05E - Appendix D.5 ORP Risk Assessment Plan.pdf

COMMUNITY BASED OUTPATIENT CLNIICS

Rolla, Missouri

Appendix D.6 Risk Assessment Plan

RLP No. 36C10F22R0047

Contract No. 36C10F21N0051

April 12, 2022

TABLE OF CONTENTS

1. Overview

1.1. Introduction

1.2. Objective and Purpose

2. Planning

2.1. Pre-Design Risk Assessment

2.2. Data Driven Decisions

3. Way-Ahead

3.1. Continuous Risk Assessment

3.2. Questionnaire

Appendix D.6 Risk Assessment Plan

RLP No. 36C10F22R0047

1.0 OVERVIEW

1.1 Introduction

A risk is an event or condition that, if it occurs, could have a positive or negative effect on the project’s objectives. For the Rolla Community-Based Outpatient Clinic (CBOC) a risk assessment will be performed to ensure the design and construction facilitates safe and efficient delivery of patient care. Areas of concern will be identified and analyzed, and solutions developed to reduce negative effects. Risk assessment is an integral part of the overall management approach, and should occur and reoccur many times throughout a project: initiation, planning, execution, control and closeout.

1.2 Objective and Purpose

The objective is to make risk assessment paramount throughout the entire project process, and have planning and design team members intricately involved at each phase of execution.

Planners and the Lessor will identify areas that need to be analyzed to improve the capability of the clinic, and managers will foster a positive work environment to achieve a high level of analysis from the entire team.

2.0 PLANNING

2.1 Pre-Design Risk Assessment

In developing Lessor documentation, which includes a proposed facility layout, the planning team used programming guides, engineering specifications, and industry codes to provide an offeror a roadmap to bid on and build the future CBOC. Additionally, medical staff members and healthcare experts were highly involved throughout the entire assessment. The groups discussed risk and interviewed the users to ensure spaces were properly allocated and services were placed in appropriate locations. For example, the team placed sections with similar functions together or public service functions in easily accessible areas. Conference rooms and break rooms were moved to back-of-the-house areas so that those spaces can be shared by several offices, while logistics of materials and equipment was incorporated for each section and corridor. Patient and staff care were the priority when laying out plans for each floor, supported by the backbone of safety and security.

2.2 Data Driven Decisions

In performing a risk assessment, any decisions for modification or improvements will be supported with pertinent data and information. The team begins with codes and specifications, discussing options with users and experts, and examining the functional relationships. Risk assessment should also include reviewing patient population needs and trends, medical service

Appendix D.6 Risk Assessment Plan

RLP No. 36C10F22R0047 historical data, and policies and procedures that drive the specific clinics, as well as any other data or information that is pertinent to the facility design and operation.

3.0 WAY AHEAD

3.1 Continuous Risk Assessment

As stated above, risk assessment is an iterative process that begins in the planning stage and continues through design, construction, and facility operations. The design and construction phases will be similar to the pre-design risk assessment; however, it will be a more in-depth assessment to capture the details of the user needs.

Risk assessment is not a linear effort, and will be synchronized with the other management plans. It overlaps with all disciplines of a project, and is intimately related with quality management, budget, and schedule. Along with ensuring the facility is functional, continuous risk assessment will ensure that the clinic is constructible, maintainable, and sustainable.

3.2 Questionnaire

The risk assessment outlined has been primarily developed by following Facility Guidelines

Institute (2018 Ed), The Joint Commission, and National Fire Protection Association Code 99.

There are common topics and themes in these references, and have been condensed in the following groups: Safety, Infection Control, Fall Protection, Medication, Behavior & Mental

Health, Security, Patient Handling, Fire & Life Safety, and Hazardous Materials & Waste. The intent of the questions is to have users and experts analyze their areas and think through processes. This list should be expanded or modified to investigate necessary components of design, construction, and operations.

QUESTIONS YES NO N/A NOTES

SAFETY

Are you aware of any hazards that include physical obstacles and underlying conditions in your section that may directly or indirectly contribute to harm patients, staff, or other users?

Will patient equipment and supplies be on site for the planned healthcare services in your area?

Does the mechanism to replenish supplies require additional space or special consideration?

Appendix D.6 Risk Assessment Plan

RLP No. 36C10F22R0047

What safety and security issues should be specifically considered in the early stages of facility planning, design and construction?

What activities, systems, or equipment whose failure pose a risk of injury to patients, staff, or visitors?

