Sample Performance Improvement Plan
Assess the impact of clinical intervention—through implementation of a pressure-relieving heel protection device—on heel pressure ulcer rates and foot drop prevention at your facility. This template includes a section to list your facility's desired objectives, your protocol, and an area to record results (including heel pressure ulcer rates, economic impact and a Clinical Evaluation Form summary).
Step 1. Establish your facility’s objectives for preventing heel pressure ulcers and foot drop. Then enter them into the left hand column of the Performance Improvement Plan template.
Performance Improvement Plan Template |
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Customize
View/print only (*.pdf)
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Step 2. Customize a Clinical Evaluation Form to measure and record staff opinions about preventing heel pressure ulcers and foot drop and the effectiveness of new practices.
Clinical Evaluation Form |
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Customize* |
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| Step 3. Analyze your results to determine the best protective heel device to achieve protocol compliance and meet documented objectives. Record your results in the right hand column of the Performance Improvement Plan template. |
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* You will need Adobe Acrobat®. If you do not have Adobe Acrobat® installed on your computer, you can download it for free by clicking here. |
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