PROPOSED CHANGES TO THE 2016 LEAPFROG HOSPITAL SURVEY
|
|
- Lee Day
- 8 years ago
- Views:
Transcription
1 PROPOSED CHANGES TO THE 2016 LEAPFROG HOSPITAL SURVEY OPEN FOR PUBLIC COMMENT Eh yer, The Lepfrog Group s tem of reserhers reviews the literture nd onvenes expert pnels to review survey ontent to ensure the Lepfrog Hospitl Survey ligns with the ltest siene s well the puli reporting needs for purhsers nd onsumers. One list of proposed hnges is finlized for the next yer s survey, Lepfrog releses those hnges for puli omment. Comments re reviewed y Lepfrog s tem of reserhers nd frequently used to further refine the survey. The proposed hnges to the Lepfrog Hospitl Survey in 2016 re outlined elow. To provide puli omment, plese respond y ompleting the puli omment form loted here. Comments will e epted until COB Deemer 22, We re grteful to those who tke the time to sumit omments eh yer. These omments ring enormous vlue to Lepfrog s tem nd ensure the survey is vlule to hospitls, purhsers, nd onsumers. For informtion on the 2015 Lepfrog Hospitl Survey visit PROPOSED CONTENT CHANGES SECTION 1: BASIC HOSPITAL INFORMATION No sustntive hnges proposed to this setion. SECTION 2: COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE) No sustntive hnges proposed to this setion. SECTION 3: EVIDENCE-BASED HOSPITAL REFERRAL (EBHR) Due to the ntionl trnsition to ICD-10 dministrtive oding on Otoer 1, 2015, the 12-month reporting period for ll four surgil proedures (orti vlve replement, dominl orti neurysm repir, pnreti resetion, nd esophgel resetion) inluded in Setion 3 EBHR, will e Otoer 1, 2014 to Septemer 30, 2015 to llow hospitls to report on the mesures using ICD-9 oded dministrtive dt. There re no proposed hnges to the soring lgorithm for this stndrd. See pges 8-10 in the 2015 Soring Algorithms for more informtion. Over the next yer, Lepfrog will e onvening ntionl expert pnel with the gol of developing 1
2 new stndrd for surgil sfety nd qulity tht onsiders hospitl nd surgeon volume nd outomes, s well s protools tht hospitls hve in ple to monitor nd prevent inpproprite use. We welome suggestions nd omments on ttining this gol. SECTION 4: MATERNITY CARE No sustntive hnges proposed to this setion. See ICD-10 speifitions nd updtes regrding reporting periods in Appendix I. There re no proposed hnges to the soring lgorithm for this stndrd. See pges in the 2015 Soring Algorithms for more informtion. SECTION 5: ICU PHYSICIAN STAFFING (IPS) We re proposing n dditionl response type for questions #5 nd #6 in Setion 5: ICU Physiin Stffing (IPS). The new response type will give hospitls the opportunity to report 24/7 intensivist overge in n pplile ICU. See detils elow. Yes Question #5: When these physiins re not present in these ICUs on-site or vi telemediine, do they return more thn 95% of lls/pges from these units within five minutes, sed on quntified nlysis of notifition devie response time? No Not pplile, Intensivists re present 24/7 Question #6: When these physiins re not present on-site in the ICU or not le to reh n ICU ptient within 5 minutes, n they rely on physiin, physiin ssistnt, nurse prtitioner, or FCCS-ertified nurse effetor who is in the hospitl nd le to reh these ICU ptients within five minutes in more thn 95% of the ses, sed on quntified nlysis of notifition devie response time? Yes No Not pplile, Intensivists re present 24/7 There re no proposed hnges to the soring lgorithm for this stndrd. Hospitls tht respond Not pplile, Intensivists re present 24/7 to oth question #5 nd question #6 will e sored in the sme wy s hospitls tht respond yes to those questions. See pge 15 of the 2015 Soring Algorithms for more informtion. 2
3 SECTION 6: NQF SAFE PRACTICES SCORE Erlier this yer, Lepfrog onvened ntionl expert pnel to updte the wording of the sfe prtie elements inluded in Setion 6 NQF Sfe Prties Sore to provide greter lrity to hospitls, nd ensure urte, stndrd responses ross ll hospitls. In ddition to wording updtes, the pnel lso reommended the following hnges to e onsistent with the NQF Sfe Prties for Better Helthre 2010 Updte nd the 2010 Sfe Prties Audit ompleted y NQF in 2014 (See tles 1 nd 2 elow). Plese see Appendix IV for detiled wording hnges. In ddition, the Culture of Sfety ntionl expert pnel performed omprehensive review of Sfe Prtie 2 Culture Mesurement, Feedk, nd Intervention nd hs identified gps in this prtie. The pnel is reommending the ddition of four (4) sfe prtie elements (see Appendix IV for detils). In response to questions out whih sfety ulture surveys meet the intent of Sfe Prtie 2, the pnel hs lso developed set of Guidelines for Culture of Sfety Survey tht Demonstrtes Vlidity, Consisteny, nd Reliility tht will e rolled out in Plese see Appendix II. Tle 1: Summry of Chnges to NQF Sfe Prties Sore NQF Sfe Prtie Weighting (totl possile points) 2015 Survey - # of Sfe Prtie Elements 2016 Survey - # of Sfe Prtie Elements Chnge in # of Sfe Prtie Elements 1 Culture of Sfety Ledership Strutures nd Systems Culture Mesurement, Feedk, nd Intervention Temwork Trining nd Skill Building Risks nd Hzrds Nursing Workfore Medition Reonilition Hnd Hygiene Helth Cre Assoited Complitions in Ventilted Ptients
4 There re no proposed hnges to the soring lgorithm for this stndrd. See pges of the 2015 Soring Algorithms for more informtion. SECTION 7: MANAGING SERIOUS ERRORS New Su-Setion on Antiioti Stewrdship Progrms In order to support ntionl efforts round the responsile use of ntiiotis in hospitls, Lepfrog will e pulily reporting hospitl ompline with the CDC's stndrds for Antiioti Stewrdship Progrms. The CDC hs pulished seven Core Elements of Antiioti Stewrdship Progrms: Ledership ommitment Aountility Drug Expertise Ation Trking Reporting Edution To ollet this informtion regrding hospitl doption of these seven Core Elements, Lepfrog will use set of 12 questions from the NHSN Annul Hospitl Survey on ntiioti stewrdship progrms (questions #23-34 from the NHSN Annul Hospitl Survey). For omplete list of questions, plese see Appendix III. Proposed Soring Algorithm Hospitls tht hve dopted ll seven of the Core Elements will e sored s Fully Meets the Stndrd. Hospitls tht hve dopted fewer thn seven of the Core Elements will e sored s Willing to Report. Lepfrog is intending to pulily report this mesure in New Hospitl-Aquired Infetion Mesures In response to requests from hospitls, Lepfrog will inlude three dditionl hospitl-quired infetion mesures on the survey: MRSA, CDI, nd SSI fter Mjor Colon Surgery. These mesures ome diretly from the NHSN nd re in use in one or more CMS inptient progrms. Unlike the entrl-line ssoited lood strem infetion nd theter-ssoited urinry trt infetion mesures, these mesures do not require hospitls to report y speifi unit or wrd, s they re hospitlwide inptient or surgery speifi mesures. Therefore, Lepfrog will not sk hospitls to report numertor nd denomintor. Insted, hospitls will report the stndrdized infetion rtio (SIR) s lulted y NHSN for speified 12- month reporting period. Hospitls sumitting survey prior to Septemer 1, 2016 will e sked to report on the 12-months ending Deemer 31, Hospitls sumitting survey on or fter Septemer 1, 2016 will e sked to report on the 12-months ending June 30,
5 Proposed Soring Algorithm Performne Ctegory SSI Colon SIR MRSA SIR CDI SIR Fully Meets the Stndrd Sustntil Progress > nd > nd > nd Some Progress > nd > nd > nd Willing to Report >1.375 >1.251 >1.093 Does Not Apply Hospitl does not perform mjor olon surgery Lepfrog is proposing to pulily report these results in In ddition, Lepfrog ntiiptes using these results in the Fll 2016 Hospitl Sfety Sore for eligile hospitls. ICD-10 Codes for Hospitl-Aquired Conditions Plese see ICD-10 speifitions nd updtes regrding reporting periods in Appendix I. There re no proposed hnges to the soring lgorithm for the stndrds in Setion 7 Mnging Serious Errors. See pges of the 2015 Soring Algorithms for more informtion. SECTION 8: BAR CODE MEDICATION ADMINISTRATION (BCMA) The BCMA expert pnel determined tht the initil fous of Lepfrog s BCMA stndrd should e the use of BCMA t the edside in dministrting meditions. The BCMA expert pnel mde reommendtion for Lepfrog s stndrd sed on the results from this setion of the 2015 Lepfrog Hospitl Survey. The proposed stndrd is omposite of four omponents: % Units: A hospitl s implementtion of BCMA throughout the hospitl, s mesured y the perentge of units with fous on dult nd peditri medil nd/or surgil units, lor nd delivery units, nd intensive re units (dult, peditri, nd neontl). % Compline: A hospitl s ompline with ptient nd medition sns prior to med dministrtion. 5
6 Deision Support: The types of deision support tht the hospitl s BCMA system offers, inluding: 1. Wrong ptient 2. Wrong medition 3. Wrong dose 4. Wrong time (e.g., erly/lte wrning; wrning tht medition nnot e dministered twie within given window of time) 5. Vitl sign hek 6. Ptient-speifi llergy hek 7. Seond nurse hek needed Workrounds: A hospitl s strutures to monitor nd redue workrounds, inluding: 1. Hs forml ommittee tht meets routinely to review dt reports on BCMA system use 2. Hs k-up systems for hrdwre filures 3. Hs help desk tht provides timely responses to urgent BCMA issues in rel-time 4. Conduts preventtive mintenne on hrdwre 5. Conduts rel-time oservtions of users using the BCMA system 6. Engges nursing ledership t the unit level on BCMA use Proposed Soring Algorithm Fully Meets Stndrd Sustntil Progress Some Progress Willing to Report % Units 100% % Compline 95% Deision Support 7 out of 7 Hospitl meets 3 out of 4 stndrds Hospitl meets 2 out of 4 stndrds Hospitl meets 1 or 0 out of 4 stndrds Workrounds 6 out of 6 These results will e pulily reported in SECTION 9: RESOURCE USE Currently, in Setion 9 Resoure Use for Common Aute Conditions, Lepfrog sks hospitls to report on oth risk-djusted lengths of sty nd redmission rtes for three ommon ute onditions: AMI, Hert Filure, nd Pneumoni. In 2016, due to the ntionl trnsition to ICD-10 dministrtive oding nd the hllenges of updting the risk djustment model given the srity of pulished ICD-10 dministrtive dt sets, Lepfrog will remove the length of sty mesures from this setion of the survey. 6
