Are there adequate tools to verify the activity of…

With the aim of becoming, as a newspaper, a tool for sharing information documentation useful for improving prevention strategies, we publish the contribution of one of our readers, Lara Fileccia, Prevention Technician at the AsFO Prevention and Protection Service (Western Friuli Health Authority).

The document presented by the reader, and attached to the article, is a checklist for the fire surveillance.

Check list for internal fire risk surveillance: experience in healthcare facilities

Fire prevention activity includes a large number of factors and situations that must be constantly monitored.

Legislative framework

The former Ministerial Decree of 10 March 1998 “General fire safety and emergency management criteria in the workplace” repealed by Ministerial Decree 1 September 2021, “General criteria for the control and maintenance of systems, equipment and other fire safety systems” defines how surveillance of fire prevention devices, a set of visual checks aimed at verifying, in the time between two periodic checks, that the systems, equipment and other fire safety systems are in normal operating conditions, are correctly usable and do not show obvious material damage . Surveillance can be carried out by workers normally present after having received adequate instructions (art. 1).

This activity is secondary to those of maintenance and control defined by legislation.

Furthermore, in annex 1 of the Ministerial Decree of 1 September 2021, point 2) Surveillance mentions “In addition to the periodic inspection and maintenance activities referred to in point 1, the equipment, systems and fire safety systems must be monitored with regularity by the workers normally present, adequately educatedthrough the preparation of suitable checklists”.

For healthcare facilities, other regulations apply in addition to the one mentioned above (used above all for administrative services in the healthcare context or other smaller entities and where the purely healthcare activity is not constant), for the remainder the Ministerial Decree of 29 March 2021 is applied. (Health facilities that provide hospital and/or residential hospitalization services on a continuous and/or day basis, retirement homes for the elderly with over 25 beds; Health facilities that provide specialist care services on an outpatient basis, including rehabilitation services , for instrumental and laboratory diagnostics, with a total surface area exceeding 500 m2)the Ministerial Decree of 18 September 2002 and the decree of 19 March 2015 containing “Approval of the fire prevention technical rule for the design, construction and operation of public and private healthcare facilities”.

However, the culture behind these regulations is the establishment of fire risk governance through the application of a Fire Management System. In this System the Employer also defines the surveillance method (with the characteristics mentioned in the Ministerial Decree 01/09/2021), in its workplaces.

Context of application of the checklist or checklist and information methods

In complex environments such as healthcare facilities, the surveillance of some preventive factors, such as free escape routes or the conservation of flammable substances, is often left to the good will of the operators or those in charge.

It must be considered that the high turnover of health workers that we have been assisting in recent years, in the various health facilities, does not help to manage well the control and surveillance of safety levels in the workplace such as, for example, the knowledge of all the exit routes present in that structure, the correct storage of flammable products in the various department warehouses, or the usability of fire extinguishers, etc. One of the consequences of turnover, applied to fire safety, is the continuous movement of workers, understood as new hires, terminated operators, internal movements, which does not allow a clear passage of deliveries and information, nor cognitive stability within the place and therefore of its management.

The other motivation that pushed for the creation of a shared tool is that issues relating to fire prevention in a department often come at the end of a myriad of problems considered more important both by those in charge and by the managers themselves.

In 2017, a checklist was created for make responsible and help operators to better understand the structure where they operate from an emergency management perspective.

There checklist was created to be used by everyone in a systematic way and not only to be in charge, like many other things, of the person in charge, also because in case of emergency, the person in charge might not be there, therefore it was deemed appropriate that all operators should be aware of your workplace with a view to managing emergencies more effectively, therefore this tool supports fire drills, as a constant reinforcement of this knowledge.

We started building the card and testing it as a pilot project on a few services, to evaluate its usefulness and feasibility. Given the good results, it was subsequently illustrated during the fire-fighting courses for staff and during specific courses for managers and supervisors. . This is in order to broaden the circle of informed people.

The communication choice was not to “drop it from above” as yet another thing to do in order to avoid obstructionism in the first phase, but above all to explain directly to the workers the reason why it was created, the compilation and its correct use.

The other information given is that the tool mentioned above it’s not mandatory, but it is part of those methods that the company adopts to improve its level of prevention; therefore if it is noticed that the checklist is not used over time, new methods will be sought to manage the fire prevention control and surveillance process.

