Form

QualityTools

Monmouth Transient Ischemic Attack and Minor Stroke Rapid Evaluation Center Referral Form 02/08/13

This referral form for emergency physicians or other specialists, helps assess a patient who recently experienced a transient ischemic attack (TIA) or a minor stroke. The form is a first step for assessing patients to determine the best stroke prevention strategies, care, and prevention based on individual test results and health needs.

Mission: Lifeline Tools and Resources 02/08/13

This Web site provides hospitals and health systems tools and resources to improve their systems of care when responding to a patient with ST-elevation myocardial infarction (STEMI) or out-of-hospital cardiac arrest.

Resources such as checklists, algorithms, protocols, strategies, requirements, fact sheets, and more are available under the following areas:

  • Systems
  • Emergency medical services
  • Referral center
  • Receiving center
  • ...
Detoxification Center Evaluation Checklist 02/06/13

The Detoxification Center Evaluation checklist can be used to evaluate intoxicated individuals to determine if they need to go to the emergency department or can safely be transported directly to a county detoxification facility.

The checklist is provided in the report linked below and also includes a followup form.

Pharmacy Survey on Patient Safety Culture 02/05/13

The Pharmacy Survey on Patient Safety Culture is designed specifically for community pharmacy staff and asks for their opinions about the culture of patient safety in their pharmacy. This Web page provides tools to help assess safety and quality-improvement areas to make changes in the facility. Included is a toolkit and the 2012 preliminary comparative results.

The toolkit includes the following:

  • Survey form
  • Survey composites and items
  • Survey user’s...
Enhancing the Management of Neuropathic Pain in the Long-Term Care Setting 01/24/13

This toolkit provides strategies and templates to help long-term care facilities and their clinicians implement a performance improvement project. The goal of this project is to help clinicians accurately and appropriately manage residents with neuropathic or persistent pain.

The toolkit includes the following components:

  1. Introduction
  2. Algorithm and instructions for toolkit implementation
  3. Sample data collection form and performance measures/...
Give Kids a Smile Toolbox 01/24/13

The American Dental Association launched the Give Kids a Smile (GKAS) program as a way for dentists across the country to join with others in their community to provide dental services to underserved children.

The GKAS Program Planning Toolbox is a resource for dentists and other team members interested in implementing the program in their community. The guide includes a step-by-step timetable on how to plan an educational, screening, or treatment event; how to promote the event...

ADOPT Toolkit 12/11/12

This Web site, for health care providers, offers “how to” resources on using technology to assist care coordination and improve the independence of older adults. The guides range from planning and development to implementation and evaluation in the following four areas:

  • Remote patient monitoring
  • Medication optimization
  • Care transitions
  • Mobile health

The toolkits contain checklists, lessons learned, and other resources to help to...
Migrant Clinicians Network Toolbox and Resources 10/23/12

This online collection for clinicians provides tools and resources for use in various departments of migrant and community health centers.

The Toolbox contains sample documents, forms, policies, tools, and protocols that can be adapted to meet the clinic’s needs to help provide quality health care to the underserved.

The Resource Database includes downloadable resources as well as links on a wide variety of primary care issues. It contains links to other organizations...

Comprehensive Unit-Based Safety Program Toolkit 10/23/12

The Comprehensive Unit-Based Safety Program (CUSP) toolkit provides training tools to make care safer by improving the foundation of how physicians, nurses, and other clinical team members work together. It builds the capacity to address safety issues by combining clinical best practices and the science of safety.

The CUSP toolkit is modular and modifiable to meet individual unit needs. Each module includes teaching tools and resources to support change at the unit level.
...

Road to Health Toolkit Evaluation Guide 10/09/12

This toolkit for community health workers, diabetes educators, and health educators presents easy-to-use tools for collecting key pieces of data in evaluations. The evaluation tools assist in determining how the Road to Health Toolkit is being implemented and if any changes are needed for participants at risk for type 2 diabetes.

The toolkit includes three forms to collect data:

  • Road to Health Intervention Tracking Form: Group Sessions
  • Road to Health...

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