Oral Care Clinical Evaluation Form

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Oral Hygiene Products

Reducing VAP/HAP Risk Factors - Product Evaluation Form

To create your custom Product Evaluation Form, start by entering the following information:

Sales Representative Name:		Click here to print the full list of statements. Click here to print a sample of a finished form.
Facility Name:
Sage Product #:

Next, check the boxes next to the statements you would like to have printed on the form. A maximum of 10 statements can be selected. When finished, click "Next Step."

I understand my unit's oral cleansing and suctioning protocol.

I understand routine oral cleansing and suctioning can help address three risk factors for healthcare-associated pneumonia (HAP).

I understand the importance of maintaining the integrity of the closed in-line tracheal system.

The Q·Care® system's ease-of-use enabled me to provide more frequent oral cleansing.

The Q·Care® system's premixed cleansing solution saves time.

The Q·Care® system's comprehensive package is convenient to use, saves nursing time and promotes a standard approach to oral care.

The Covered Yankauer's retractable sheath helps protect itself from environmental debris [excludes Q·Care® Petite Yankauer (#6720) in #6704 kit].

The Suction Catheter effectively removes secretions from the oropharyngeal cavity.

Toothette® Oral Care Mouth Moisturizer effectively moisturized the lips and oral tissues.

By keeping oral care tools available at the point of use, the Q·Care® Bedside Bracket saves time and eliminates steps.

I recommend the Q·Care® Oral Cleansing and Suctioning System over previous interventions.

The Q·Care® system makes it easier to follow my units oral care protocol.

Compared to previous interventions, the Q·Care® system makes it easier to comply with my unit's oral care protocol.

I understand the importance of brushing teeth to remove dental plaque, a known risk factor for healthcare-associated pneumonia (HAP).

A single unit dose of oral chg included in the kit makes it easier to comply with my unit's protocol.

A single unit dose of oral chg included in the kit improves compliance to comprehensive oral care.

Oral Check bar code system makes it easier to document that oral care has been done.

The Sage Suction Toothbrush, with over 4000 contact points and nylon bristles, is effective in removing plaque.

The Sage Suction Toothbrush, with swab on the back, delivers the proper amount of solution to perform oral care

The perpendicular ridges on the Sage Suction Swab allow me to better remove thick oral secretions.

The sodium bicarbonate in the Sage Suction Toothbrush and Suction Swab aid in breaking down thick oral secretions for easier cleaning.

The burst packets provide an easier method for saturating the swab or brush with the appropriate amount of solution.

This area of our website and its content is intended for healthcare professionals only.

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