7 The redmission rtes re reported diretly from the CMS Hospitl Compre wesite. These rtes re omined into volume-weighted omposite for n overll sore. In ddition to removing the length of sty mesures, we re plnning on severl dditionl hnges: New Mesures: We will dd three dditionl redmission mesures to this setion to etter lign with the CMS Redmission Redution Progrm: CABG, COPD, nd THA/TKA. Soring: Lepfrog will ontinue to lulte volume-weighted omposite sore for hospitl redmissions. The omposite will e mde up of six, rther thn three mesures. No other hnges to the soring lgorithm re ntiipted. See pges for desription of the 2015 Soring Algorithms. Dt Entry: Hospitls will no longer need to look up the volume nd redmission rte for eh mesure. This informtion will e pre-populted in eh survey sed on the hospitl s Medire Provider Numer. Hospitls will still need to respond to some filter questions nd ffirm the setion efore it n e sumitted. Puli Reporting: Lepfrog plns to pulily report this updted redmissions omposite in
8 NON-CONTENT RELATED CHANGES NEW ONLINE SURVEY TOOL & SURVEY LAUNCH DATE ON APRIL 15, 2015 Lepfrog will e lunhing new nd improved survey wesite nd online survey tool in The new online survey tool hs een re-designed with feedk from hospitls nd hospitl systems ross the ountry. Due to the development nd testing of the new tool, the online survey tool will not e ville to hospitls until April 15, The hrd opy of the survey nd soring lgorithms, s well s tools nd supporting mterils will e ville on April 1 st so tht hospitls n egin to ollet dt nd reord responses in the hrd opy of the survey. However, the online survey tool nd CPOE Evlution Tool will not e ville for sumitting responses until April 15 th. The new online survey tool will inlude three importnt funtions: 1. Profile: The profile setion of the online survey will e ville to hospitls yer-round to ensure tht hospitls re lwys le to provide the most urrent informtion regrding hospitl nme, ddress (physil nd miling), ontt informtion, MPN, nd other generl informtion tht my hnge during the yer. 2. New Survey Dshord: The newly designed survey dshord will inlude setion nd su-setion nvigtion, setion sttus, nd list of dt entry errors y setion. Hospitls will lso ffirm setions nd sumit the survey diretly from the dshord. Hospitls will e le to run desk review efore they sumit, s well s print opies of their lst sved survey, lst sumitted survey, nd previous yer s survey. Hospitls will lso e le to ess their detil pges whih inlude onfidentil soring informtion. Lstly, the dshord will inlude link to the CPOE Evlution Tool (for dult hospitls only) nd link to the CPOE Evlution Tool sore one the Tool hs een sumitted. 3. New Survey Tool: Lepfrog hs upgrded the survey pltform nd enhned the user experiene through omplete re-design tht inludes n uto sve feture (to redue the onfusion etween sving nd sumitting survey ) s well s new questions lyouts nd setion-level nvigtion. To provide puli omment, plese respond y ompleting the puli omment form loted here. Comments will e epted until COB Deemer 22, Thnk you for your interest in the Lepfrog Hospitl Survey. 8
9 APPENDIX I ICD-10 Codes nd Updted Reporting Periods for the 2016 Lepfrog Hospitl Survey for Setion 4 Mternity Cre nd Setion 7 Mnging Serious Errors Bkground As of Otoer 1 st, 2015, ll providers/entities overed y the Helth Insurne Portility nd Aountility At re required to omply with the implementtion of ICD-10 for medil oding, s indited in finl rule estlished in Jnury of 2009 y the U.S. Deprtment of Helth nd Humn Servies (DHHS). Aording to regultions, oded servies provided on or fter Otoer 1 st, 2015 must e oded using ICD-10. Code servies provided efore Otoer 1 st, 2015 must e oded using ICD-9. Reporting Periods Given the implementtion dte of Otoer 1 st, Lepfrog hs djusted the reporting periods for those mesures tht require ICD dignosis or proedure odes. The reporting periods for seleted mesures will e 9-months s speified elow: Jnury 1, 2015 Septemer 30, 2015, for surveys sumitted prior to Septemer 1, 2016 (will use ICD-9 odes); Otoer 1, 2015 June 30, 2016 for surveys (re)sumitted on or fter Septemer 1, 2016 (will use ICD-10 odes) 9
10 SECTION 4 MATERNITY CARE REFERENCE INFORMATION The following Mternity Cre mesures will require the use of 9-month reporting period nd ICD-10 odes if surveys re (re)sumitted on or fter Septemer 1, 2016: Mternity Cre Volume Erly Eletive Deliveries (PC-01) NTSV Cesren Setion (PC-02) Inidene of Episiotomy DVT Prophylxis in Women Undergoing Cesren Setion High-risk Neworn Deliveries (inluding PC-03) MATERNITY CARE VOLUME Use the following mesure speifitions for surveys sumitted on or fter Septemer 1, Totl Live Births Soure: The Lepfrog Group Reporting Time Period: Otoer 1, 2015 June 30, 2016 for surveys (re)sumitted on or fter Septemer 1, 2016 Question 3: The numer of live irths t this hospitl lotion, reported to your stte during the reporting time period. Alterntively, the elow list of Z odes n e used to identify live irths, with the ution tht these odes re oded for the neworn, not the mother; likely to e found in your hospitl s irth CIS/medil reord system; ut often not in lims dt sine norml neworn re my e inluded in the mother s lim without y s dignosis oding. Z38.00 Z38.01: Single liveorn infnt, orn in hospitl Z38.30 Z38.31: Twin liveorn infnt, orn in hospitl Z38.61 Z38.69: Other multiple liveorn infnt, orn in hospitl Note: This dt point is simply used to qulify hospitl for further reporting of the norml delivery mesures. 10
11 EARLY ELECTIVE DELIVERIES Use the following mesure speifitions for surveys sumitted on or fter Septemer 1, Note on Chnges: Note 1: Mesure speifitions for identifying the denomintor for Erly Eletive Deliveries is now using ICD proedure odes tht indite delivery (previously the denomintor speifitions used ICD dignosti odes tht indited pregnny). Note 2: The exlusion riterion for the denomintor for gesttionl ge now inludes the exlusion of ses where the gesttionl ge is unle to determine. Note 3: the mesure speifition for identifying the numertor for erly eletive deliveries no longer inludes the inlusion riterion for esren irths where the ptient is not experiening spontneous rupture of memrnes. Other Notes: Note 1: Erly Eletive Deliveries n e reported sed on ll eligile ses OR suffiient smple of ses s outlined in the denomintor speifitions. Note 2: Lepfrog uses the speifitions reted y The Joint Commission (TCJ) for the Eletive Delivery Prior to 39 Weeks mesure. As suh, Lepfrog will updte its instrutions nnully, nd more frequently if pproprite, to mintin lignment with TJC. Hospitls n ess TJC s mesure speifitions diretly t: Eletive Delivery At or After 37 Completed Weeks or Prior to 39 Completed Weeks of Gesttion Soure: The Joint Commission (PC-01) v.2015b1 Reporting Time Period: Otoer 1, 2015 June 30, 2016 for surveys (re)sumitted on or fter Septemer 1, 2016 If you mesured this qulity inditor, reported the results to TJC, nd ontinue to sumit these dt to The Joint Commission, use those dt when responding to this susetion of the survey. Otherwise, use TJC s PC-01 Eletive Delivery mesure speifitions (version 2015B1) to retrospetively ollet nd report dt for this mesure. The PC-01 mesure speifitions re outlined elow. To ess the mesure speifitions diretly on The Joint Commission s wesite, visit Smpling Cses: Hospitls tht report the Perintl Cre Mesure Set to TJC my use the smpling methodology used y the TJC to report on these questions. 11
12 Hospitls opting to identify suffiient smple of mothers for this mesure, in lieu of full se reporting, should follow these instrutions: Review your hospitl s first delivery s of Otoer 15, Evlute this se ginst the inlusion riteri; retin the se for the smple if the delivery ws t or fter 259 dys gesttion (37 ompleted weeks gesttion) nd efore 273 dys gesttion (39 ompleted weeks gesttion). Evlute this se ginst the exlusion riteri; retin the se for the smple if it does not meet ny of the listed exlusions. Move to the next delivery nd evlute for inlusion/exlusion ppliility. Continue through ses in sequentil order until smple of t lest 100 ses is rehed, or ll ses in the reporting period re reviewed, whihever omes first. Question 2 (denomintor): Ptients delivering neworns with >= 37 nd < 39 weeks of gesttion ompleted with Exluded Popultions removed. Inluded Popultions: ICD-10-PCS Prinipl Proedure Code or ICD-10-PCS Other Proedure Codes for delivery s defined in Appendix A, Tle ICD-10-CM Prinipl Dignosis Code or ICD-10-CM Other Dignosis Codes for plnned esren irth in lor s defined in Appendix A, Tle Exluded Popultions: Less thn 8 yers of ge or greter thn or equl to 65 yers of ge Length of sty > 120 dys Enrolled in linil trils Gesttionl Age < 37 or >= 39 weeks or Unle to Determine (UTD) Exlude ny ses with one or more of the following ICD-10-CM Prinipl Dignosis Codes or ICD-10-CM Other Dignosis Codes for onditions possily justifying eletive delivery prior to 39 weeks gesttion, s defined in Appendix A, Tle (Note: ICD-10-CM ode must e oded) If fewer thn 10 ses during the reporting period, skip the next question. Dt Elements Needed to Report on the Mesure: Admission Dte Birthdte Clinil Tril Dishrge Dte Gesttionl Age ICD-10-PCS Other Proedure Codes ICD-10-PCS Prinipl Proedure Code ICD-10-CM Other Dignosis Codes ICD-10-CM Prinipl Dignosis Code 12
13 Question 3 (numertor): Ptients with eletive deliveries inluded in the denomintor Inluded Popultions: ICD-10-PCS Prinipl Proedure Code or ICD-10-PCS Other Proedure Codes for one or more of the following: Medil indution of lor s defined in Appendix A, Tle while not in Lor prior to the proedure Cesren irth s defined in Appendix A, Tle nd ll of the following: not in Lor no history of Prior Uterine Surgery Exluded Popultions: None Dt Elements Needed to Report on the Mesure: ICD-10-PCS Other Proedure Codes ICD-10-PCS Prinipl Proedure Code Lor Prior Uterine Surgery 13
