OR - Riskassesment Chiclist

KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬
Directorate of Health Affairs in Taif ‫مديرية الشئون الصحية بمحافظة الطائف‬

KING FAISAL HOSPITAL ‫مستشفى الملك فيصل‬
Scope of risk (OR) Checklist

WARD/UNIT: _____________________ DATE: ____________________
LEGEND: PT = Preparation Tool INT = Interview OBS = Observation MR = Medical Record O/I = Observation/Interview DR=Document
Review NM =Not met (Score = 0 when < 50 % compliance) PM = Partially met (Score=1 ≥ 50 to < 80 % compliance) FM = Fully met( Score= 2 when ≥
80 % compliance) NA = Not applicable(Cancelled Score )
RESULT
Points of measurement PT NM PM FM NA COMMENTS
0 1 2
1. The OR is directed and staffed according to the specific patient care needs and the DR
scope of services provided.
2. OR has an emergency care protocol in P & P. DR
3. Staffs are working according to the policies and procedures. O/I

4. Incidents are reported timely and accurately. DR
5. Staffs work according to their job description. DR
6. Policy-procedure in place for the unit DR
7. Staffs are aware of emergency protocols in any kind of emergencies. INT
8. Staffs follow all policies and procedures pertaining to documentation. DR
9. Crash cart checklist maintained daily & replenished after each code blue DR
10. Emergency medication tray checklist maintained DR
11. Lifting & moving techniques adhered to for patients handling & lifting items. O/I
12. Staffs are holding licenses and are displayed/available in their working areas. OBS
13. Consent MR
 Is available for all admitted patients.
Page 1 of 6

 Informed consent is available for patients under going any special procedures or MR
surgery.
 Consent is clearly written, signed and stamped. MR
14. Security OBS
 All patients admitted have ID bands.
 Signs posted in restricted areas OBS
 Emergency door & exits are in good condition OBS
 Medication cabinets, medication fridge, crash cart & Narcotic cabinets are locked OBS
securely
15. Equipment and Utilities OBS
 All medical equipment and utilities are in good working condition and are available
at all times.
 Emergency equipment are checked and documented daily. DR
 Equipment/machinery limited to authorized persons only O/I
 Medical equipments tagged with Bio-med stickers OBS
 Emergency power outlets are identified & staff are familiarized O/I
 Electrical cords/cables for medical equipment in good condition, not frayed. OBS
 Sufficient oxygen flow meters to meet the ward requirements OBS
 Reports and damages are reported promptly to Biomed/Facilities Engineering. DR
 Head lights working OBS

 Ceiling lights working OBS
 Switches without damage & cracks OBS
 Thermostats of room air-conditioning working OBS
 Tap Hot water facility available & the temperature adequate OBS
Page 2 of 6

 Tap water facility available & the temperature adequate OBS
 Toilets flush properly OBS
 Water supplies free of leakage OBS
 Over-head paging system heard in the area OBS
 Staff know to relay emergency information to Telephone Operator for paging O/I
 Nurse call system function correctly OBS
 Intercom system work properly OBS
16. Employee Health DR
 All new hires are screened and routine medical check up carried out.
 Staff receives immunization as per employee health clinic schedule. DR
 Needle and sharp injury is reported to employee health clinics as per P & P DR
17. Occurrence Variance Reports DR
 Adverse occurrences or unusual situations are reported at the time of discovery.
 Corrective actions are taken to prevent recurrences DR
18. Safety OBS
 All electrical switches / outlets are in good working condition.
 Cables securely fastened to prevent tripping OBS
 Call bells are working OBS
 Adequate lighting is available throughout the area. OBS
 All safety equipment (bed rails, safety belts, etc.) are practiced while handling O/I
patient.

