

There are six components of consideration: infection control, patient handling, medication safety, falls, behavioral health, and security. You may want to get started by looking at some high-level concepts and considerations in the Safe Design Roadmap .

Skip the Safe Design Roadmap:Get Started with Project Information

Take Me to the Safe Design Roadmap

Home

I'm ready to go directly to the risk data and design considerations

Infection Control

Patient Handling

Medication Safety

Falls Behavioral Health

Security

Safe Design Roadmap Intro 8 A Safety Risk Assessment for Healthcare Facility Environments


Home Project Data

The Risk Component Links Glossary/Definitions

Safe Design Roadmap Introduction Next: Take Me to the Safe Design Roadmap Questions

A well-designed healthcare facility literally shapes all healthcare delivery, directly and indirectly underpinning patient and staff safety. Evidence shows that poorly designed and operated healthcare environments contribute to adverse events and subsequent patient harm, such as healthcare associated infections, medication errors and patient falls. Facility replacement and renovation projects provide an excellent opportunity to proactively identify and eliminate building related features that may lead to harm for patients and staff.

The Safe Design Roadmap provides a tool that enables CEOs and leadership team identify and implement key strategies that ensure their facility project is strongly focused on patient and staff safety. Completing this self-evaluation tool, modeled on the American Hospital Association’s Second Curve Road Map for Health Care , helps leaders ensure that an organization’s strategy to use evidence-based practices to improve quality and patient safety are integrated with the facility design process.

Designing a healthcare facility is a complex process, which requires a careful balance of many priorities. From the first moment a facility project is considered, it is critical to make safety a priority, so that safety issues are immediately identified, and become a central focus of all subsequent planning, design and construction activities. It is usually cost-prohibitive to ameliorate design related safety concerns once a building is under construction, built or occupied. There are significant financial advantages of designing for safety.

The companion Safety Risk Assessment (SRA) tool is used by the multidisciplinary facility project team, providing them with more evidence-based information about how to use built environment design to help mitigate the following safety issues: healthcare-associated infections; patient falls, medication safety; patient handling and movement; patient immobility; security and elopement and behavioral health and psychiatric injury. In addition to patient safety, both tools also focus on staff safety, as an important project consideration.

Figure 1: The SRA Cost Influence Curve (Based upon Taylor, Hignett, and Joseph, 2014)

Safe Design Roadmap Intro 9 A Safety Risk Assessment for Healthcare Facility Environments


Safe Design Roadmap Introduction Next: Take Me to the Safe Design Roadmap QuestionsThe Safe Design Roadmap self-assessment tool is organized around the various phases of the facility lifecycle: 1) Strategic & Operational Planning. This phase reflects the organization’s high-priority strategies, supported by a concept of operation achieved through the creation of operational planning and performance improvement projects to realize patient and staff safety goals.

3) Construction & Commissioning. Construction, which sometimes begins before the design is finished, includes the clearing of the site and all activities involved in actually building the facility, including the placement of some built-in equipment and furniture. During the commissioning phase, the building is outfitted with all additional equipment, furniture, medical and administrative supplies and other healthcare essential materials.

2) Programming & Design. During the program and design phase, the concept of operations is translated into the amount of space required and then the design of the facility itself. Designs are submitted in an iterative fashion, beginning with more general designs, such as block adjacency drawings (e.g. radiology is located next to the emergency department), to the specific, such as hardware specification and furnishing material selection.

4) Sustainment. The phase begins with occupancy of the building and includes all of the routine maintenance and repair activities necessary to keep the building in good working order over the life of the building.

Definitions of Project Phases Next: Take Me to the Safe Design Roadmap Questions

Safe Design Roadmap 10 A Safety Risk Assessment for Healthcare Facility Environments


Home

PhaseRating Scale

Item

2: in process #DIV/0! = Safe Design Score (average rating)

1

2

3

4

5

6

7

8

9

10

1: Not developed or just starting

Succ

essf

ully

laun

chin

g th

e fa

cilit

y pr

ojec

t (St

rate

gic

plan

ning

, fac

ility

m

aste

r pla

nnin

g, p

roce

ss a

nd o

pera

tiona

l pla

nnin

g)

Key Safety Questions Notes

3: fully developed, working well.

We focus on safety as both a strategic and operational goal, as reflected in our mission, vision and values’ statements.We examined root cause analysis and other performance improvement projects to identify safety improvement opportunities.We identified specific safety goals for the project (e.g. reduce patient healthcare-associated infections, falls, medication errors, staff musculoskeletal injuries, injuries associated with patient and staff violence).We evaluated the impacts on reimbursement (e.g. CMS’ Inpatient Prospective Payment System and Hospital Value Based Payment program) consequent to present safety outcome results.We identified fiscal improvement targets for safety outcomes that the project will help to achieve.We began an ROI for equipment purchases (e.g. ceiling mounted lifts, ultra-violet gamma irradiation) needed to support identified safety goals.We considered the role that safety has on the brand recognition of our organization.We included safety as a key priority in the guiding principles for the project.

We hired an A-E and project team with proven expertise in designing for safety.

We oriented the design team to our safety culture and priorities.

For each section, evaluation statements are provided to assess your hospital or clinic’s position as you enter each project phase; strategic and process planning; programming and design; construction and commissioning; and sustainment. To complete the assessment, please evaluate the organization’s status for each evaluation statement:

This assessment tool has four sections that correspond to a facility project lifecycle, in order to support a healthcare organization’s strategy to use evidence-based practices to improve patient and staff safety.