14 CESAREAN SECTIONS Use the following mesure speifitions for surveys sumitted on or fter Septemer 1, Note on Chnges: Note 1: Mesure speifitions for identifying the denomintor for NTSV Cesren Setions is now using ICD proedure odes tht indite delivery (previously the denomintor speifitions used ICD dignosti odes tht indited pregnny). Note 2: The exlusion riterion for the denomintor for gesttionl ge now inludes the exlusion of ses where the gesttionl ge is unle to determine. Other Notes: Note 1: NTSV Cesren Setions n e reported sed on ll eligile ses OR suffiient smple of ses s outlined in the denomintor speifitions. Note 2: Lepfrog uses the speifitions reted y The Joint Commission for the NTSV Cesren Setions mesure. As suh, Lepfrog will updte its instrutions nnully, nd more frequently if pproprite, to mintin lignment with the Joint Commission. Hospitls n ess the Joint Commission s mesure speifitions diretly t Cesren Setions Soure: Joint Commission PC-02 (version 2015B1) Reporting Time Period: Otoer 1st, 2015 June 30, 2016 for surveys (re)sumitted on or fter Septemer 1, 2016 If you mesured this qulity inditor, reported the results to The Joint Commission, nd ontinue to sumit these dt to The Joint Commission, use those dt when responding to this susetion of the survey. Otherwise, use The Joint Commission s PC-02 Cesren Setion mesure speifitions (version 2015B1) to retrospetively ollet nd report dt for this mesure. The PC-02 mesure speifitions re outlined elow. To ess the mesure speifitions diretly on The Joint Commission s wesite, visit Smpling Cses: Hospitls tht report the Perintl Cre Mesure Set to TJC my use the smpling methodology used y the TJC to report on these questions. Hospitls opting to identify suffiient smple of mothers for this mesure, in lieu of full se reporting, should follow these instrutions: 14
15 Review your hospitl s first delivery s of Otoer 15, Evlute this se ginst the inlusion riteri; retin the se for the smple if the delivery ws t or fter 259 dys gesttion (37 ompleted weeks gesttion) nd efore 273 dys gesttion (39 ompleted weeks gesttion). Evlute this se ginst the exlusion riteri; retin the se for the smple if it does not meet ny of the listed exlusions. Move to the next delivery nd evlute for inlusion/exlusion ppliility. Continue through ses in sequentil order until smple of t lest 100 ses is rehed, or ll ses in the reporting period re reviewed, whihever omes first. Question 2 (denomintor): Nulliprous ptients delivered of live term singleton neworn in vertex presenttion. Inluded Popultions: ICD-10-PCS Prinipl Proedure Code or ICD-10-PCS Other Proedure Codes for delivery s defined in Appendix A, Tle Nulliprous ptients with ICD-10-CM PRINCIPAL DIAGNOSIS CODE OR ICD-10-CM OTHER DIAGNOSIS CODES for outome of delivery s defined in Appendix A, Tle 11.08, nd with delivery of neworn with 37 weeks or more of gesttion ompleted. Exluded Popultions: ICD-10-CM PRINCIPAL DIAGNOSIS CODE OR ICD-10-CM OTHER DIAGNOSIS CODES for multiple gesttions nd other presenttions s defined in Appendix A, Tle Less thn 8 yers of ge or greter thn or equl to 65 yers of ge Length of sty >120 dys Enrolled in linil trils Gesttionl Age < 37 weeks or Unle to Determine (UTD) If fewer thn 10 ses during the reporting period, skip the next question. Dt Elements Needed to Report on the Mesure: Admission Dte Birthdte Clinil Tril Dishrge Dte Gesttionl Age ICD-10-PCS Other Proedure Codes ICD-10-PCS Prinipl Proedure Code ICD-10-CM Other Dignosis Codes ICD-10-CM Prinipl Dignosis Codes Numer of Previous Live Births 15
16 Question 3 (numertor): Ptients in the denomintor with esren irths. Inluded Popultions: ICD-10-PCS PRINCIPAL PROCEDURE CODE OR ICD-10-PCS OTHER PROCEDURE CODES for esren irth s defined in Appendix A, Tle Exluded Popultions: None Dt Elements Needed to Report on the Mesure: ICD-10-PCS Other Proedure Codes ICD-10-PCS Prinipl Proedure Code 16
17 EPISIOTOMY Use the following mesure speifitions for surveys sumitted on or fter Septemer 1, Inidene of Episiotomy in Vginl Deliveries Soure: Ntionl Qulity Forum #0470 Reporting Time Period: Otoer 1st, 2015 June 30, 2016 for surveys (re)sumitted on or fter Septemer 1, 2016 Question 2 (denomintor): Totl numer of vginl deliveries during the reporting period with Exluded Popultions removed. For the purposes of this mesure, use the following MS-DRGs to identify vginl delivery: 767: Vginl delivery with steriliztion nd/or D&C 768: Vginl delivery with O.R. proedure exept steriliztion nd/or D&C 774: Vginl delivery with ompliting dignoses 775: Vginl delivery without ompliting dignoses Exluded Popultions: Exlude ny ses with the following ICD-10-CM dignosti ode in primry or seondry field: O66.0: Ostruted lor due to shoulder dystoi Question 3 (numertor): Numer of ses inluded in the denomintor tht hd n episiotomy proedure performed. For purposes of this mesure, the following ICD-10-PCS proedure odes should e used for identifying n episiotomy: 0W8NXZZ: Division of femle perineum, externl pproh 0WQNXZZ: Repir femle perineum, externl pproh 10D07Z3: Extrtion of produts of oneption, low foreps, vi nturl or rtifiil opening 10D07Z4: Extrtion of produts of oneption, mid foreps, vi nturl or rtifiil opening 10D07Z5: Extrtion of produts of oneption, high foreps, vi nturl or rtifiil opening 10D07Z6: Extrtion of produts of oneption, vuum, vi nturl or rtifiil opening 17
18 MATERNITY CARE PROCESS MEASURE SPECIFICATIONS Use the following mesure speifitions for surveys sumitted on or fter Septemer 1, APPROPRIATE DVT PROPHYLAXIS IN WOMEN UNDERGOING CESAREAN DELIVERY Soure: Ntionl Qulity Forum #0473 Reporting Time Period: Otoer 1st, 2015 June 30, 2016 for surveys (re)sumitted on or fter Septemer 1, 2016 Questions 3 (denomintor): Eligile ses inlude ll women undergoing esren delivery during the reporting period. Inlude ses with one of the following MS-DRG odes: 765: Cesren setion w CC/MCC 766: Cesren setion w/o CC/MCC Exluded Popultions: None. Question 3 (numertor): Numer of eligile ses inluded in denomintor who reeived either frtionted or unfrtionted heprin or heprinoid, or pneumti ompression devies prior to surgery. 18
19 HIGH-RISK DELIVERIES MEASURE SPECIFICATIONS Use the following mesure speifitions for surveys sumitted on or fter Septemer 1, HIGH RISK DELIVERIES VOLUME STANDARD Soure: The Lepfrog Group Reporting Time Period: Otoer 1st, 2015 June 30, 2016 for surveys (re)sumitted on or fter Septemer 1, 2016 Question 5 (instrutions for volume reporting): numer of very-low irth-weight ies dmitted to your hospitl s neontl intensive re unit(s) during the reporting period. Importnt Note: Do not use volume odes for mesuring nd reporting the proess mesure; use the seprte speifitions for tht inditor. Ptient popultions used for the proess mesure my DIFFER from ptient popultions inluded here in the volume ounts. Use only ICD-10-CM Dignosis Codes s indited in the speifitions when lulting hospitl volume for the numer of very-low irth-weight ies (VLBWB) your hospitl treted. These ICD-10 CM Dignosis Codes should e used only to identify the numer of VLBWB for question #5. The ount n inlude inorn s well s trnsfer ses. Numer of neworns dmitted to the NICU with the following ICD-10 CM Dignosis Codes: P05.02 P05.05: Neworn light for gesttionl ge, grms P05.12 P05.15: Neworn smll for gesttionl ge, grms P05.2: Neworn ffeted y fetl (intruterine) mlnutrition not light or smll for gesttionl ge P05.9: Neworn ffeted y slow intruterine growth, unspeified P07.02 P07.03: Extremely low irth weight neworn, grms P07.14 P07.15: Other low irth weight neworn, grms Exluded Popultions: None. * Hospitls opting to report on Outome (Deth or Moridity) insted of Volume, y providing dt from their Vermont Oxford Network (VON) report in question #6-11 will not need to use ICD-10 oding. Insted, they will report dt diretly from VON using the sme methodology s in prior survey yers. 19
20 HIGH-RISK DELIVERIES PROCESS MEASURE SPECIFICATIONS Use the following mesure speifitions for surveys sumitted on or fter Septemer 1, Note on Chnges: Note 1: The Joint Commission hs updted the gesttionl ge inlusion riterion for the denomintor to >= 24 nd <34 weeks gesttion ompleted (previously the denomintor speifitions inluded ptients delivering live preterm neworns with >= 24 nd <32 weeks gesttion ompleted). Note 2: Mesure speifitions for identifying the denomintor for ntentl steroids is now using ICD proedure odes tht indite delivery (previously the denomintor speifitions used ICD dignosti odes tht indited pregnny). Note 3: The exlusion riterion for the denomintor for gesttionl ge now inludes the exlusion of ses where the gesttionl ge is unle to determine. ANTENATAL STEROIDS Soure: Vermont Oxford Network (see Mnul of Opertions) or The Joint Commission (see PC-03 version 2015B1) If you prtiipte in the Vermont Oxford Network, mesured dherene to this proess-of-re qulity inditor, reported the results to VON, nd ontinue to sumit these dt to VON, then use those dt when responding to this susetion of survey, nd ignore The Joint Commission (TJC) speifitions listed elow for the mesure. If you prtiipte with The Joint Commission, mesured dherene to this proess-of-re qulity inditor, reported the results to The Joint Commission, nd ontinue to sumit these dt to The Joint Commission, use those dt when responding to this susetion of the survey. Otherwise, use The Joint Commission s PC-03 Antentl Steroids mesure speifitions (version 2015B1) detiled elow to retrospetively ollet nd report dt for this mesure. To ess the mesure speifitions diretly on The Joint Commission s wesite, visit Smpling Cses: Hospitls tht report the Perintl Cre Mesure Set to TJC my use the smpling methodology used y the TJC to report on these questions. Otherwise, hospitls with suffiient smple size (s defined in endnote 24), n rndomly smple for the denomintor of eh inditor, nd mesure nd report dherene sed on tht smple. Most likely the numertor riteri for this mesure will require medil hrt review if these speifi dt re not lredy extrted or oded onsistently for other purposes. Question 16 (denomintor) Ptients delivering live preterm neworns with >=24 nd <34 weeks gesttion ompleted. 20
