In spring, an environmental manager’s
attention turns to tidiness. It’s the
season for spring cleaning of all types, and what better time to conduct an envi- ronmental tour of your facility? This tour is required at least once a year anyway for business occupancies—and twice a year for health care occupancies.
An environmental tour is essential- ly a routine comprehensive inspection of your organization’s physical milieu, conducted as a walk-through event. Its purpose is to assess environment of care
safety; identify environmental weakness- es, hazards, and unsafe practices; and evaluate how effective and knowledgeable staff are at managing safety and security risks. An environmental tour is not syn- onymous with a patient safety tour, and it’s not focused on aesthetics like paint colors or decor. Instead, it’s a carefully planned checkup of the factors affecting the patient care environment and those working in it.
“The tour’s goal is for the organization to take a hard, honest look at itself and
Joint Commission–accredited facilities are required to conduct environmental tours, per the following Environment of Care standards:
EC.02.01.01, which states that the organization must:
Manage safety and security risks
Identify safety and security risks associated with the environment of care that could affect patients, staff, and other people coming to the organization’s facilities
Take action to minimize or eliminate identified safety and security risks in the
physical environment
Maintain all grounds and equipment
EC.04.01.01, which states that the organization must:
Collect information to monitor conditions in the environment
Conduct environmental tours every six months in patient care areas to evaluate the effectiveness of previously implemented activities intended to minimize or eliminate environment of care risks
Conduct annual environmental tours in non-patient care areas to evaluate the effectiveness of previously implemented activities intended to minimize or eliminate risks in the environment
Use its tours to identify environmental deficiencies, hazards, and unsafe practices
Evaluate each environment of care management plan every 12 months, including a review of the plan’s objectives, scope, performance, and effectiveness
EC.04.01.03, which states that the organization must:
Analyze identified environment of care issues
Use the results of data analysis to identify opportunities to resolve environmental safety issues
determine where it’s struggling with environmental safeguarding so that it can improve those areas,” says John Maurer, SASHE, CHFM, CHSP, engi- neer, Department of Engineering, The Joint Commission. “The first of these tours should be conducted closer to the early part of the year, so it can be used to help your organization monitor whatever expectations and goals it has set in its annual evaluation from the prior year,” he notes.
Each tour event usually takes a few hours and is scheduled to visit all nursing units and departments. An environmental tour is required:
At least twice a year (once every six months) in patient care areas
At least once annually in non-patient care areas, including public waiting areas, doors, walkways, stairs, elevators, parking lots, sidewalks, and garages
See “EC Standards and Environmental Tours,” above.
Scheduling to repeat these tours at approximately the same time every year at consistent intervals allows you
to compare data and track progress or lack thereof. Extra tours can be added if desired, and a tour can be moved up sooner to accelerate the schedule, but a tour cannot be delayed. For instance,
six-month tours normally slated for June and December can be bumped up to occur every April and October instead; but if the first occurs in April, the second cannot occur any later than six months
after that date.
“Many organizations break these up into shorter, easier-to-manage monthly tours, during which different designated departments are scheduled to be investi- gated. This reduces the burden of trying to cover so much ground twice a year,” Maurer says.
The actual walk-through tour is best performed by a multidisciplinary group consisting of the assigned safety officer and members of various departments (see “Tour Teammates,” page 10). To efficiently structure the touring process,
these groups often create forms or check- lists to scrutinize various areas and keep the steps organized.
Staying organized is important, as an environmental tour usually involves
(continued on page 10)
Take a Walk-Through
(continued from page 9)
several components, each necessary to thoroughly evaluate the environment of care and weed out any safety deficien- cies that could lead to accidents, secu- rity breaches, and/or harm to staff and patients. These tour components include the following:
Visual observations
Random staff interviews
Review of relevant documents
During the visual observation phase, aim to keep an eye out for red flags in the physical environment, including any of the following:
Clutter in halls, corridors, and heavily trafficked rooms
Soiled and clean laundry that is
On your EC tour, keep an eye out for hallway clutter that might endanger patients or staff.
procedures and policies related to safety
mixed/bundled together
Incorrect storage, such as medication that’s not securely stored or that’s not in its recommended climate; lack of or improper placement of a sharps container; supplies storage areas that are not clean or sterile; blood products that aren’t clearly labeled; or cleaning products accidentally mixed in with clinical supplies
Fire hazards, such as equipment that uses flammable gases or oxygen that is not safely secured or stored
“Workarounds”—shortcuts taken by workers to save time but that can lead to exposure to risk such as a disabled door latch, which could allow unau- thorized personnel into restricted areas
Lack of needed safety signage in key areas
See the October 2014 issue of EC News for additional problem areas to watch for.
During the tour, conducting random interviews of personnel is highly recom- mended, as these queries can help gauge staff awareness of and compliance with
and security. Several key topics can be broached during these interviews—from the practices involved in reporting defec- tive equipment, to the availability and use of safety data sheets (SDS), to fire safety protocols.
“In addition to learning worker practices, this is a great opportunity to educate staff about crucial safety mat- ters,” says Maurer.
Reviewing documents during your tour is worthwhile as well, to ensure that items are adequately logged and inven- toried and processes are being correctly followed. Items of documentation to review may include the following:
Training records—Is staff training documented properly?
Identification badges—Are they worn and displayed as required?
Policies/procedures—Are they appropriately posted and accessible?
Annual competencies—Are they conducted on time?
Chemical, medication, and supply inventories—Is the paperwork effec- tively managed and updated?
A review of all six required Manage- ment Plans (See EC.01.01.01, EPs 3–8), including a review of the plan’s
An environmental tour should include a team of assigned personnel from different disciplines in the health
care organization. Joint Commission engineer John Maurer recommends that you try to include staff members from as many of the following departments as possible:
Safety
Clinical/nursing
Infection control
Security
Risk management
Quality assurance
Performance improvement
Administration
Facilities management
Engineering
Clinical engineering
Environmental services
Housekeeping
Laundry distribution
Materials management
objectives, scope, performance, and effectiveness
Once the tour is completed, your organization is required to review the data gathered, document and analyze the problems and areas of improvement identified, and take action to resolve or
improve those issues.
“When it conducts its survey of your facility every three years, The Joint Commission will inquire about the
environmental tours you performed over this period and may ask to see the data, which it will use to gauge compliance and improvement,” says Maurer.
ly part of the year, it can be scheduled to be completed prior to an annual inspec- tion by fire officials and local authori- ties,” he notes.
Moreover, a spring tour can be advantageous for facilities in colder climates, as they can carefully examine the building perimeter, parking lots, and other external areas that may have been affected by freezing, thawing, and other weather events. These problems could have been obscured while snow and ice were present. For example, an upheaved sidewalk that could create a tripping
hazard outside an organization exit may not have been visible before the snow covering it melted.
Finally, slating a springtime tour can also possibly better address the Environ- ment of Care, Emergency Management, and Life Safety standards that are most frequently cited for the highest incidence of noncompliance.
“This list, published every year in
EC News [see the table on page 8 of this issue], can be checked against during the tour to ensure that the facility is meeting these key standards,” says Maurer. EC