Glossary/DefinitionsProject Data The Risk Component Links



PhaseRating Scale

ItemKey Safety Questions Notes

11

12

13

14

15

16

17

18

19

20

21

22

23

24Alig

ning

the

desi

gn to

supp

ort t

he st

rate

gic

visi

on a

nd g

oals

for t

he

proj

ect

(Pro

gram

min

g an

d de

sign

)

Stra

tegi

c pl

anni

ng, f

acili

ty m

aste

r pl

anni

ng, p

roce

ss a

nd o

pera

tiona

l pl

anni

ng (c

ontin

ued)

With the design team, we developed statements that highlight how the proposed safety features will improve our safety metrics.

As appropriate, we identified environmental safety features missing in our present environment for comparison purposes and to facilitate and understanding of care processes that may require reengineering.We used different tools such as virtual tools and mock-up rooms to understand how design features may support our safety culture and processes.

We ensure that the design supports the desired safety concepts of operation from all perspectives: patients, family and visitors, the community, staff, material movement, equipment and technology use.During the programming and design phases, we ensure that critical safety design features are not lost (e.g during design development – design works from the general to the specific, value reengineering).We updated the safety equipment ROI.

We identified the baseline, pre-occupancy safety metrics that will be used for comparison purposes during post-occupancy measurements.We reviewed the evidence and completed the Safety Risk Assessment to identify specific safe design features we will include in the project.

We approved a functional program that accommodates safety features to support our goals.

As appropriate, we assigned multidisciplinary staff members to support the facility project.

The project vision and goals were communicated to key stakeholder groups (Board, Medical Staff, Staff, Patients, Community)

We ensured that the project team provided the key stakeholders with an overview of EBD features that research reveals contribute to improved safety

We aligned processes of care using safety as a focus.

We identified safety as a high priority during the visioning session used to launch the project.



PhaseRating Scale

ItemKey Safety Questions Notes

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

We observed positive safety trends.

We implemented a facility maintenance and repair plan that ensures the integrity safety design features over the life of the building.

Max

imiz

ing

the

faci

lity

inve

stm

ent (

Sust

ainm

ent)

We regularly report on all relevant data points for patient and staff safety, including the same pre-occupancy safety measures now monitored longitudinally during the post-occupancy.We completed the ROI.

We informed key stakeholders (e.g. board, staff, patients, community) when the ROI was met.

We captured the stories associated with the project and shared them with our stakeholders and interested national audiences.

We evaluated the results of our safety program investments through the use of longitudinal post-occupancy measures and shared those results at conferences and meetings, in peer-reviewed journals and in trade industry magazine, website, and blog articles.

As appropriate, we informed key stakeholders about the emerging safety focused design features.

We collected the final pre-occupancy measures for targeted safety outcomes.Mai

ntai

ning

the

proj

ect’s

vis

ion

and

goal

s and

re

engi

neer

ing

cultu

re a

nd p

roce

sses

(C

onst

ruct

ion

and

com

mis

sion

ing)

During the construction and commissioning phases, we ensure that critical safety design features are not lost.

We finalized care processes reengineering based on the design of the new facility.

We modified our existing comprehensive safety program to reflect the safety design features and reengineered processes of care.

We established training programs, which integrate the new safety design features, equipment and reengineered care processes.

To the degree possible, we implemented the new care processes in our present environment.

As needed, we updated the safety equipment’s ROI.

Project Data 13 A Safety Risk Assessment for Healthcare Facility Environments


Home The Risk Component Links

Project Name Initiated by (name): Organization

Construction New Construction Major Renovation

Renovation changing function of space Minor/minimal renovation

Other

Project

Infection Control Security

Complete Patient Handling Assessment Complete Medication Safety Assessment

Areas where a patient or family member has access?

Complete Behavioral Health Injury Assessment Complete Falls Assessment

Does your project include any of the following?

Areas where patient handling, transport, transfer, and movement occur?

Areas where medication preparation, processing, and distribution occurs?

Areas where behavioral health patient treatment occurs?

Consider the location where there is a risk of the hazard components.

All projects need to consider:

Safe Design Roadmap Glossary/Definitions

Project Background Information and Data

RiskComponentLinks 14 A Safety Risk Assessment for Healthcare Facility Environments


Home Risk Components

Infection Control Risk and Historic Data

Infection Control Design Considerations

Infection Control Risk Assessment (ICRA) Matrix of Precautions (tab in file)

Patient Handling Risk and Historic Data

Patient Handling Design Considerations

Patient Handling and Assessment White Paper (outside link)

Medications Safety Risk and Historic Data

Medication Safety Design Considerations

USP General Chapter Physical Environments (outside link)

Falls Risk and Historic Data

Falls Design Considerations

CDC report - Slips, Trips, and Falls: Healthcare Workers (outside link)

Behavioral Health and Psychiatric Injury Risk and Historic Data

Behavioral Health and Psychiatric Injury

NAHPS Behavioral Health Facility Guidelines (outside link)

Security Risk and Historic Data

Security Design Considerations

IAHSS Security Guidelines information (outside link)

Security

Infection Control

Patient Handling

Medication Safety

Falls

Behavioral Health

http://www.fgiguidelines.org/pdfs/FGI_PHAMA_whitepaper_042810.pdfhttp://www.usp.org/sites/default/files/usp_pdf/EN/USPNF/gc1066PhysicalEnvironments.pdfhttp://www.cdc.gov/niosh/docs/2011-123/pdfs/2011-123.pdfhttps://www.naphs.org/quality/design-guide-for-the-built-environmenthttp://iahss.org/About/Guidelines-Preview.asp

Infection Control Risk Data 15 A Safety Risk Assessment for Healthcare Facility Environments


Project Data

LikelihoodRare Unlikely Possible Likely Almost Certain

Sentinel eventPartial disabilityMedical treatmentFirst aidNo injury or disability

Cons

eque

nce

See the ICRA Matrix of Precautions for Construction & Renovation for assessing risk consequence and likelihood.