21 Inluded Popultions: ICD-10-PCS Prinipl Proedure Code or ICD-10-PCS Other Proedure Codes for delivery s defined in Appendix A, Tle Exluded Popultions: Less thn 8 yers of ge or greter thn or equl to 65 yers of ge Length of Sty >120 dys Enrolled in linil trils Doumented Reson for Not Inititing Antentl Steroids ICD-10-CM Prinipl Dignosis Code or ICD-10-CM Other Dignosis Codes for fetl demise s defined in Appendix A, Tle Gesttionl Age < 24 or >= 34 weeks or Unle to Determine (UTD) Dt Elements Needed to Report on the Mesure: Admission Dte Birthdte Clinil Tril Dishrge Dte Gesttionl Age ICD-10-CM Other Dignosis Codes ICD-10-CM Prinipl Dignosis Code Reson for Not Inititing Antentl Steroids Question 17 (numertor): The numer of ptients inluded in the denomintor with ntentl steroids initited prior to delivering preterm neworns (>=24 nd <34 weeks gesttion ompleted). Inluded Popultions: Antentl steroids initited (refer to Appendix C, Tle 11.0, ntentl steroid meditions) Exluded Popultions: None. Dte Elements Needed to Report on the Mesure: Antentl Steroids Initited 21
22 SECTION 7 MANAGING SERIOUS ERRORS REFERENCE INFORMATION The following mesures from Setion 7 Mnging Serious Errors will require the use of 9-month reporting period nd ICD-10 odes if surveys re (re)sumitted on or fter Septemer 1, 2016: Hospitl-Aquired Pressure Ulers Hospitl-Aquired Injuries These mesures do not pply to peditri hospitls. PRESSURE ULCERS MEASURE SPECIFICATIONS Use the following mesure speifitions for surveys sumitted on or fter Septemer 1, HAC - Rte of Stge III/IV Pressure Ulers Soure: The Lepfrog Group Reporting Time Period: Otoer 1, 2015 June 30, 2016 for surveys (re)sumitted on or fter Septemer 1, 2016 Q.3 Denomintor: Totl dult (ges 18 nd older) inptient dishrges (inluding deths) during the reporting time period. [Note: Hospitls should inlude in the denomintor ny ptient for whih they ode present-on-dmission (POA). This would inlude most short-sty psyh nd reh ptients.] Q.4 Numertor: Numer of eligile ses inluded in the denomintor with ny of the following ICD-10 dignosis odes for stge III nd IV pressure ulers s seondry dignosis (dignosis 2-9 on lim), with Present-on-Admission (POA) inditor of N or U, s defined in CMS Appendix I Hospitl Aquired Conditions (HAC) List for HAC 04: Stge III nd IV Pressure Ulers Seondry Dignosis (see pge 1). 22
23 INJURIES MEASURE SPECIFICATIONS Use the following mesure speifitions for surveys sumitted on or fter Septemer 1, HAC - Rte of Hospitl-Aquired Injuries Soure: The Lepfrog Group Reporting Time Period: Otoer 1st, 2015 June 30, 2016 for surveys (re)sumitted on or fter Septemer 1, 2016 Q.3 Denomintor: Totl dult (ges 18 nd older) inptient dishrges (inluding deths) during the reporting time period. [Note: Hospitls should inlude in the denomintor ny ptient for whih they ode present-on-dmission (POA). This would inlude most short-sty psyh nd reh ptients.] Q.5 Numertor: Numer of eligile ses inluded in the denomintor with ny of the following ICD-10 dignosis odes for flls nd trum s seondry dignosis (dignosis 2-9 on lim), with Present-on-Admission (POA) inditor of N or U, s defined in CMS Appendix I Hospitl Aquired Conditions (HAC) List for HAC 05: Flls nd Trum Seondry Dignosis (see pge 1-10). 23
24 APPENDIX II Guidelines for Culture of Sfety Survey tht Demonstrtes Vlidity, Consisteny, nd Reliility For the purposes of reporting on Sfe Prtie 2 Culture Mesurement, Feedk, nd Intervention, hospitls must ondut ulture of sfety survey of their employees (the units surveyed must ount for t lest 50% of the ggregted re delivered to ptients within the fility, nd inludes the high ptient sfety risk units or deprtments) using ntionlly reognized tool tht hs demonstrted vlidity, onsisteny nd reliility within the pst 24 months. There re numerous ntionlly-reognized ulture of sfety survey tools tht hve demonstrted vlidity, onsisteny, nd reliility in peerreviewed literture. However, some hospitls hve stted these ulture surveys do not meet their needs. These hospitls often hoose to rete their own surveys. In onsulttion with Lepfrog s Culture of Sfety Expert Pnel, we hve developed set of guidelines for wht onstitutes vlid, onsistent, nd relile survey tool for the purposes of reporting on Sfe Prtie 2 on the Lepfrog Hospitl Survey. The Lepfrog Culture of Sfety Expert Pnel hs developed hierrhy for survey ontent: Tier 1 (Most Preferred): Unltered, ntionlly-reognized tool with informtion on the vlidity, onsisteny, nd reliility of the tool pulished in peer-reviewed literture (i.e. AHRQ Hospitl Survey on Ptient Sfety Culture, Sfety Attitudes Questionnire, Ptient Sfety Climte for Helthre Orgniztions, Zohr). Tier 2: Minor modifitions to Tier 1 tool, suh s simple word hnges tht do not lter the intent or tone of questions (e.g., hnging unit to deprtment ). However, the survey is utilized in its entirety. Tier 3 (Lest Preferred): Mjor modifitions to n estlished tool or development of self-reted tool (e.g., rewording questions from Tier 1 tool from negtive to positive, employee enggement surveys tht inlude some questions relted to ulture of sfety, et.) Hospitls tht use Tier 3 survey (s desried ove), must ensure tht the tool demonstrtes similr psyhometri properties to Tier 1 survey for the purposes of reporting on Sfe Prtie 2 Culture Mesurement, Feedk, nd Intervention on the Lepfrog Hospitl Survey. Hospitls tht use Tier 3 survey my e sked to provide doumenttion tht the tool hs een ssessed for vlidity, onsisteny, nd reliility. To stisfy this requirement, hospitls must doument tht the tool demonstrtes three of the four following qulities: 1. Sle reliility. One ommon ssessment of reliility is Cronh s Alph, sttistil index of internl onsisteny tht lso provides n estimte of the rtio of true sore to error in Clssil Test Theory. 2. Explortory/onfirmtory ftor nlysis (this qulity is required if reting new domin or omposite sores). Explortory Ftor Anlysis (EFA) is tehnique whose overrhing gol is to identify the underlying reltionships etween mesured vriles. EFA is ommonly used y reserhers when developing sle nd serves to identify set of ltent onstruts underlying ttery of mesured vriles. Confirmtory ftor nlysis (CFA) is used to test whether mesures of onstrut re onsistent with reserher's understnding of the nture of tht onstrut. The ojetive of CFA is to test whether the dt fit hypothesized mesurement model. 24
25 3. The tool ws ssessed nd shown to e vlid, whih ould inlude: Convergent/divergent vlidity. To estlish onvergent vlidity, one needs to show tht mesures tht should e relted re in relity relted. To estlish disriminnt vlidity, one needs to show tht mesures tht should not e relted re in relity not relted. Both of these re ommonly demonstrted y exmining the item interorreltions for ll item pirings. Preditive vlidity. Preditive vlidity is the extent to whih sore on sle predits sores on some riterion. As n exmple, the preditive vlidity of ulture of sfety sle would e demonstrted y exmining the orreltion etween unit s sore on the sle (t point in time) nd rtes of preventle hrm in the unit (t future point in time). Fe vlidity. Fe vlidity is mesure of how representtive sle or tool is 't fe vlue,' nd whether it ppers to e good sle/tool. On mesure of hppiness, for exmple, the test would e sid to hve fe vlidity if it ppered to tully mesure levels of hppiness. Fe vlidity only mens tht the test looks like it works; it does not men tht the test hs een proven to work. 4. The tool underwent ognitive testing. Dt from ognitive interviews re qulittive, nd nlysis of this dt n identify soures of response error s well s vrious interprettions of questions. By onduting omprtive nlysis of the ognitive interviews, it is possile to identify ptterns of error nd misinterprettion ross groups of people. For more omplete understnding of these onepts, plese see the following rtiles: Sexton JB, Helmreih RL, Neilnds TB, Rown K, Vell K, Boyden J, et l. The Sfety Attitudes Questionnire: psyhometri properties, enhmrking dt, nd emerging reserh. BMC Helth Servies Reserh. 2006;6:44. Singer SJ, Meterko M, Bker L, G G, Flwell A, nd Rosen A. Workfore pereptions of hospitl sfety ulture: Development nd vlidtion of the Ptient Sfety Climte in Helthre Orgniztions survey. Helth Servies Reserh. 2007;42(5):1999. Sorr J nd Dyer N. Multilevel psyhometri properties of the AHRQ hospitl survey on ptient sfety ulture. BMC Helth Servies Reserh. 2010;10:199 While the Expert Pnel did not identify speifi domins or questions tht need to e inluded to e onsidered ulture of sfety survey, Tier 3 survey tools need to e grounded in n underlying theory of the orgniztion s ulture. The tool developers must estlish why they inluded the questions nd domins in the survey to support the theory of ulture. The following guidelines should e onsidered for survey dministrtion: Employees ompleting the survey should hve fmilirity with the fility (i.e., not employees who rrely work in the fility). The survey should e dministered to, t lest, the frontline linil stff nd ledership. The survey should e dministered in wy tht voids oerion. The survey s smple popultion should e representtive of the fility s linil nd dministrtive workfore. High response rtes re onsidered more importnt thn high survey sores. 25
