Sample Performance Improvement Plan
Track the impact of Routine Oral Care and Closed End Suction on VAP rates at your facility with this customizable template. |
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Customize
(Microsoft® Word Document)
Download (.pdf*)
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Sample Process Improvement Plan
Assess staff knowledge and opinions about oral care practices in your facility. This template includes a section to list your facility's desired oral care objectives, your protocol, and an area to record results from the Clinical Evaluation Form. |
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| Step 1. Establish your facility's objectives for oral care. Then enter them into the left hand column of the Process Improvement Plan template. |
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Process Improvement Plan Template
Customize
(Microsoft® Word Document)
Download (.pdf*)
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| Step 2. Customize a Clinical Evaluation Form to measure and record staff opinions about oral care and the effectiveness of new practices. |
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Q·Care Clinical Evaluation Form for codes 6402, 6404, 6412, 6414, 6802, 6804, 6808, 6812, 6704, 6602
Customize* |
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Q·Care Rx Clinical Evaluation Form for codes 6904, 6912, 6914
Customize* |
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| Step 3. Analyze your completed Clinical Evaluation Form to determine the best oral care tools to achieve protocol compliance and meet objectives. Record results in the right hand column of the Process 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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