Infection control includes airborne, surface and water transmission issues. The CDC and Patient Safety & Quality Healthcare sites including National Nosocomial Infections Surveillance (NNIS) provide information about statistics and the implications of infections. Risks for specific HAI's are associated with multiple factors including building construction type, healthcare service types, and patient populations.

For at-risk populations, identify potential harms and areas within the proposed project associated with those potential harms. Consider the patient risk groups (spaces) to be affected and the potential outcomes, including during construction. Is the likelihood rare or almost certain? Is the consequence negligible or minor injury or a sentinel event?

The degree of potential harm related to HAI's may vary across at risk populations and other factors. An organization may invest more resources in areas associated with relatively higher degree of potential harm. A panel of experts created a generic level of risk, but this should be considered with respect to your own organization and patient demographic. You might consider a typical “heat map” of risk throughout your decision process. A sample is shown.

Home Glossary/DefinitionsThe Risk Component

LinksDesign Considerations:

Infection ControlSafe Design Roadmap

Infection Control Risk Data 16 A Safety Risk Assessment for Healthcare Facility Environments


Project DataHome Glossary/DefinitionsThe Risk Component

LinksDesign Considerations:

Infection ControlSafe Design Roadmap

Infection Type Location/Unit Type RateSubject Matter Expert

Consulted (Name)Title/Role Data Source

Evaluate historical data to ascertain all conditions (e.g. construction type, service type, patient populations) that contribute to HAIs in both inpatient and outpatient areas in your facility.

Past performance does not guarantee future results, but this may help identify the likelihood of events, specific to the organization. Are there patterns of vulnerability?

ICRA Matrix 17 A Safety Risk Assessment for Healthcare Facility Environments


Using the following table, identify the Type of Construction Project Activity (Type A-D)

Type A

Type B

Type C

Type D

Includes, but is not limited to:removal of ceiling tiles for visual inspection only, e.g., limited to 1 tile per 50 square feet; painting (but not sanding); wallcovering, electrical trim work, minor plumbing, and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.

Step 1

Inspection and non-invasive activities.

Small scale, short duration activities which create minimal dust

Includes, but is not limited to:installation of telephone and computer cabling; access to chase spaces; cutting of walls or ceiling where dust migration can be controlled.

Work that generates a moderate/high level of dust or requires demolition/removal of any fixed building components/assemblies

Includes, but is not limited to:sanding of walls for painting or wall covering; removal of floorcoverings, ceiling tiles and casework; new wall construction; minor duct work or electrical work above ceilings; major cabling activities; any activity which cannot be completed within a single workshift.

Major demolition and construction projects

Includes, but is not limited to: activities which require consecutive work shifts; requires heavy demolition or removal of a complete cabling system; new construction.

Infection Control Risk Assessment (ICRA) Matrix of Precautions(https://www.premierinc.com/quality-safety/tools-services/safety/topics/construction/icra.jsp)

Project Data Safe Design RoadmapThe Risk Component

LinksGlossary/DefinitionsHome

Design Considerations: Infection Control






Low Risk Medium Risk High Risk Highest RiskOffice areas Cardiology

EchocardiographyEndoscopyNuclear MedicinePhysical TherapyRadiology/MRIRespiratory Therapy

CCUEmergency RoomLabor & DeliveryLaboratories (specimen)Medical UnitsNewborn NurseryOutpatient SurgeryPediatricsPharmacyPost Anesthesia Care UnitSurgical Units

Any area caring for immunocompromised patientsBurn UnitCardiac Cath LabCentral Sterile SupplyIntensive Care UnitsNegative pressure isolation roomsOncologyOperating rooms including C-section rooms

Patient Risk Group Type A Type B Type C Type DLOW Risk Group I II II III/IVMEDIUM Risk Group I II III IVHIGH Risk Group I II III/IV IVHIGHEST Risk Group II III/IV III/IV IV

Step 2

Step 3

Match the Patient Risk Group (Low, Medium, High, Highest) with the planned …Construction Project Type (A, B, C, D) on the following matrix, to find the …Class of Precautions (I, II, III or IV) or level of infection control activities required.






Identify the areas surrounding the project area, assessing potential impact

Unit Below Unit Above Lateral Lateral Behind Front

Risk Group Risk Group Risk Group Risk Group Risk Group Risk Group

Step 8

Consider potential risk of water damage. Is there a risk due to compromising structural integrity? (e.g., wall, ceiling, roof)

Step 6

Identify issues related to: ventilation, plumbing, electrical in terms of the occurrence of probable outages.

Step 7

Identify containment measures, using prior assessment. What types of barriers? (E.g., solids wall barriers); Will HEPA filtration be required?

Identify specific site of activity e.g., patient rooms, medication room, etc.

Step 4

Step 5






Step 12

Does the infection prevention & control staff agree with the minimum number of sinks for this project? (Verify against FGI Design and Construction Guidelines for types and area.)

Step 13

Does the infection prevention & control staff agree with the plans relative to clean and soiled utility rooms?