26 APPENDIX III Questions from the NHSN Annul Hospitl Survey on Antimiroil Stewrdship Questions 1. Does your fility hve written sttement of support from ledership tht supports efforts to improve ntiioti use (ntiioti stewrdship)? 2. Is there leder responsile for outomes of stewrdship tivities t your fility? 2. If yes, wht is the position of this leder: (hek one) Physiin Phrmist Other (plese speify): 3. Is there t lest one phrmist responsile for improving ntiioti use t your fility? 4. Does your fility provide ny slry support for dedited time for ntiioti stewrdship tivities? 5. Does your fility hve poliy tht requires presriers to doument n indition for ll ntiiotis in the medil reord or during order entry? 6. Does your fility hve fility-speifi tretment reommendtions, sed on ntionl guidelines nd lol suseptiility, to ssist with ntiioti seletion for ommon linil onditions? 7. Is there forml proedure for ll liniins to review the ppropriteness of ll ntiiotis t or fter 48 hours from the initil orders (e.g. ntiioti time out)? 8. Do ny speified ntiioti gents need to e pproved y physiin or phrmist prior to dispensing t your fility? 9. Does physiin or phrmist review ourses of therpy for speified ntiioti gents nd ommunite results with presriers (i.e., udit with feedk) t your fility? 10. Does your fility monitor ntiioti use (onsumption) t the unit, servie, nd/or fility wide? 11. Do presriers ever reeive feedk y the stewrdship progrm out how they n improve their ntiioti presriing? 12. Hs your stewrdship progrm provided edution to liniins nd other relevnt stff on improving ntiioti use? 26
27 APPENDIX IV Detiled Wording Chnges nd Additions/Deletions for Setion 6 NQF Sfe Prties PRACTICE #1 CULTURE OF SAFETY LEADERSHIP STRUCTURES AND SYSTEMS (pge numers referene NQF Sfe Prties for Better Helthre 2010 Updte report) 2015 Lepfrog Hospitl Survey Sfe Prtie Wording 2016 Lepfrog Hospitl Survey Sfe Prtie Wording 1.1 In regrd to rising the wreness of key stkeholders to our orgniztion s efforts to improve ptient sfety, the following tions relted to identifition nd mitigtion of risk nd hzrds hve een tken: Bord (governne) minutes for the pst 12 months reflet regulr ommunition regrding ll three of the following: risks nd hzrds (s defined y Sfe Prtie #4, Identifition nd Mitigtion of Risks nd Hzrds); ulture mesurement (s defined y Sfe Prtie #2, Culture Mesurement, Feedk, nd Intervention); nd, progress towrds resolution of sfety nd qulity prolems. (p.75) Ptients (who re not employed y the orgniztion) nd fmily of ptients re forml prtiipnts in sfety nd qulity ommittees tht meet on regulrly sheduled sis. (p.75) Ptients (who re not employed y the orgniztion) nd fmily of ptients re tive prtiipnts in sfety nd qulity ommittees tht meet on regulrly sheduled sis. (p.75) 27
28 2015 Lepfrog Hospitl Survey Sfe Prtie Wording 2016 Lepfrog Hospitl Survey Sfe Prtie Wording steps hve een tken to report to the ommunity in the lst 12 months of ongoing efforts to improve sfety nd qulity in the orgniztion nd the results of these efforts. (p.75) d ll stff nd independent prtitioners were mde wre in the pst 12 months of ongoing efforts to redue risks nd hzrds nd to improve ptient sfety nd qulity in the orgniztion. (p.75) d 1.2 In regrd to holding the Bord, senior mngement, mid-level mngement, physiin ledership, nd frontline regivers diretly ountle for results relted to mitigting unsfe prties, the orgniztion hs done the following: In regrd to holding the Bord, senior mngement, mid-level mngement, physiin ledership, nd frontline regivers diretly ountle for results relted to identifying nd reduing unsfe prties, the orgniztion hs done the following: n integrted, ptient sfety progrm hs een in ple for t lest the pst 12 months providing oversight nd lignment of sfe prtie tivities. (p.76) ptient sfety offier (PSO) hs een ppointed nd ommunites regulrly with the Bord (governne) nd senior dministrtive ledership; the PSO is the primry point of ontt of the integrted, ptient sfety progrm. (p.76) performne hs een doumented in performne reviews nd/or ompenstion inentives for ll levels of hospitl mngement nd hospitlemployed regivers noted ove. (p.76) 28
29 2015 Lepfrog Hospitl Survey Sfe Prtie Wording 2016 Lepfrog Hospitl Survey Sfe Prtie Wording d the interdisiplinry ptient sfety tem ommunited regulrly with mngement regrding ll three of the following: d root use nlyses (s defined y Sfe Prtie #4, Culture Mesurement, Feedk, nd Intervention); progress in meeting sfety gols; nd, providing tem trining to regivers (s defined y Sfe Prtie #3, Temwork Trining nd Skill Building); nd, doumented these ommunitions in meeting minutes. (pp.76-77) e the fility reported dverse events to externl mndtory or voluntry progrms. (p.77) 1.3 In regrd to implementtion of the ptient sfety progrm, the Bord (governne) nd senior dministrtive leders hve provided resoures to over the implementtion during the lst 12 months, nd: dedited ptient sfety progrm udgets support the progrm, stffing, nd tehnology investment. (p.77) doumenttion of these udgets is ville for review y externl orgniztions. (p.77) Removed in
30 2015 Lepfrog Hospitl Survey Sfe Prtie Wording 2016 Lepfrog Hospitl Survey Sfe Prtie Wording 1.4 Strutures nd systems for ssuring tht ledership is tking diret nd speifi tions hve een in ple for the pst 12 months, s evidened y: CEO nd senior dministrtive leders re personlly engged in reinforing ptient sfety improvements, e.g., wlk-rounds, holding ptient sfety meetings, reporting to the Bord (governne). Clendrs reflet lloted time. (p.78) CEO hs tively engged unit, servie-line, deprtmentl nd mid-level mngement leders in ptient sfety improvement tions. (p.79) hospitl hs estlished struture for input into the ptient sfety progrm y independent medil prtitioners nd medil ledership. Input doumented in meeting minutes or mterils. (p.79) hospitl hs estlished struture for input into the ptient sfety progrm y liensed independent prtitioners nd the orgnized medil stff nd medil ledership. Input doumented in meeting minutes or mterils. (p.79) 30
31 PRACTICE #2 CULTURE MEASUREMENT, FEEDBACK, AND INTERVENTION (pge numers referene NQF Sfe Prties for Better Helthre 2010 Updte report) 2015 Lepfrog Hospitl Survey Sfe Prtie Wording 2016 Lepfrog Hospitl Survey Sfe Prtie Wording 2.1 In regrd to Culture Mesurement, our orgniztion hs done the following within the lst 24 months: onduted ulture of sfety survey of our employees using ntionlly reognized tool tht hs demonstrted vlidity, onsisteny nd reliility. The units surveyed ount for t lest 50% of the ggregted re delivered to ptients within the fility, nd inludes the high ptient sfety risk units or deprtments.(p.88) If this item is not heked, no other items in this Prtie #2 my e heked. portryed the results of the ulture survey in report, whih reflets oth hospitl-wide nd individul unit level results. (p.88) portryed the results of the ulture survey in report, whih reflets oth hospitl-wide nd individul unit level results, s pplile. (p.88) New in 2016 enhmrked results of the ulture survey ginst externl orgniztions, suh s like hospitls or other hospitls within the sme helth system. 31
32 2015 Lepfrog Hospitl Survey Sfe Prtie Wording 2016 Lepfrog Hospitl Survey Sfe Prtie Wording d New in 2016 ompred results of the ulture survey ross internl work groups, roles, nd stff levels. e New in 2016 used results of the ulture survey to derief t the relevnt unit level, using semi-strutured pprohes for the deriefings nd presenting results in ggregte form to ensure the nonymity of survey respondents. 2.2 In regrd to ountility for improvements in the mesurement of the ulture of sfety, our orgniztion hs done the following within the lst 24 months: involved senior dministrtive ledership in the identifition nd seletion of smpled units; nd, in the seletion of n pproprite tool for mesuring the ulture of sfety. (p.88) shred the results of the ulture mesurement survey with the Bord (governne) nd senior dministrtive ledership in forml report nd disussion. (p.88) 32
33 2015 Lepfrog Hospitl Survey Sfe Prtie Wording 2016 Lepfrog Hospitl Survey Sfe Prtie Wording New in 2016 performne evlution riteri for senior dministrtive leders inluded oth response rtes to the survey nd the use of survey results in improvement efforts. 2.3 In regrd to the ulture of sfety mesurement, the orgniztion hs done the following (or hs hd the following in ple) within the lst 12 months: onduted stff edution progrm(s) on methods to improve the ulture of sfety, or onduted tem trining development progrms, sed on survey results. Trining ws doumented in personnel or other dministrtive reords. (p.89) onduted stff edution progrm(s) on methods to improve or sustin the ulture of sfety, tilored to the orgniztion s survey results. (p.89) inluded the osts of nnul ulture mesurement/follow-up tivities in the ptient sfety progrm udget. (p.88) 2.4 In regrd to ulture mesurement, feedk, nd interventions, our orgniztion hs done the following or hs hd the following in ple within the lst 12 months: 33
34 2015 Lepfrog Hospitl Survey Sfe Prtie Wording 2016 Lepfrog Hospitl Survey Sfe Prtie Wording developed or implemented expliit, hospitl-wide orgniztionl poliies nd proedures for regulr ulture mesurement (p.88) OR implemented strtegies for improving ulture sed on survey results. (p.88) disseminted the results of the survey widely ross the institution, with follow-up meetings held y senior dministrtive ledership with the smpled units. (p.88) identified performne improvement interventions sed on the survey results, whih were shred with senior dministrtive ledership nd susequently mesured nd monitored. (p.88) 34