 Items in the store room arranged correctly with heavy items on to the bottom of OBS
the shelf.
 Evacuation plan map is posted in all rooms & coridoors indicating the evacuation OBS
Page 3 of 6

route.
 Corridors & passages free of obstruction OBS
 Emergency exits are clearly labeled. OBS
 Rooms are locked when not in use. OBS
 Housekeepers use sign boards while mopping floors to prevent slips & falls. OBS
 Utility rooms locked when unattended. OBS
 Furniture in OR are safe, no broken wheels etc OBS
 Rooms are clean, free of litters & debris. OBS
 Refrigerators are cleaned on regular basis OBS

 Temperature chart maintained for all indicated refrigerators. OBS
 Walls in good general condition OBS
 Doors free from damage or sharp edges OBS
 Ceiling tiles free from stains/dirts/soakages OBS
 Familiar with the Emergency Codes & the number to dial INT
 “No smoking signs” are posted wherever indicated OBS
 “No smoking policy” strictly enforced OBS
 Staff aware of what to do in case of fire INT
 Staff oriented to Life Safety Emergency Response Program. INT
 All equipment used are appropriate and suitable to the age and size of the OBS
patients being cared for.
 Red line system is adhered to at all times. OBS
Page 4 of 6

 Standard precautions are practiced by all staff. O/I
 Sufficient trash containers of the approved type are available. OBS
 Infectious waste collected daily & as necessary by the housekeeping staff OBS
 Infectious waste identified with Biohazard Sticker. OBS
 Infectious waste containers are located away from the main stream traffic but OBS
accessible to users.
 Color coded plastic bags are used for disposal of infectious wastes. OBS
 Wastes collected by Housekeepers regularly OBS
 Sharps are disposed of in puncture resistant container. OBS
 Sharp disposal containers are removed when ¾ full OBS

 Staff are trained in Blood spill policy O/I
 Spill kits available in the unit OBS
 Soiled linens are placed in water soluble bags & send to laundry in a timely O/I
manner
19. Emergency Preparedness Factors INT
Staff understands their role in Internal & External Disasters
20. Education & Training DR
 Staff trained in their specific job role, are records maintained
 Staff encouraged to seek further education-training in-house INT
 Are there a regular in-house training program to ensure that staff are kept DR
updated with new advancements & techniques
 Staff attend in-service educational activities DR
 New hires are oriented & trained to fire & safety program INT
21. Staff receive documented orientation and training that includes: DR
 Recognition and interpretation of dysrhythmias
Page 5 of 6

 Use of electronic life support equipment. DR
 Prevention of cross infection from one patient to another. DR
 Parental administration of fluids, blood, electrolytes etc. DR
 How sterile equipment is monitored and maintained. DR
 Draping and gowning materials and techniques. DR
 Special infection control and safety DR
 Hazards relevant to the job. DR

 Electrical safety. DR
 Hazardous material handling and disposal. DR
 Life Safety. DR
 Safety DR
22. Staffs are competent and knowledgeable in skills and theories as appropriate to INT
specific services offered.
23. Staff is aware & oriented to EOC Program INT
24. Evacuation plan map is posted, indicating the evacuation route. OBS
25. Confidentiality OBS
All documentation respects the privacy and confidentiality of patient information
______________ :NAME &SIGNATURE OF ASSESSOR: ______________ NAME &SIGNATURE OF HEAD NURSE
Page 6 of 6

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KINGDOM OF SAUDI ARABIA ‫المملكة العربية السعودية‬

Directorate of Health Affairs in Taif ‫مديرية الشئون الصحية بمحافظة الطائف‬

Scope of risk (OR) Checklist

2. OR has an emergency care protocol in P & P. DR

3. Staffs are working according to the policies and procedures. O/I

Scope of risk (OR) Checklist

 Head lights working OBS

Scope of risk (OR) Checklist

Scope of risk (OR) Checklist

 Refrigerators are cleaned on regular basis OBS

Scope of risk (OR) Checklist

 Sharp disposal containers are removed when ¾ full OBS

Scope of risk (OR) Checklist

 Hazards relevant to the job. DR

:NAME &SIGNATURE OF ASSESSOR: NAME &SIGNATURE OF HEAD NURSE

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