Structuring of the checklist or check list

There checklist contains 11 items to check, listed below. The recipients of this checklist are all operators of a specific service. This tool must be filled in, not by a single identified operator, but by the whole working groupalternating on a monthly basis.

Before using the form, the SPP calls a meeting with the staff to illustrate the methods of compilation, the comment on each individual item, the methods of archiving it and the areas of competence for each service where the use of the form is recommended. form.

The form is present in the company Intranet. Once the card has been downloaded, the operator responsible for that month will have to carry out an inspection in the facility under his responsibility (in the context of an inpatient department, the average time for the survey is approximately 10 minutes).

The form consists of checking the 11 items. For each item it will be marked if the condition is consistent with reality (YES column) or if the real situation does not comply with that indicated on the form (NO column) or NOT APPLICABLE, where that condition does not exist or is not contemplated for that structure. The operator can also insert notes at his discretion to perfect the control.

In the event that, for items n° 1, 5, 6, 7, 8, 9 where the item Not is marked with * and the condition does not comply with that indicated (cross on the NO column) e.g. Item 1: The escape routes are maintained clear from deposits (materials, chairs, carpets, etc.) which could cause obstruction to their practicabilityit must be the operator’s responsibility to restore safety conditions (e.g. by removing the obstacle…).

In the event that for items n° 2, 3, 4, 10, 11 where the item is marked with * and the condition is not the one indicated (cross on the NO column) e.g. Item 2: The emergency exit doors are easily openable in the direction of the exodus *,the operator or his representative will send the form to the Technical Office which will be responsible for restoring the safety condition.

Once the inspection and any involvement of other structures have been completed, the operator will have to scan the form, send it to the relevant person and archive it.

The items identified are:

The escape routes are kept clear of deposits (materials, chairs, carpets, etc.) which could cause obstruction to their practicability
The emergency exit doors can be easily opened in the direction of escape *
Emergency exit doors close properly *
If the REI door is held open by the magnet, when it is unlocked the door closes correctly *
Dangerous substances/preparations are stored in places not accessible to outsiders (kept under lock and key)
The power sockets are free from paper and/or flammable material
The depots/warehouses are tidy and free from obstacles in movement
The technical rooms are free from stored materials
The fire extinguishers and/or fire cabinets present are located in an accessible and visible position
The fire extinguishers are present and are accompanied by the tag/label which certifies that the six-monthly maintenance has been carried out *
The pressure gauge of powder extinguishers has the needle in the green area *

Tracking data

The check list has been activated in 51 structures of the Pordenone healthcare company since 2017. Following the initial meeting to present the check list, we decided as SPP to leave each service free to apply the sheet, precisely to to prevent operators from feeling controlled in this activity, the data on the progress of the survey are reported below:

From 2017 to 2021, consistency in the application of the checklist was recorded in the 51 services analyzed, despite the pandemic event.

The data collected explains the following:

6 out of 51 services stopped using the checklist in 2021,
7 out of 51 services have stopped in 2022,
10 out of 51 services will have stopped in 2023.
28 services continue, without “pressure” from the SPP, to monitor the items on a monthly basis, reporting anomalies when they are found.

Conclusions

The reasons for theabandonment of the instrument are mainly attributable to the change of person in charge and to the failure to hand over deliveries and to forgetfulness.

The reasons for the I continue in the application of the list are attributable to the sense of responsibility of the individual operator and the importance of the task assigned to each during a possible emergency situation as, obviously, it is not known who will be present in that context and have full knowledge of the place of work supported by fire drills and the card helps the operator to be more efficient and effective.

The form is also illustrated at TYPE 1 – FOR courses according to Ministerial Decree 2 September 2021, to increase the sensitivity of operators to constantly apply it, also given the results obtained with the autonomous continuation by operators, the same will be illustrated and extended to all the company.

The repairs of the anomalies were quick and the completed checklist is treated as a report by the person in charge or worker pursuant to articles. 19 and 20 Legislative Decree 81/2008.

Following the specific courses for managers and supervisors, carried out according to the 2011 State-Regions Agreement, with the illustration of the method and its relevance regarding its level of prevention, requests increased for the application of the checklist in the services still discovered.