Step 10

Do plans allow for adequate number of isolation/negative airflow rooms?

Step 11

Do the plans allow for the required number & type of handwashing sinks?

Step 9

Work hours: Can or will the work be done during non-patient care hours?






Step 14

Plan to discuss the following containment issues with the project team. e.g., traffic flow, housekeeping, debris removal (how and when).

Appendix: Identify and communicate the responsibility for project monitoring that includes infection prevention & control concerns and risks. The Infection Control Risk Assessment (ICRA) may be modified throughout the project. Revisions must be communicated to the Project Manager.

100-Infection Control Design 22 A Safety Risk Assessment for Healthcare Facility Environments


Risk Data: Infection Control Safe Design Roadmap

Sort # What is being discussed?

(Design Consideration)

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Why should this be considered? (Rationale)

(This cell hyperlinks to references)

101 Include physical separation/ isolation methods (e.g. separate soiled workroom, supply chain flow separation) in unit layout to prevent contamination of clean supplies and equipment. M

ed-H

igh The contamination of linen and other supplies increase the risk of infections. Physical

separation (e.g. a separate soiled workroom) is an important method of preventing the transfer of pathogens from soiled to clean linen, equipment and other supplies.

102 Include physical separation /isolation methods in rooms to prevent cross-transmission between patients (e.g. single room, appropriate physical distance/separation between roommates if multi-bed rooms are used). M

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Direct and indirect contact constitute a major route of pathogen transmission between patients (Chang & Nelson, 2000). Reducing the chances of direct/indirect contact between patients through physically separating and isolating patients, especially the provision of single-bed patient rooms, has been associated with significantly lower risks of HAI's and better health outcomes (MacKenzie et al., 2007; McManus, Mason, McManus, & Pruitt, 1992).

103 Include adequate number of negative isolation rooms for air-borne infectious patients in patient care areas based on projected number of such patients during normal and contingent surge operations.

High

est

Contaminated air flowing from rooms where air-borne infectious patients stayed was reported to increase the risks of infections among patients and staff in nearby spaces (Gustafson et al., 1982; Hutton, Stead, Cauthen, Bloch, & Ewing, 1990). Research strongly suggests that air-borne infectious patients should be isolated in negative-pressured rooms to minimize the risk of cross-contamination by preventing contaminated air flowing from isolation rooms to nearby spaces (Sehulster & Chinn, 2003).

104 Include adequate number of positive-pressure isolation rooms for high-risk, immuno-compromised patients in the patient care areas based on projected number of such patients during normal and contingent surge operations.

High

est

Immunocompromised patients are particularly vulnerable to infections. Research strongly suggests that immunocompromised patients should be isolated in positive-pressured rooms to minimize the risk of contracting air-borne pathogens by preventing potentially contaminated air from flowing from nearby spaces into the isolation rooms (Sehulster & Chinn, 2003).

Project Data



Risk Data: Infection Control



101 Include physical separation/ isolation methods (e.g. separate soiled workroom, supply chain flow separation) in unit layout to prevent contamination of clean supplies and equipment.

102 Include physical separation /isolation methods in rooms to prevent cross-transmission between patients (e.g. single room, appropriate physical distance/separation between roommates if multi-bed rooms are used).

103 Include adequate number of negative isolation rooms for air-borne infectious patients in patient care areas based on projected number of such patients during normal and contingent surge operations.

104 Include adequate number of positive-pressure isolation rooms for high-risk, immuno-compromised patients in the patient care areas based on projected number of such patients during normal and contingent surge operations.

The Risk Component Links

Location Key: GEN = General Consideration; OL = Overall Layout; IP = Inpatient; D&T = Diagnostic & Treatment; Rx = Pharmacy; ED = Emergency Department; HIM = Med. Records/Health Information Mgmt; OR = Operating; SEC = Seclusion

How is this done? Explanations/Clarifications (How Accomplished, Reasons Against) L

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GEN Unit Layout B

GEN Room Layout B

GEN Unit Layout B

GEN Unit Layout B

Glossary/Definitions

B = Body (required); A = Appendix (suggested); N/I or blank = not included






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105 Provide a sufficient number of hand hygiene devices to support convenient use by staff, patients and families. (This consideration is also relevant under the following category: room layout)

High

est

Hand hygiene is considered the single most important method of infection prevention because pathogens are often transferred via the unwashed hands of staff, patients and families. The number of hand hygiene devices is an important factor significantly impacting hand hygiene performance. More sinks, gel dispensers, and other hand hygiene devices likely make it easier for staff, patients and families to gain access to the devices and clean their hands when needed (Kaplan & McGuckin, 1986).

106 Designate a single-patient use bathroom for each patient for the duration of their stay on the unit.

High

est

Shared bathrooms may serve as reservoirs of infectious pathogens discharged from one patient and contribute to the transmission of the pathogens to other patients who use the same bathroom during the same time period. Even in bathrooms less frequently used by patients, pathogens could be brought in through staffs hands or used equipment and supplies. Single-patient bathroom may help reduce cross-contamination and improve environmental cleanliness.

107 Design room layout to allow easy visual and physical access to hand hygiene devices (such as sinks, alcohol hand rub dispensers, etc.).

High

est Hand hygiene is considered to be the single most important method of infection

prevention because pathogens are often transferred via the unwashed hands of staff. Well located hand hygiene devices may make it easy for staff and other individuals to see and use the devices to clean their hands.