35 PRACTICE #3 TEAMWORK TRAINING AND SKILL BUILDING (pge numers referene NQF Sfe Prties for Better Helthre 2010 Updte report) 2015 Lepfrog Hospitl Survey Sfe Prtie Wording 2016 Lepfrog Hospitl Survey Sfe Prtie Wording 3.1 In regrd to temwork trining nd skill uilding, our orgniztion hs done the following within the lst 12 months: onduted literture review of the temwork trining impt in helthre or in other settings. (p.101) onduted literture review of temwork trining in helthre or other settings nd hve identified est prties. OR OR onduted review of ville temwork trining progrms in progressive orgniztions. (p.99) onduted review of ville temwork trining progrms in progressive orgniztions to identify est prties. (p.99) onduted n ssessment of high ptient sfety risk res y n Interdisiplinry Ptient Sfety Tem to determine speifi proesses in need of temwork improvement. Those proesses were identified to senior dministrtive ledership. (p.97) onduted n ssessment of high-risk res, in terms of ptient sfety, y n interdisiplinry ptient sfety tem to determine speifi proesses (e.g., ommunition, ollortion) nd those involved in those proesses in need of temwork improvement. Those proesses were identified to senior dministrtive ledership. (p.97) informed senior mngement, mid-level mngement nd physiin ledership out the need for temwork trining, skill uilding, nd identified internl resoures nd possile resoures from progressive orgniztions. (pp.97-98) informed senior mngement, mid-level mngement nd physiin ledership out the need for temwork trining nd skill uilding. 35
UNIVERSITY AND WORK-STUDY EMPLOYERS WEBSITE USER S GUIDE
UNIVERSITY AND WORK-STUDY EMPLOYERS WEBSITE USER S GUIDE Tble of Contents 1 Home Pge 1 2 Pge 2 3 Your Control Pnel 3 4 Add New Job (Three-Step Form) 4-6 5 Mnging Job Postings (Mnge Job Pge) 7-8 6 Additionl
More informationRevised products from the Medicare Learning Network (MLN) ICD-10-CM/PCS Myths and Facts, Fact Sheet, ICN 902143, downloadable.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Meire & Meii Servies Revise prouts from the Meire Lerning Network (MLN) ICD-10-CM/PCS Myths n Fts, Ft Sheet, ICN 902143, ownlole. MLN Mtters Numer: SE1325
More informationEnterprise Digital Signage Create a New Sign
Enterprise Digitl Signge Crete New Sign Intended Audiene: Content dministrtors of Enterprise Digitl Signge inluding stff with remote ess to sign.pitt.edu nd the Content Mnger softwre pplition for their
More informationEuropean Convention on Social and Medical Assistance
Europen Convention on Soil nd Medil Assistne Pris, 11.XII.1953 Europen Trety Series - No. 14 The governments signtory hereto, eing memers of the Counil of Europe, Considering tht the im of the Counil of
More informationOUTLINE SYSTEM-ON-CHIP DESIGN. GETTING STARTED WITH VHDL August 31, 2015 GAJSKI S Y-CHART (1983) TOP-DOWN DESIGN (1)
August 31, 2015 GETTING STARTED WITH VHDL 2 Top-down design VHDL history Min elements of VHDL Entities nd rhitetures Signls nd proesses Dt types Configurtions Simultor sis The testenh onept OUTLINE 3 GAJSKI
More informationActive Directory Service
In order to lern whih questions hve een nswered orretly: 1. Print these pges. 2. Answer the questions. 3. Send this ssessment with the nswers vi:. FAX to (212) 967-3498. Or. Mil the nswers to the following
More informationStudent Access to Virtual Desktops from personally owned Windows computers
Student Aess to Virtul Desktops from personlly owned Windows omputers Mdison College is plesed to nnoune the ility for students to ess nd use virtul desktops, vi Mdison College wireless, from personlly
More informationKEY SKILLS INFORMATION TECHNOLOGY Level 3. Question Paper. 29 January 9 February 2001
KEY SKILLS INFORMATION TECHNOLOGY Level 3 Question Pper 29 Jnury 9 Ferury 2001 WHAT YOU NEED This Question Pper An Answer Booklet Aess to omputer, softwre nd printer You my use ilingul ditionry Do NOT
More informationPRIVATE HEALTH INSURANCE. Geographic Variation in Spending for Certain High-Cost Procedures Driven by Inpatient Prices
United Sttes Government Aountility Offie Report to the Rnking Memer, Committee on Energy nd Commere, House of Representtives Deemer 2014 PRIVATE HEALTH INSURANCE Geogrphi Vrition in Spending for Certin
More informationOrthodontic marketing through social media networks: The patient and practitioner s perspective
Originl rtile Orthodonti mrketing through soil medi networks: The ptient nd prtitioner s perspetive Kristin L. Nelson ; Bhvn Shroff ; l M. Best ; Steven J. Linduer d BSTRCT Ojetive: To (1) ssess orthodonti
More informationGAO POSTSECONDARY EDUCATION. Student Outcomes Vary at For-Profit, Nonprofit, and Public Schools. Report to Congressional Requesters
GAO United Sttes Government Aountbility Offie Report to Congressionl Requesters Deember 2011 POSTSECONDARY EDUCATION Outomes Vry t For-Profit, Nonprofit, nd Publi Shools GAO-12-143 Contents Letter 1 Limited
More information- DAY 1 - Website Design and Project Planning
Wesite Design nd Projet Plnning Ojetive This module provides n overview of the onepts of wesite design nd liner workflow for produing wesite. Prtiipnts will outline the sope of wesite projet, inluding
More informationPsychological health and safety in the workplace Prevention, CAN/CSA-Z1003-13/BNQ 9700-803/2013
Psychologicl helth nd sfety in the workplce Prevention, CAN/CSA-Z1003-13/BNQ 9700-803/2013 promotion, nd guidnce to stged implementtion This smple udit tool is n nnex of the Ntionl Stndrd of Cnd on Psychologicl
More information2007 National Home and Hospice Care Survey
OMB #: 090-098 Exp.: 07/3/009 Ageny Nme: Ageny ID: 007 Ntionl Home nd Hospie Cre Survey Stffing Questionnire Prepred for the Centers for Disese Control nd Prevention Ntionl Center for Helth Sttistis y
More informationIncluded in CMS/JCAHO Core Measures for CAP*
Inluded in S/JHO ore esures for P* TELRO illing nd oding Guide orest Lortories, In. * TELRO (eftroline fosmil) is one of the reommended -ltm ntiiotis for ommunity-quired Pneumoni in Immunoompetent Ptients
More informationUtilization of Smoking Cessation Benefits in Medicaid Managed Care, 2009-2013
Utiliztion of Smoking Cesstion Benefits in Medicid Mnged Cre, 2009-2013 Office of Qulity nd Ptient Sfety New York Stte Deprtment of Helth Jnury 2015 Introduction According to the New York Stte Tocco Control
More informationHow To Organize A Meeting On Gotomeeting
NOTES ON ORGANIZING AND SCHEDULING MEETINGS Individul GoToMeeting orgnizers my hold meetings for up to 15 ttendees. GoToMeeting Corporte orgnizers my hold meetings for up to 25 ttendees. GoToMeeting orgnizers
More informationInnovation in Software Development Process by Introducing Toyota Production System
Innovtion in Softwre Development Proess y Introduing Toyot Prodution System V Koihi Furugki V Tooru Tkgi V Akinori Skt V Disuke Okym (Mnusript reeived June 1, 2006) Fujitsu Softwre Tehnologies (formerly
More informationEuropean Convention on Products Liability in regard to Personal Injury and Death
Europen Trety Series - No. 91 Europen Convention on Produts Liility in regrd to Personl Injury nd Deth Strsourg, 27.I.1977 The memer Sttes of the Counil of Europe, signtory hereto, Considering tht the
More informationMcAfee Network Security Platform
XC-240 Lod Blner Appline Quik Strt Guide Revision D MAfee Network Seurity Pltform This quik strt guide explins how to quikly set up nd tivte your MAfee Network Seurity Pltform XC-240 Lod Blner. The SFP+
More informationQualmark Licence Agreement
Terms nd Conditions Qulmrk Liene Agreement Terms nd Conditions Terms nd Conditions 1. Liene Holder Applint 2. Confirmed Sttus 3. Term nd Renewl 4. Use of the Intelletul Property 5. Qulmrk Progrmme Rtings
More informationTechnician Level Framework TLF a
Est & South Est Engln Speilist Phrmy Servies Tehniin Level Frmework TLF professionl evelopment frmework for phrmy tehniins in meiines mngement Clinil Phrmy Clinil Governne & Tehnil Servies Community Helth
More informationORGANIZER QUICK REFERENCE GUIDE
NOTES ON ORGANIZING AND SCHEDULING MEETINGS Individul GoToMeeting orgnizers my hold meetings for up to 15 ttendees. GoToMeeting Corporte orgnizers my hold meetings for up to 25 ttendees. GoToMeeting orgnizers
More informationPUBLIC DISCLOSURE COPY 05481017 793760 2127 2011.04030 JAMES A. MICHENER ART MUSEU 2127 1
Cution: Forms printed from within Adoe Arot produts my not meet IRS or stte txing geny speifitions. When using Arot.x produts, unhek the "Shrink oversized pges to pper size" nd unhek the "Expnd smll pges
More information1. Definition, Basic concepts, Types 2. Addition and Subtraction of Matrices 3. Scalar Multiplication 4. Assignment and answer key 5.
. Definition, Bsi onepts, Types. Addition nd Sutrtion of Mtries. Slr Multiplition. Assignment nd nswer key. Mtrix Multiplition. Assignment nd nswer key. Determinnt x x (digonl, minors, properties) summry
More informationHealth insurance marketplace What to expect in 2014
Helth insurnce mrketplce Wht to expect in 2014 33096VAEENBVA 06/13 The bsics of the mrketplce As prt of the Affordble Cre Act (ACA or helth cre reform lw), strting in 2014 ALL Americns must hve minimum
More informationJaERM Software-as-a-Solution Package
JERM Softwre-s--Solution Pckge Enterprise Risk Mngement ( ERM ) Public listed compnies nd orgnistions providing finncil services re required by Monetry Authority of Singpore ( MAS ) nd/or Singpore Stock
More informationClearPeaks Customer Care Guide. Business as Usual (BaU) Services Peace of mind for your BI Investment
ClerPeks Customer Cre Guide Business s Usul (BU) Services Pece of mind for your BI Investment ClerPeks Customer Cre Business s Usul Services Tble of Contents 1. Overview...3 Benefits of Choosing ClerPeks
More informationHealth insurance exchanges What to expect in 2014
Helth insurnce exchnges Wht to expect in 2014 33096CAEENABC 02/13 The bsics of exchnges As prt of the Affordble Cre Act (ACA or helth cre reform lw), strting in 2014 ALL Americns must hve minimum mount
More informationSmall Businesses Decisions to Offer Health Insurance to Employees
Smll Businesses Decisions to Offer Helth Insurnce to Employees Ctherine McLughlin nd Adm Swinurn, June 2014 Employer-sponsored helth insurnce (ESI) is the dominnt source of coverge for nonelderly dults
More informationGATEWAY HOMES, INC 11901 REEDY BRANCH ROAD CHESTERFIELD, VA 23838 GATEWAY HOMES, INC: ENCLOSED IS THE ORGANIZATION S 2012 EXEMPT ORGANIZATION RETURN.
