Clinical Evaluation Form - Preventing Incontinence-Associated Dermatitis (IAD)

Sales Force Login   Speaker Login   Distributor Locator   Contact Us

Home > Clinical Education > Preventing Incontinence-Associated Dermatitis (IAD) > Clinical Evaluation Form

	Clinical Support
	Symposia Presentations Other Expert Presentations Published Studies and Articles Continuing Education Professional Guidelines
	Implementation Tools
	Pre-Trial Checklist (.doc) Implementation Plan (.doc) Clinical Practice Assessment IAD Prevalence Data Collection Product Evaluation Form Customizable Protocol Performance Improvement Product Evaluation Form
	Education Tools
	Training Video (flash) Training Posters
	Related Organizations
	Government/Associations Publications


	Upcoming Events

Clinical Evaluation Form

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

Your Name:		Click here to print the full list of questions. Click here to print a sample of a finished form.
Facility Name:
Unit:
Sage Product #:
Return Form To:

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

I recognize the importance of skin cleansing and barrier application in maintaining perineal skin integrity, and Comfort Shield® helps me better facilitate this process.

Comfort Shield® makes it easier to follow my unit's incontinence skin care protocol.

Comfort Shield's® mild cleansing formula is an improvement over our current soap/cleanser, barrier cream(s) and other products.

Comfort Shield® washcloths effectively cleaned the perineal skin.

Comfort Shield® washcloths were smooth and comfortable on my patient's skin.

I understand the importance of perineal skin assessment, and Comfort Shield's® transparent barrier makes assessment easier.

Comfort Shield® washcloths were easy to use.

Comfort Shield® saved considerable time versus the current method.

Comfort Shield's® ease of use saves time and enables me to focus on other patient care activities.

With Comfort Shield®, I decreased the amount of linens, washcloths, towels, cleansers, moisturizers and barriers used vs. previous methods of incontinence care.

Comfort Shield® replaces other incontinence care products. (Circle all that apply: washcloths, wipes, basins, cleansers, soaps, moisturizers, barrier creams/ointments)

The Comfort Personal Cleansing® Microwave and/or Warmer was easy to use and saved time.

I believe Comfort Shield's® cleansing/protective washcloths are an improvement in the quality of patient care at this facility.

My patients like Comfort Shield®.

My patients prefer Comfort Shield® over previous methods of incontinence care.

I recommend Sage Comfort Shield® over previous methods of incontinence care.

The Comfort Personal Cleansing® Microwave and/or Warmer was easy to use and saved time.

I recognize the importance of routine skin monitoring, and this new communication tool (Peri-Check™ Guide) better facilitates this process.

The Peri-Check™ Guide is easy to use and understand.

The Peri-Check™ Guide is an effective communication tool between the caregiver and nurse.

This new communication tool (Peri-Check™ Guide) enables me to better meet my unit's reporting protocol.

The Peri-Check™ Guide is a useful reminder of the importance of routine skin monitoring.

I believe this communication tool (Peri-Check™ Guide) is an important improvement in the quality of patient care at this facility.

The new Shield Barrier Station made it more convenient and easy to apply the barrier 100% of the time.

The Shield Barrier Station bedside made it easier for me to facilitate incontinence care.

The Shield Barrier Station makes my job more efficient so I can do other patient care activities.

Skin condition of the incontinent patient looks better because of the Barrier Station and Comfort Shield Barrier Cloths.

Storing the barrier cloths in the barrier station vs. the warmer facilitates better practice.

I prefer the Shield Barrier Station and Shield Barrier Cloths compared to my previous approach to incontinence care.

Bedside availability helped me utilize the right product for incontinence clean-up.

I prefer having the product available at the bedside.

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