108 Position sink location so that splashes from the sinks cannot reach the patient zone or clean supplies.

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Water splashes from sinks to nearby patient care areas have been found to increase risk of contamination and infection transmission of water-borne pathogens. Research has found that the location and orientation of hand hygiene devices are important factors that impact the possibility of water being splashed from sinks reaching nearby patient care area (Hota et al., 2009).






105 Provide a sufficient number of hand hygiene devices to support convenient use by staff, patients and families. (This consideration is also relevant under the following category: room layout)

106 Designate a single-patient use bathroom for each patient for the duration of their stay on the unit.

107 Design room layout to allow easy visual and physical access to hand hygiene devices (such as sinks, alcohol hand rub dispensers, etc.).

108 Position sink location so that splashes from the sinks cannot reach the patient zone or clean supplies.




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GEN Unit Layout B

GEN Room Layout B

GEN Room Layout B

GEN Room Layout






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109 Select sinks with design elements to prevent splashing into nearby areas where direct patient care is provided (including faucets, sink size/depth, water pressure, physical barrier between sinks and surrounding areas, etc.). M

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Water splashed from sinks to nearby patient care areas ahve been found to increase risk of contamination and infection transmission of water-borne pathogens. Beside the location of sinks, the design of sinks themselves should be considered in order to prevent splashing into nearby patient care area. Several sink design features were recommended by research: faucet spouts not flowing directly into the drain, decreased water pressure, and physical barrier between sinks and adjacent preparatory spaces (Hota et al., 2009).

110 Select hand hygiene devices with design features (e.g. foot-operated sinks, hands-free faucets) that help prevent contamination of the fixture and re-contamination of user's hands.

Med

-Hig

hIt has been reported that hand hygiene devices themselves may become contaminated and play a role in pathogen transmission by contaminating the hands of staff, patients, and families (Harrison, Griffith, Ayers, & Michaels, 2003). Certain features of hand hygiene devices such as foot-operated sinks, hands-free faucets, may help reduce the likelihood of re-contamination of hands after cleaning.

111 Consider using hand hygiene reminder methods (e.g. electronic devices providing automatic audible or visual reminders) to improve hand hygiene compliance.

Med

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Hand hygiene is considered the single most important method of infection prevention because pathogens are often transferred via the unwashed hands of staff. Design soutions that provide reminders (electronic or visual) and/or offer automated compliance reporting have been found in multiple studies to effectively improve hand hygiene compliance (Armellino et al., 2012; Fakhry, Hanna, Anderson, Holmes, & Nathwani, 2012).

112 Select interior finish materials for patient care areas especially high touch surfaces (e.g. floor, wall, ceiling, furniture covering, door handles) that are easy to clean, disinfect, and maintain or contain antibacterial characteristics in order to minimize the risk of surface contamination. H

ighe

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Research shows that the contamination of environmental surfaces may serve as a link in the chain of infection transmission. Certain surface materials have been reported to be easier to clean, disinfect, and maintain and are associated with lower risk of contamination (Anderson, Mackel, Stoler, & Mallison, 1982; Harris, Pacheco, & Lindner, 2010; Lankford et al., 2006; Noskin, Bednarz, Suriano, Reiner, & Peterson, 2000). Recent research reports indicated that antibacterial characteristics of certain surface materials may be associated with lower risk of surface contamination therefore may help prevent infection transmission (Karpanen et al., 2012; Takai et al., 2002).






109 Select sinks with design elements to prevent splashing into nearby areas where direct patient care is provided (including faucets, sink size/depth, water pressure, physical barrier between sinks and surrounding areas, etc.).

110 Select hand hygiene devices with design features (e.g. foot-operated sinks, hands-free faucets) that help prevent contamination of the fixture and re-contamination of user's hands.

111 Consider using hand hygiene reminder methods (e.g. electronic devices providing automatic audible or visual reminders) to improve hand hygiene compliance.

112 Select interior finish materials for patient care areas especially high touch surfaces (e.g. floor, wall, ceiling, furniture covering, door handles) that are easy to clean, disinfect, and maintain or contain antibacterial characteristics in order to minimize the risk of surface contamination.




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GEN Plumbing B,A

GEN Plumbing

GENTechnology Integration

GENInterior

Design/FinishesB,A






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113 Minimize dust catching through design of environmental surfaces (e.g. sloped instead of horizontal tops) for the purpose of reducing risk of contamination.

Med

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Dust particles may carry pathogens. Without proper cleaning, environmental surfaces (especially high touch objects) may catch dust and become reservoirs of pathogens. Proper environmental design that reduces the amount of dust caught on environmental surfaces may help reduce the risk of environmental surfaces becoming pathogen reservoirs thus reduce the risk of infection transmission (Williams, Singh, & Romberg, 2003).

114 Identify and assess environmental fixtures (e.g. shelves, soft curtains) that likely serve as reservoirs of pathogens.

Med

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According to multiple recent epidemiological reports, without proper maintenance and cleaning, certain environmental fixtures (e.g. open water fountains, curtains) could become reservoirs of pathogens and cause outbreaks of infections (e.g., Palmore et al., 2009). Precautions should be taken to reduce the risk involved with environmental features known to be potential reservoirs of pathogens.

115 Use building design (e.g. movable furniture) to make it easy for environmental service personnel to clean and disinfect environmental surfaces and equipment (e.g. curtains, walls, floors). M

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Without proper cleaning, environmental surfaces (especially high touch objects) often become reservoirs of pathogens. Environmental design may facilitate the cleaning of high touch objects (e.g. door handles, toilet handles, hand rails) thus reduce environmental contamination and reduce the risk of infection transmission (Williams et al., 2003).