INFECTION CONTROL

Do you have a high-risk area for infection and communicable diseases?

What policies and procedures are required to be in place to prevent, identify, and contain infections and communicable diseases? Please provide the policies.

What policies, procedures, and mechanisms should be in place to isolate and prevent contamination from any unused areas of the organization? Please provide the policy.

What is the required process for discarding contaminated supplies, medications, etc.? Please provide the policies.

Based on historical data and the patient population, what infection control measures should be in place? Please provide the policy.

Does patient population dictate requirements for isolation rooms?

Does your department have a history of Hospital

Acquired Infections? Please provide data.

Appendix D.6 Risk Assessment Plan

RLP No. 36C10F22R0047

FALL PREVENTION

Where do slips, trips, and falls occur in your department? Can you please provide the data?

What policies or procedures are in place in your department to prevent falls?

Based on your patient population and history, what areas or processes are considered at-risk?

What facility features do you find helpful to prevent falls for your patient population?

Do you have patient design features in place to reduce falls in your high risk areas?

Does your section/clinic serve a high-risk population?

What policies and procedures are in place to ensure nurse call stations are maintained and operational?

Based on patient population, how often are the nurse call systems used? And in what areas?

MEDICATION

What policies and procedures are in place to deliver, secure, and dispose of medication?

Identify number and locations of medication safety zones.

Are staff members able to control medications at all times?

What facility measures are needed to adequately secure drugs/ medication?

Appendix D.6 Risk Assessment Plan

RLP No. 36C10F22R0047

Does the current patient population pose a significant risk to appropriately securing medication? Please provide data on incidents.

BEHAVIOR HEALTH AND MENTAL HEALTH

What policies and procedures are in place to keep patient and staff safe/secure?

Based on patient population and historical data, what are the physical areas of concern?

Are service areas and transit area considered at-risk? Hallways & stairwells?

What doors to service and supply rooms will be required to be locked/secured?

What equipment or materials should be secured/locked or in an area inaccessible to patients/clients?

Do entrances and exits to the unit need to be within the line of sight of a nurses’ station?

Based on policy and history, are suicide prevention rooms required?

Questions Yes No N/A Notes

SECURITY

Is there a history in your department of security infractions?

What areas are considered security sensitive?

What access control measures need to be active in security-sensitive areas?

Appendix D.6 Risk Assessment Plan

RLP No. 36C10F22R0047

Given the history of the patient population, is closed-circuit TV appropriate in high-risk areas?

Or any other security measures?

Which reception and work areas need to provide staff with good visibility of patients/clients and visitors?

PATIENT HANDLING

What policies and procedures are in place in your area to ensure proper patient handling?

Based off patient population and historical data, what are the at-risk areas for patient handling?

Are patients able to easily move from your section to another clinic?

What process is in place to coordinate care and facilitate the transfer of patients/clients to an alternative provider or care site?

Based off historical data, does your area require special equipment? Ceiling lift vs portable lift, larger areas for maneuvering, etc.

Does your area require larger doors for exam and procedure rooms due to patient needs (bariatric, immobility, etc.)?

Does your clinic require special space or equipment at patient transfer points and in corridors?

FIRE & LIFE SAFETY

Appendix D.6 Risk Assessment Plan

RLP No. 36C10F22R0047

Do you have measures in place to ensure exits discharge individuals to a safe location outside the facility?

Has your section experienced challenges in personnel exiting the area?

What activity, system, or equipment do you have in your area whose failure is likely to cause patients or staff to have discomfort?

What activity, system, or equipment do you have in your area whose failure is likely to cause patients or staff to become injured?

According to policy and past experiences, what equipment or system requires back up power?

What systems in your area are currently connected to the Essential Electrical System?

HAZARDOUS MATERIAL AND HAZARDOUS WASTE

What policies and procedures are in place to properly manage your HAZMAT/HAZWASTE?

Based on patient care/population, do you have the appropriate/secure storage space for your required HAZMAT?

Based on patient care/population, do you have the appropriate/secure storage space for your

HAZWASTE that is produced?

Are your gas tanks, gas zones, and valves properly supplied, managed, and stored based on patient care supply needs? Please provide supporting data.

Appendix D.6 Risk Assessment Plan

RLP No. 36C10F22R0047

Is your medical and biohazardous waste storage and removal system adequate for the patient population/needs? Please provide supporting data.

Do storage, inventory, and disposal systems meet the requirements for Radioactive, Pharmaceuticals, and Chemicals materials?