GATEWAY HOMES, INC 11901 REEDY BRANCH ROAD CHESTERFIELD, VA 88 GATEWAY HOMES, INC: ENCLOSED IS THE ORGANIZATION S 01 EEMPT ORGANIZATION RETURN. SPECIFIC FILING INSTRUCTIONS ARE AS FOLLOWS. FORM 990 RETURN:
More informationYour duty, however, does not require disclosure of matter:
Your Duty of Disclosure Before you enter into contrct of generl insurnce with n insurer, you hve duty, under the Insurnce Contrcts Act 1984 (Cth), to disclose to the insurer every mtter tht you know, or
More information2014 Department of the Treasury Internal Revenue Service
** PUBLIC DISCLOSURE COPY ** OMB. -007 Return of Orgniztion Exempt From Inome Tx Form 990 Under setion 0(), 7, or 97()() of the Internl Revenue Code (exept privte foundtions) 0 Deprtment of the Tresury
More informationPUBLIC DISCLOSURE COPY
PUBLIC DISCLOSURE COPY TA RETURN FILING INSTRUCTIONS ** FORM 990 PUBLIC DISCLOSURE COPY ** FOR THE YEAR ENDING ~~~~~~~~~~~~~~~~~ Deemer, 0 Prepred for Prepred y Amount due or refund Mke hek pyle to Mil
More informationVMware Horizon FLEX Administration Guide
VMwre Horizon FLEX Administrtion Guide Horizon FLEX 1.0 This doument supports the version of eh produt listed nd supports ll susequent versions until the doument is repled y new edition. To hek for more
More informationRFPUm IKA NG PIUPINAS TANGGAPAN NG SANGGUNIANG PANLUNGSOQ LUMGSOD NG BAKOLOD -0O0- CITY ORDINANCE NO. 546 July?0.?011
RFPUm IKA NG PIUPINAS TANGGAPAN NG SANGGUNIANG PANLUNGSOQ LUMGSOD NG BAKOLOD -0O0- CITY ORDINANCE NO. 546 July?0.?011 AN ORDINANCE STRENGTHENING CLINICS IN PUBLIC ELEMENTARY SECONDARY SCHOOLSiN BACOLOD
More informationMINNESOTA 4-H FOUNDATION
MINNESOTA -H FOUNDATION 990 Return Puli Inspetion Copy For the Yer Ended June 0, 0 00 INWOOD AVENUE NORTH SUITE 0 OAKDALE, MN 8 TEL: () -80 FA: () - www.kinshenke.om ** PUBLIC DISCLOSURE COPY ** OMB. -007
More informationBEC TESTS Gli ascolti sono disponibili all indirizzo www.loescher.it/business
Gli solti sono disponiili ll indirizzo www.loesher.it/usiness SURNAME AND NAME CLASS DATE BEC TEST Prt one Questions 1-8 For questions 1-8 you will her eight short reordings. For eh question, hoose one
More informationWould your business survive a crisis? A guide to business continuity planning. www.staffordbc.gov.uk
Would your usiness survive risis? A guide to usiness ontinuity plnning www.stfford.gov.uk 2 A guide to Business Continuity Plnning A guide to usiness ontinuity plnning Contents The Lw Wht type of inidents
More informationDo not enter Social Security numbers on this form as it may be made public. Open to Public Internal Revenue Service
PUBLIC INSPECTION COPY OMB. 1-007 Return of Orgniztion Exempt From Inome Tx Form 990 Under setion 01(), 7, or 97()(1) of the Internl Revenue Code (exept privte foundtions) 01 Deprtment of the Tresury Do
More information*These academic programs have no specific Academic Program Rules and therefore are bound entirely by the General Academic Program Rules
Msters Degrees by Reserh (exluding Mster of Philosophy) These progrms re only vilble to Interntionl Students in 2012. Interntionl students seeking to enrol in Msters Degree in Eonomis or Publi Helth must
More information2014 Department of the Treasury Internal Revenue Service
ETENDED TO NOVEMBER 6, 0 OMB. -007 Return of Orgniztion Exempt From Inome Tx Form 990 Under setion 0(), 7, or 97()() of the Internl Revenue Code (exept privte foundtions) 0 Deprtment of the Tresury Internl
More informationTOA RANGATIRA TRUST. Deed of Trust 3714386.2
TOA RANGATIRA TRUST Deed of Trust 1 Deed dted 2011 Prties 1 Te Runng o To Rngtir Inorported n inorported soiety hving its registered offie t Poriru (the Runng ) Bkground A B C D The Runng is n inorported
More informationAssessor s guidelines for the: SVQ 2 in Pharmacy Services at SCQF level 5 SVQ 3 in Pharmacy Services at SCQF level 6
Assessor s guidelines for the: SVQ 2 in Phrmy Servies t SCQF level 5 SVQ 3 in Phrmy Servies t SCQF level 6 Pulition dte: My 2011 Pulition ode: DB5818 The informtion in this pulition my e reprodued in support
More informationUB-04 Claim Form Instructions Required?
U-0 lim Form Instrutions Required? Field Lotion Instrutions Required 1 Enter the legl nme of the fility tht rendered the servies nd their omplete physil ddress. Required, if pplies 2 Enter the omplete
More informationSouthern Midlands. Tasmanian Municipal Emergency Management Plan. Plan Details. Approval
Tsmnin Muniipl Emergeny Mngement Pln Southern Midlnds Pln Detils Pln Title: Southern Midlnds Emergeny Mngement Pln Issue Detils: Issue 5, 2011 Review Authority: Southern Midlnds Muniipl Emergeny Mngement
More informationDlNBVRGH + Sickness Absence Monitoring Report. Executive of the Council. Purpose of report
DlNBVRGH + + THE CITY OF EDINBURGH COUNCIL Sickness Absence Monitoring Report Executive of the Council 8fh My 4 I.I...3 Purpose of report This report quntifies the mount of working time lost s result of
More informationArchitecture and Data Flows Reference Guide
Arhiteture nd Dt Flows Referene Guide BES12 Version 12.3 Pulished: 2015-10-14 SWD-20151014125318579 Contents Aout this guide... 5 Arhiteture: BES12 EMM solution... 6 Components used to mnge BlkBerry 10,
More informationYoung Women s Christian Association of Form 990 (2014) Northwest Georgia, Inc 58-0617782
Young Women s Christin Assoition of Form 990 (0) rthwest Georgi, In 8-0778 Prt III Sttement of Progrm Servie Aomplishments Chek if Shedule O ontins response or note to ny line in this Prt III Briefly desrie
More informationEnd-to-end development solutions
TECHNICAL SERVICES Endtoend development solutions Mnged y TFE HOTELS TFE Hotels re the only Austrlin Hotel group with inhouse end to end development solutions. We hve expertise in Arhiteturl nd Interior
More informationInter-domain Routing
COMP 631: COMPUTER NETWORKS Inter-domin Routing Jsleen Kur Fll 2014 1 Internet-sle Routing: Approhes DV nd link-stte protools do not sle to glol Internet How to mke routing slle? Exploit the notion of
More informationBSA E-Filing - Report of Foreign Bank and Financial Accounts (FBAR) THEFREE20140001
FINANCIAL CRIMES ENFORCEMENT NETWORK BSA E-Filing - Report of Foreign Bnk nd Finnil Aounts (FBAR) THEFREE0000 Version Numer:. FinCEN Form OMB Control Numer: 0-0009 Effetive Jnury, 0 Filing Nme THE FREEDOM
More informationEquivalence Checking. Sean Weaver
Equivlene Cheking Sen Wever Equivlene Cheking Given two Boolen funtions, prove whether or not two they re funtionlly equivlent This tlk fouses speifilly on the mehnis of heking the equivlene of pirs of
More informationReasoning to Solve Equations and Inequalities
Lesson4 Resoning to Solve Equtions nd Inequlities In erlier work in this unit, you modeled situtions with severl vriles nd equtions. For exmple, suppose you were given usiness plns for concert showing
More informationROGERS, ANDERSON, MALODY & SCOTT, LLP CPAS 735 E. CARNEGIE DRIVE, SUITE 100 SAN BERNARDINO, CA 92408 (909) 889-0871
ROGERS, ANDERSON, MALODY & SCOTT, LLP CPAS 7 E. CARNEGIE DRIVE, SUITE 00 SAN BERNARDINO, CA 908 (909) 889-087 APRIL 8, 0 UNIVERSITY ENTERPRISES CORPORATION AT CSUSB 00 UNIVERSITY PARKWAY SAN BERNARDINO,
More informationAntiSpyware Enterprise Module 8.5
AntiSpywre Enterprise Module 8.5 Product Guide Aout the AntiSpywre Enterprise Module The McAfee AntiSpywre Enterprise Module 8.5 is n dd-on to the VirusScn Enterprise 8.5i product tht extends its ility
More informationEnterprise Risk Management Software Buyer s Guide
Enterprise Risk Mngement Softwre Buyer s Guide 1. Wht is Enterprise Risk Mngement? 2. Gols of n ERM Progrm 3. Why Implement ERM 4. Steps to Implementing Successful ERM Progrm 5. Key Performnce Indictors
More informationHealth insurance exchanges What to expect in 2014
Helth insurnce exchnges Wht to expect in 2014 33096CAEENABC 11/12 The bsics of exchnges As prt of the Affordble Cre Act (ACA or helth cre reform lw), strting in 2014 ALL Americns must hve minimum mount
More informationENCLOSED ARE THE ORGANIZATION'S 2014 EXEMPT ORGANIZATION RETURNS. THE PAPER FILED RETURN(S) SHOULD BE SIGNED, DATED, AND MAILED, AS INDICATED.