116 Select furnishings, fixtures and equipment (e.g. water faucets) that are easy to clean and maintain in order to minimize pathogen growth and prevent them from becoming pathogen reservoirs. (This consideration is also relevant under the following categories: equipment, furnishings).

Med

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There are reports about infections associated with fixtures and equipment (e.g. certain types of water faucets) (Sydnor et al., 2012). Fixtures and equipment that are easy to clean and maintain may be associated with lower chance of becoming pathogen reservoirs and lower risk of contributing to infection transmission.

117 Consider water disinfection methods if the patient population is considered at high risk for infection.

Med

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Research has found different levels of effectiveness of various water disinfection methods in preventing or controlling various types of water contamination and outbreaks of water-borne infections (Modol et al., 2007). Proper water disinfection methods should be considered when designing plumbing systems.






113 Minimize dust catching through design of environmental surfaces (e.g. sloped instead of horizontal tops) for the purpose of reducing risk of contamination.

114 Identify and assess environmental fixtures (e.g. shelves, soft curtains) that likely serve as reservoirs of pathogens.

115 Use building design (e.g. movable furniture) to make it easy for environmental service personnel to clean and disinfect environmental surfaces and equipment (e.g. curtains, walls, floors).

116 Select furnishings, fixtures and equipment (e.g. water faucets) that are easy to clean and maintain in order to minimize pathogen growth and prevent them from becoming pathogen reservoirs. (This consideration is also relevant under the following categories: equipment, furnishings).

117 Consider water disinfection methods if the patient population is considered at high risk for infection.




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GENInterior

Design/Finishes

GEN Furnishings B

GEN Furnishings

GEN Plumbing B

GEN Plumbing B,A






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118 Include control measures (elimination, disinfecting equipment/featuresto address environmental infection risks and reduce infection risk related to environmental furnishings and fixtures (e.g. shelves, soft curtains)(This consideration is also relevant under the following categories: equipment, plumbing).

Med

-Low

According to multiple recent epidemiological reports, without proper maintenance and cleaning, certain environmental fixtures (e.g. fountains, curtains) could become reservoirs of pathogens and cause outbreaks of infections (e.g., Palmore et al., 2009). Certain infection control measures including equipment and design characteristics that address contamination risks may help reduce the contamination.

119 Collaboratively review with Infection Prevention, Facilities Management and the Mechanical Design issues related to infection prevention, reliability and maintainability of HVAC systems for each area affected by this project. Considerations include:

for critical areas)

temperature and humidity

zones to allow environmental control flexibility

intended use of space

unique environmental conditions (e.g. entryways, protection in food service area for pest control, patient centric environmental control in burn, ICU or neonatal

)

Med

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hResearch indicates that HVAC system design elements (including location of ventilation grilles, air pressure difference between nearby spaces to prevent leakage of contaminated air, type and location of air filters, air disinfection, ventilation rates, etc.) significantly impacts a HVAC system’s effectiveness of reducing air contamination and improving air hygiene in healthcare settings (Beggs, Kerr, Noakes, Hathway, & Sleigh, 2008; Menzies, Fanning, Yuan, & FitzGerald, 2000)






118 Include control measures (elimination, disinfecting equipment/featuresto address environmental infection risks and reduce infection risk related to environmental furnishings and fixtures (e.g. shelves, soft curtains)(This consideration is also relevant under the following categories: equipment, plumbing).

119 Collaboratively review with Infection Prevention, Facilities Management and the Mechanical Design issues related to infection prevention, reliability and maintainability of HVAC systems for each area affected by this project. Considerations include:

for critical areas)

temperature and humidity

zones to allow environmental control flexibility

intended use of space

unique environmental conditions (e.g. entryways, protection in food service area for pest control, patient centric environmental control in burn, ICU or neonatal

)




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GEN Furnishings B

GENMechanical

(HVAC)/ElectricalB






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120 Optimize the location of air filters (including high-efficiency particulate air [HEPA] filters) within the ventilation system (e.g. inside main air ducts vs. at the openings of ducts) to minimize the risk of re-contamination of filtered clean air.

Med

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Research shows that the filtered air is often re-contaminated after being filtered with central filters (located inside main air ducts) and before flowing into healthcare spaces. Peripheral filters (located at the openings of ducts) were found to make the air flowing into healthcare spaces cleaner (Crimi et al., 2006).

121 Select HVAC equipment containing antibacterial characteristics that reduce the risk and degree of contamination.

Med

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HVAC equipment can be contaminated and subsequently contaminate the air entering into healthcare spaces (Lutz, Jin, Rinaldi, Wickes, & Huycke, 2003). Studies found that certain HVAC components with antibacterial characteristics were associated with lower risk of HVAC system contamination and air contamination (Schmidt et al., 2012).

122 Select the most effective ventilation method among various design options (e.g. conventional, laminar, nonaspirating, displacement) in keeping the air in OR clean based on simulation or other studies. M

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Research found that the effectiveness of different OR ventilation methods (e.g. conventional, laminar, non-aspirating, displacement) varies significantly depending on different surgical procedures and OR layout (Memarzadeh & Manning, 2002). To minimize the risk of infection contracted in OR, the most effective OR ventilation method should be selected.

123 Put in place proper monitoring devices to ensure that the ventilation system works as designed throughout its whole lifecycle.

