Posts Tagged ‘Forms/Templates’

BEAGLES – Surgical Site Infection Poster

Friday, May 6th, 2011

BEAGLES – Surgical Site Infection Poster

This poster was developed to assist bedside clinicians to betterunderstand and to remember the quality measures associated withdecreasing surgical site infections. The poster displays an acronymthat can help all to remember.

This was edited from a prior CATS poster submitted by HealthServices Advisory Group.

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Georgia Medical Care Foundation

Atlanta, Georgia

 

 

NHSOPS Planning Tool

Friday, May 6th, 2011

NHSOPS Planning Tool

A template for use in translating results from the AHRQ Nursing Home Survey on Patient Safety Culture survey into actionable improvement.

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Patient Safety QIOSC, Stratis Health

Bloomington , Minnesota

 

NH Action Planning Template

Friday, May 6th, 2011

NH Action Planning Template

A template for use in translating results from a Nursing Home Survey on Patient Safety Culture survey into actionable improvement.

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Patient Safety QIOSC, Stratis Health

Bloomington, Minnesota

 

Long Term Care Intake Form

Friday, May 6th, 2011

Long Term Care Intake Form

An intake form to be used as a screening tool before acceptance into LTC/Skilled Nursing Facility that assists in identifing resident needs prior to arrival and identifying  information for MDS coordinator/submission of data.

Please note that this should not be used as a transfer form.

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OFMQ

Oklahoma City, Oklahoma

 

 

Hall Pass Hand-off Form

Friday, May 6th, 2011

Hall Pass Hand-off Form

This hand-off form, called a Hall Pass, is used by Warren Memorial Hospital in Front Royal, VA.  The department secretary fills out what they can, then when the patient is admitted, the nurse fills in any blanks.  The departments that the patient goes to for tests or procedures use the second page to send any info back for the nurse and a contact number, if they have questions.  These forms are printed in bright green so they are easily identified.

This document was used in a hospital, but can/should be adapted to your facility’s requirements.

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Warren Memorial Hospital

Front Royal, Virginia

 

 

 

Hall Pass Hand-off Form

Thursday, May 5th, 2011

Hall Pass Hand-off Form

This hand-off form, called a Hall Pass, is used by Warren Memorial Hospital in Front Royal, VA.  The department secretary fills out what they can, then when the patient is admitted, the nurse fills in any blanks.  The departments that the patient goes to for tests or procedures use the second page to send any info back for the nurse and a contact number, if they have questions.  These forms are printed in bright green so they are easily identified.

This document was used in a hospital, but can/should be adapted to your facility’s requirements.

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Provider

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Warren Memorial Hospital

Front Royal, Virginia