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Patient Safety Improvement Table of Contents

JOINT COMMISSION SUGGESTED PSI PLAN DESIGN & OUTLINE
Development Strategy and Organizational Impact
Program Goals	Consistent with organization mission
Scope of the Program	Activities & functions related to patient safety Participating sites, settings, and services
Structure	Management of the patient safety program Components (safety-related offices, committees, functions) Interdisciplinary participation Oversight
Mechanisms for Integration and Coordination	Among components of the Program Among the professional disciplines Across the organization
Communicating with Patients about Safety	Patient education Informing patients about their care
Staff Education	Safety-related orientation and training Team training Expectations for reporting
Patient Safety Assessment & Improvement Strategies Activities	Prioritization of improvement activities
	Routine safety-related data collection and analysis
	Incident reporting Medication error reporting Infection surveillance Facility safety surveillance Staff perceptions of, and suggestions for, improving patient safety Staff willingness to report errors Patient/family perceptions of, and suggestions for, improving patient safety
	Identification, reporting, and management of sentinel events
	Proactive risk management
	Identification of high-risk processes Failure mode, effects, and criticality analysis
	Reporting of results
	To the Patient Safety Program To organization staff To executive leadership and the governing body
	Definition of Terms (Glossary)

PATIENT SAFETY IMPROVEMENT PLAN SUPPORTING EXHIBITS
1	2008 PSI Dashboard (12 Month) Template [New for 2008]
2	Sample PSI Dashboard 12 Month Summary for Education and Comparing Performance [Excel]
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PSI PROGRAM POLICIES (Alphabetical Order)
3	2008 Patient Safety Improvement Plan [New for 2008]
4	Abbreviations and Symbols Policy
5	Anticoagulation Guideline Policy [New for 2008]
6	Code RRT Medication Boxes
7	Code RRT Policy and Process Diagram [New for 2008]
8	Correct Patient Side and Site Policy
9	Critical Test Results Policy
10	Disclosure of Medical Accidents Policy
11	Fall Prevention Assessment Policy
12	Filing of Incident and Occurrence Report Policy
13	Food Drug Interaction Policy [New for 2008]
14	High Alert Medication Policy
15	INFECTION CONTROL PLAN [Policy Format]
16	Interdisciplinary Discharge Planning Policy [New for 2008]
17	Instructions for Using Hand Hygiene Observation Tool
18	Interdepartmental Transfer / Hand-off Policy and Form/td>
19	Medication, Medication Containers, and other Solutions: Preparation, Labeling, and Dispensing
20	Medication Variance Reporting Policy
21	New Employee Orientation Program Policy
22	Nursing Change of Shift Report Policy
23	O.R. Medication, Solution and Container Labeling Policy
24	Patient Identification Time Out Policy
25	Patient Rights and Responsibilities Policy
26	Safe Anticoagulation Therapy Plan (Policy Format) [New for 2008]
27	SBAR Guideline for RRT Communication [New for 2008]
28	Sentinel Event Policy and RCA Tools
29	Solution and Container Labeling in the O.R.
30	Suicide Awareness Policy
31	Telephone Verbal Orders Policy
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PSI PROGRAM FORMS (Alphabetical Order)
32	2008 Hospital Patient Safety Goals and Change Summary
33	2007 Annual PSI Program Appraisal Template
34	Anticoagulation Flowsheet [New for 2008]
35	Anticoagulation Services Patient Handout [New for 2008]
36	Calculation for Hand Cleaner Use [Excel]
37	Code RRT Decision Tree for Hospital Operator [New for 2008]
38	Code RRT Guideline for Hospital Operator [New for 2008]
39	Coumadin (Warfarin) INR Flowsheet [New for 2008]
40	Decision Tree for Suspected SE [PowerPoint]
41	Environment of Care Surveillance Rounds Documentation Form
42	Fall Prevention Home Brochure
43	Fall Prevention Hospital Brochure
44	Hand Hygiene / Glove Use Observation Form
45	Heparin Infusion Physician Order Set [New for 2008]
46	HIM MR Review Form [Excel]
47	How to Conduct a 2006 Annual Appraisal [PowerPoint]
48	Initiation of Suicide Awareness Competency Program
49	Initiation of Suicide Awareness / Precautions Checklist Form
50	Lovenox and Heparin Physician Order Set [New for 2008]
51	MD Discharge Order Form
52	Medication History and Tracking Form
53	Medication Look Alike Sound Alike Drug List (PDF)
54	Medication Tracking Form - For Patients
55	Medical Staff Newsletter for IHI 100,000 Live Campaign [New for 2008]
56	Nursing Change of Shift Report Form
57	Nursing 24 Hour Flow Sheet [PDF]
58	One-Page CDC Hand Hygiene Summary Form
59	Op and Invasive TIME OUT Procedure Form [PDF]
60	Organizational and Departmental Orientation Form [New for 2008]
61	Partners in Safety Brochure
62	Partners in Safety Code RRT Patient Safety Brochure [New for 2008]
63	Patient Discharge Medication Form -- For Nursing [New for 2008]
64	Patient Safety Improvement Information Flow Process
65	Patient Safety Staff Survey Form
66	Physician Order Set - Adult DVT [New for 2008]
67	Physician Order Sheet with No Abbrev Form
68	PSI Reporting Structure Form [PowerPoint]
69	PSI Staff Survey Questionnaire Form
70	PSI Staff Survey Report Template Form [PowerPoint]
71	Rapid Response Team Evaluation Form [New for 2008]
72	Rapid Response Team Record [New for 2008]
73	RCA Assessment Action Plan Form
74	RCA Matrix Form
75	Risk and Coping Assessment Form
76	Safe Medication Info Brochure for Patients
77	SAMPLE Failure Mode and Effects Analysis Form
78	SAMPLE Fall Prevention FEMA Form
79	SAMPLE Letter to MDs to Introduce New Medication Documentation Process
80	SE Assessment Criteria Form [Excel]
81	SE Evaluation Process Steps Form [PowerPoint]
82	Six Sigma Falls Prevention Analysis [PowerPoint]
83	Suicide Awareness Checklist Form
84	Ten Safety Tips Template for Patients in English
85	Ten Tips for Patients Template in Spanish
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TO ERR IS HUMAN ABSTRACTS Permission Granted From Institute of Medicine
	Executive Summary
Chapter One	A Comprehensive Approach to Improving Patient Safety
Chapter Two	Errors in Health Care: A Leading Cause of Death and Injury
Chapter Four	Building Leadership and Knowledge for Patient Safety
Chapter Seven	Setting Performance Standards and Expectations for Patient Safety
	Glossary
	Index
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