Med

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Research has found cases in which the ventilation systems may not work as designed (e.g. air flowing from negative pressure rooms to other spaces) and the deficiency in ventilation may cause infection outbreaks (Fraser et al., 1993). Proper monitoring, commissioning and maintenance should be done in order to optimize the performance of ventilation systems.

124 Provide adequate monitoring equipment (e.g. moisture and leakage alarm) to monitor possible environment hazards (e.g. dampness) in HVAC in the building lifecycle.

Med

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Research indicates that environmental hazards such as dampness in the HVAC system may result in contamination during the life cycle of a building (Lutz et al., 2003). It's essential to proactively monitor the possible environmental hazards (e.g. dampness) so that proper maintenance and other contamination prevention/reduction methods can be implemented to eliminate the hazards thus reduce risk of infection transmission.






120 Optimize the location of air filters (including high-efficiency particulate air [HEPA] filters) within the ventilation system (e.g. inside main air ducts vs. at the openings of ducts) to minimize the risk of re-contamination of filtered clean air.

121 Select HVAC equipment containing antibacterial characteristics that reduce the risk and degree of contamination.

122 Select the most effective ventilation method among various design options (e.g. conventional, laminar, nonaspirating, displacement) in keeping the air in OR clean based on simulation or other studies.

123 Put in place proper monitoring devices to ensure that the ventilation system works as designed throughout its whole lifecycle.

124 Provide adequate monitoring equipment (e.g. moisture and leakage alarm) to monitor possible environment hazards (e.g. dampness) in HVAC in the building lifecycle.




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GENMechanical

(HVAC)/ElectricalB

GENMechanical

(HVAC)/ElectricalB,A

ORMechanical

(HVAC)/ElectricalB

GENMechanical

(HVAC)/ElectricalB

GENMechanical







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125 Through building design (e.g. adequate access opening), allow easy access to properly maintain or replace contaminated HVAC and other building components in order to mitigate potential environmental hazards (e.g. contamination due to dampness) in the building lifecycle.

Med

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Research indicates that environmental hazards such as dampness in the HVAC system may result in contamination during the life cycle of a building (Lutz et al., 2003). It's essential to proactively monitor the possible environmental hazards and identify methods of controlling contamination. After the identification of potential problems, easy access would be very important to facilitate necessary maintenance or replacement to mitigate the environmental hazards.

126 Identify potential major sources of airborne, waterborne and other contaminants such as a construction site within or close to the patient care areas in operation.(This consideration is also relevant under the following categories: building layout, unit layout.)

Med

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hResearch indicates that construction sites, as well as other building activities or components, may become a source of contaminants and cause infection outbreaks (Barnes & Rogers, 1989).

127 Provide for appropriate environmental disinfection methods (e.g. HEPA filters, barriers, isolated HVAC system) to control the contamination from major sources of contaminants such as a construction site.(This consideration is also relevant under the following categories: building layout, unit layout.)

Refer to the ICRA Matrix for more detailed risk assessment considerations related to construction and renovation activities according to ICRA-defined construction type and patient risk.

Med

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Research has found certain disinfection methods such as HEPA filtration are effective in controlling major sources of contaminants such as construction sites (Barnes & Rogers, 1989).

The ICRA Matrix includes detailed steps for identifying the appropriate environmental disinfection methods based on construction type and patient risk level.






125 Through building design (e.g. adequate access opening), allow easy access to properly maintain or replace contaminated HVAC and other building components in order to mitigate potential environmental hazards (e.g. contamination due to dampness) in the building lifecycle.

126 Identify potential major sources of airborne, waterborne and other contaminants such as a construction site within or close to the patient care areas in operation.(This consideration is also relevant under the following categories: building layout, unit layout.)

127 Provide for appropriate environmental disinfection methods (e.g. HEPA filters, barriers, isolated HVAC system) to control the contamination from major sources of contaminants such as a construction site.(This consideration is also relevant under the following categories: building layout, unit layout.)

Refer to the ICRA Matrix for more detailed risk assessment considerations related to construction and renovation activities according to ICRA-defined construction type and patient risk.




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GENMechanical


GEN Site Optimization B

GEN Site Optimization B,A






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128 Minimize the needs of OR door openings necessary to conduct routine work through OR suite design (e.g. supply storage in OR, wireless consultation/communication).(This consideration is also relevant under the following category: room layout.)

Med

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h

Research has found that the number of door openings during surgical procedures may generate disturbances to air flows and cause increase of the air contamination level in OR's (Andersson, Bergh, Karlsson, Eriksson, & Nilsson, 2012). The need for OR door openings during surgical procedures may be reduced through building design (e.g. locating certain supplies within the OR, wireless consultation). This in turn may help reduce the risk of infections for OR patients.






128 Minimize the needs of OR door openings necessary to conduct routine work through OR suite design (e.g. supply storage in OR, wireless consultation/communication).(This consideration is also relevant under the following category: room layout.)




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OR Unit Layout

Med Safety Risk Data 38 A Safety Risk Assessment for Healthcare Facility Environments


Project Data

Rare Unlikely Possible Likely Almost CertainSentinel eventPartial disabilityMedical treatmentFirst aidNo injury or disability

Design Considerations: Medication Safety

Safe Design Roadmap The Risk Component Links Glossary/Definitions

The number and locations of medication safety zones (MSZs) should be clearly identified. A MSZ is defined in the literature as a critical area where medications are prescribed, orders are entered into a computer or transcribed onto paper documents, and where medications are prepared, dispensed or administered. Examples include work surfaces of medication cart, nursing units, any location where prescribing decisions are made, work surface of an automated medication dispensing device, pharmacy, and patient bed-side. Identifying these zones early on is critical to developing design solutions.

A panel of experts created a generic level of risk, but this should be considered with respect to your own organization and patient demographic. You might consider a typical “heat map” of risk throughout your decision process. A sample is shown.

Likelihood

Cons

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An understanding of historical data can help identify and assess current issues around medication errors, and define how operational and physical environment conditions may overlap. A healthcare organization should evaluate its own historical data on medication errors to identify existing physical environment conditions (e.g. lighting levels, workspace organization etc.), that could be related to medication errors in both inpatient and outpatient areas. Evaluate historical data to ascertain all conditions that contribute to medication errors in your facility.

Medication errors, the most common medical errors, may adversely impact healthcare outcomes, as indicated in the Institute of Medicine (IOM) reports such as "Crossing the Quality Chasm" and "To Err is Human". It was estimated that between 380,000 and 450,000 preventable adverse drug events (ADEs) occurred annually in United States (US) hospitals. ADEs refer to any injuries resulting from medication use, including physical harm, mental harm, or loss of function. ADEs have been found to directly contribute to increased morbidity and mortality, prolonged hospitalizations, and higher costs of care. Consider the patient risk groups (spaces) to be affected and the potential outcomes. Is the likelihood rare or almost certain? Is the consequence negligible or minor injury or a sentinel event?

Home

Med Safety Risk Data 39 A Safety Risk Assessment for Healthcare Facility Environments


Project DataDesign Considerations:

Medication SafetySafe Design Roadmap The Risk Component Links Glossary/DefinitionsHome

Medication safety type (e.g. error, sticks)/rate

Subject Matter Expert Consulted (Name)

Title/Role Data SourceLocation/Unit Type

Evaluate historical data to ascertain all conditions (e.g. service type, patient populations) that contribute to self-harm in both inpatient and outpatient areas.

Past performance does not guarantee future results, but this may help identify the likelihood of events, specific to the organization. Are there patterns of vulnerability?

200-Medication Safety Design 40 A Safety Risk Assessment for Healthcare Facility Environments


Risk Data: Medication Safety Safe Design Roadmap



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200 Clearly identify the purpose, associated work tasks, and workflow in the functional and operational program for each medication safety zone in order to design ergonomic and efficient workspaces. (This consideration is also relevant under the following category: room layout.)

Med

-Low

Refer to the functional and operational program provided for the project to understand the work tasks and workflows that are anticipated for the space (Grissinger, 2012; United States Pharmacopeia (USP), 2010). It is important that the design enables the fulfillment of the defined tasks in the most efficient manner possible. This is linked to increased efficiency and reduced fatigue, which can have an impact on errors. Empirical evidence on specific strategies to improve efficiency is lacking.

201 Locate the medication safety zones out of circulation paths to minimize distraction and interruption. (This consideration is also relevant under the following category: room layout.)

Med

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hThere is high probability of interruptions occurring when medication preparation activities take place near or in a circulation zone (such as a corridor). Medication safety zones should be located away from areas with heavy staff, patient or family activity. Research supports that sensory/perceptual interference (e.g. interruption by a co-worker) can impair error-free performance due to the cognitive load of switching tasks (i.e. time to reorient to the task after being interrupted) or prospective memory failure (i.e. forgetting where you left off). Being interrupted can result in both procedural failures (e.g. failure to read labels, check patient ID or record administration on medication chart) and clinical errors (e.g. wrong drug, dose, formulation, strength) (Chaudhury, Mahmood, & Valente, 2009; E. A. Flynn et al., 1999; L. Flynn, Liang, Dickson, Xie, & Suh, 2012; Mahmood, Chaudhury, & Valente, 2011).

202 Limit traffic through the medication safety zone. (This consideration is also relevant under the following category: room layout)

Med

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When medication safety zones are located in spaces where other activities also take place (such as a clean utilities room), the additional traffic in the room can increase the potential of distractions and interruptions. Research supports that sensory/perceptual interference (e.g. interruption by a co-worker) can impair error-free performance due to the cognitive load of switching tasks (i.e. time to reorient to the task after being interrupted) or prospective memory failure (i.e. forgetting where you left off). Being interrupted can result in both procedural failures (e.g. failure to read labels, check patient ID or record administration on medication chart) and clinical errors (e.g. wrong drug, dose, formulation, strength) (Grissinger, 2012; United States Pharmacopeia (USP), 2010).

Project Data



Risk Data: Medication Safety



200 Clearly identify the purpose, associated work tasks, and workflow in the functional and operational program for each medication safety zone in order to design ergonomic and efficient workspaces. (This consideration is also relevant under the following category: room layout.)

201 Locate the medication safety zones out of circulation paths to minimize distraction and interruption. (This consideration is also relevant under the following category: room layout.)

202 Limit traffic through the medication safety zone. (This consideration is also relevant under the following category: room layout)




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GEN Unit Layout Q

OL Unit Layout B

OL Unit Layout A





Risk Data: Medication Safety Safe Design Roadmap



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203 Use visual and/or physical barriers to reduce distractions and interruptions; without compromising the main clinical function in the medication safety zone.

Med

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In situations where medication safety zones have to be located in areas with heavy staff, patient or family activity, physic

Attribution-NonCommercial-NoDerivatives 4.0 International · 2015-03-18 · 34 Barbara Braun PhD,...

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Transcript of Attribution-NonCommercial-NoDerivatives 4.0 International · 2015-03-18 · 34 Barbara Braun PhD,...