CHILD, INC. 88 E. RD STREET AUSTIN, T 787 ATTENTION: ALBERT L. BLACK DEAR MR. BLACK: ENCLOSED ARE THE ORGANIZATION'S 0 EEMPT ORGANIZATION RETURNS. THE PAPER FILED RETURN(S) SHOULD BE SIGNED, DATED, AND
More informationQuick Guide to Lisp Implementation
isp Implementtion Hndout Pge 1 o 10 Quik Guide to isp Implementtion Representtion o si dt strutures isp dt strutures re lled S-epressions. The representtion o n S-epression n e roken into two piees, the
More informationVMware Horizon FLEX Administration Guide
VMwre Horizon FLEX Administrtion Guide Horizon FLEX 1.1 This doument supports the version of eh produt listed nd supports ll susequent versions until the doument is repled y new edition. To hek for more
More informationActive & Retiree Plan: Trustees of the Milwaukee Roofers Health Fund Coverage Period: 06/01/2015-05/31/2016 Summary of Benefits and Coverage:
Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge for: Single & Fmily Pln Type: NPOS This is only summry. If you wnt more detil bout your coverge nd costs, you cn get the complete
More informationCombined Liability Insurance. Information and Communication Technology Proposal form
Comined Liility Insurnce Informtion nd Communiction Technology Proposl form Comined Liility Insurnce Informtion nd Communiction Technology - Proposl form This proposl form must e completed nd signed y
More informationDo not enter Social Security numbers on this form as it may be made public. Open to Public Internal Revenue Service
OMB. 1-007 Return of Orgniztion Exempt From Inome Tx Form 990 Under setion 01(), 7, or 97()(1) of the Internl Revenue Code (exept privte foundtions) 01 Deprtment of the Tresury Do not enter Soil Seurity
More informationReturn of Organization Exempt From Income Tax
PUBLIC DISCLOSURE COPY Form 99 Return of Orgniztion Exempt From Inome Tx Uner setion 51, 527, or 4947(1) of the Internl Revenue Coe (exept privte fountions) OMB 1545-47 Do not enter Soil Seurity numers
More informationHumana Critical Illness/Cancer
Humn Criticl Illness/Cncer Criticl illness/cncer voluntry coverges py benefits however you wnt With our criticl illness nd cncer plns, you'll receive benefit fter serious illness or condition such s hert
More informationNote: Principal version Modification Amendment Equivalence list Consolidated version from October 1 2014
Note: The following curriculum is consolidted version. It is leglly non-inding nd for informtionl purposes only. The leglly inding versions re found in the University of Innsruck Bulletins (in Germn).
More informationQuick Reference Guide: One-time Account Update
Quick Reference Guide: One-time Account Updte How to complete The Quick Reference Guide shows wht existing SingPss users need to do when logging in to the enhnced SingPss service for the first time. 1)
More informationCalculating Principal Strains using a Rectangular Strain Gage Rosette
Clulting Prinipl Strins using Retngulr Strin Gge Rosette Strin gge rosettes re used often in engineering prtie to determine strin sttes t speifi points on struture. Figure illustrtes three ommonly used
More informationOxCORT v4 Quick Guide Revision Class Reports
OxCORT v4 Quik Guie Revision Clss Reports This quik guie is suitble for the following roles: Tutor This quik guie reltes to the following menu options: Crete Revision Clss Reports pg 1 Crete Revision Clss
More informationOpenness and honesty when things go wrong: the professional duty of candour
Openness nd honesty when things go wrong: the professionl duty of ndour The professionl duty of ndour 1 Every helthre professionl must e open nd honest with ptients when something tht goes wrong with their
More informationChapter. Contents: A Constructing decimal numbers
Chpter 9 Deimls Contents: A Construting deiml numers B Representing deiml numers C Deiml urreny D Using numer line E Ordering deimls F Rounding deiml numers G Converting deimls to frtions H Converting
More informationFDIC Study of Bank Overdraft Programs
FDIC Study of Bnk Overdrft Progrms Federl Deposit Insurnce Corportion November 2008 Executive Summry In 2006, the Federl Deposit Insurnce Corportion (FDIC) initited two-prt study to gther empiricl dt on
More informationTroop Open House. tool to reach youth who have never tried Scouting.
Troop Open House The Boy Sout troop open house llows troop to swing open its doors nd roll out the red rpet to welome guests. It provides forum to show off Souting tivities nd the troop s omplishments.
More informationMERSEY-LEVEN. Tasmanian Municipal Emergency Management Plan. Plan Details: Approval: Issue 2, December 2014 Page 1 of 53.
Tsmnin Muniipl Mngement Pln MERSEY-LEVEN Pln Detils: Pln Title: Mersey-Leven Mngement Pln Issue Detils: Issue 2, Deemer 2014 Review Authority: Mersey-Leven Mngement Committee Sumission Authority: North-West
More informationOpenness and honesty when things go wrong: the professional duty of candour
Openness nd honesty when things go wrong: the professionl duty of ndour The professionl duty of ndour 1 Every helthre professionl must e open nd honest with ptients when something tht goes wrong with their
More informationLEGISLATIVE BUDGET SYSTEM BUDGET COMPARISON WORKSHEET EXPLANATION A W
LEGISLTIVE UDGET SYSTEM UDGET COMPRISON ORKSHEET Page 1 of 24 Program ID: JUD101 Structure #: 010101000000 COURTS OF PPEL JUDICIRY SEQ # EXPLNTION FIRST FY SECOND FY EXPLNTION 79.00 6,429,114 79.00 6,429,114
More informationCorporate Compliance vs. Enterprise-Wide Risk Management
Corporte Complince vs. Enterprise-Wide Risk Mngement Brent Sunders, Prtner (973) 236-4682 November 2002 Agend Corporte Complince Progrms? Wht is Enterprise-Wide Risk Mngement? Key Differences Why Will
More informationData Quality Certification Program Administrator In-Person Session Homework Workbook 2015-2016
Dt Qulity Certifition Progrm Aministrtor In-Person Session Homework Workook 2015-2016 Plese Note: Version 1.00: Pulishe 9-1-2015 Any exerises tht my e upte fter this printing n e foun online in the DQC
More informationthe machine and check the components Black Yellow Cyan Magenta Starter Ink Cartridges Product Registration Sheet (USA only)
Quik Setup Guide Strt Here DCP-J140W Thnk you for hoosing Brother, your support is importnt to us nd we vlue your usiness. Your Brother produt is engineered nd mnuftured to the highest stndrds to deliver
More informationNational Firefighter Ability Tests And the National Firefighter Questionnaire
Ntionl Firefighter Aility Tests An the Ntionl Firefighter Questionnire PREPARATION AND PRACTICE BOOKLET Setion One: Introution There re three tests n questionnire tht mke up the NFA Tests session, these
More informationAudit Regulations. (This includes all amendments to the 2008 printed version of the Regulations as previously notified to firms in Audit News 53)
Audit Regultions Institute of Chrtered Aountnts in Englnd nd Wles Institute of Chrtered Aountnts of Sotlnd Chrtered Aountnts Irelnd 2013 (This inludes ll mendments to the 2008 printed version of the Regultions
More informationArc-Consistency for Non-Binary Dynamic CSPs
Ar-Consisteny for Non-Binry Dynmi CSPs Christin Bessière LIRMM (UMR C 9928 CNRS / Université Montpellier II) 860, rue de Sint Priest 34090 Montpellier, Frne Emil: essiere@rim.fr Astrt. Constrint stisftion
More informationWord Wisdom Correlations to the Common Core State Standards, Grade 6
Reing Stnrs for Informtionl Text Key Ies n Detils 1 Cite textul eviene to support nlysis of wht the text sys expliitly s well s inferenes rwn from the text. 6, 7, 12, 13, 18, 19, 28, 29, 34, 35, 40, 41,
More informationAssessing authentically in the Graduate Diploma of Education
Assessing uthenticlly in the Grdute Diplom of Eduction Dr Mree DinnThompson Dr Ruth Hickey Dr Michelle Lsen WIL Seminr JCU Nov 12 2009 Key ides plnning process tht embeds uthentic ssessment, workintegrted
More informationthe machine and check the components Starter Ink Cartridges Basic User s Guide Product Safety Guide Telephone Line Cord
Quik Setup Guide Strt Here MFC-J450DW MFC-J470DW Thnk you for hoosing Brother, your support is importnt to us nd we vlue your usiness. Your Brother produt is engineered nd mnuftured to the highest stndrds
More informationINITIATION OF THERAPY Patient-specific considerations for initiation of apixaban therapy include the following:
UNC HEALTH CARE GUIDELINE Mngement of Apixn in Adults Apixn (Eliquis ) is n orl nticogulnt tht cts s fctor X inhiitor. It is pproved y the FDA for the prevention of stroke nd systemic emolism in ptients
More informationIn addition, the following elements form an integral part of the Agency strike prevention plan:
UNITED STTES DEPRTMENT OF GRICULTURE Wshington, DC 20250 Federl Grin Inspection Service FGIS Directive 4711.2 6/16/80 STRIKE PREVENTION ND STRIKE CONTINGENCY PLNS I PURPOSE This Instruction: Estlishes
More informationGood practice in prescribing and managing medicines and devices
You n fin the ltest version of this guine on our wesite t www.gm-uk.org/guine. Referenes to Goo meil prtie upte in Mrh 2013 Goo prtie in presriing n mnging meiines n evies 1 In Goo meil prtie (2013) 1
More informationINSTALLATION, OPERATION & MAINTENANCE
DIESEL PROTECTION SYSTEMS Exhust Temperture Vlves (Mehnil) INSTALLATION, OPERATION & MAINTENANCE Vlve Numer TSZ-135 TSZ-150 TSZ-200 TSZ-275 TSZ-392 DESCRIPTION Non-eletril temperture vlves mnuftured in
More informationIssues in Information Systems Volume 14, Issue 2, pp.329-335, 2013 TOOLS AND TIPS FOR TEACHING SMARTPHONE SECURITY
TOOLS AND TIPS FOR TEACHING SMARTPHONE SECURITY Lynn R. Heinrihs, Elon University, lheinrihs@elon.edu Beth H. Jones, Western Crolin University, jones@emil.wu.edu ABSTRACT The growth of smrtphone ownership
More information17643L 3947 12/9/2015 1:28:02 PM V 14-7.8F 25879 PAGE 2
For 99 (1) Pge Prt Stteent of Progr Servie Aoplishents Chek if Shedule O ontins response or note to ny line in this Prt 1 Briefly desrie the orgniztion's ission: ATTACHMENT 1 RAPE, ABUSE & NCEST NATONAL
More informationAnthem Blue Cross Life and Health Insurance Company University of Southern California Custom Premier PPO 800/20%/20%
Anthem Blue Cross Life nd Helth Insurnce Compny University of Southern Cliforni Custom Premier 800/20%/20% Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge Period: 01/01/2015-12/31/2015
More informationSan Mateo County ACCEL Adult-Education College and Career Educational Leadership AB 86 Adult Education Consortium Project Management Plan 24, 2014 -
A Sn Mteo County ACCEL Adult-Eduction College nd Creer Eductionl Ledership AB 86 Adult Eduction Consortium Project Mngement Pln - Februry 24, 2014 - This project mngement pln presents ACCEL s process frmework
More informationQRG 141 British guideline on the management of asthma. Quick Reference Guide October 2014. Evidence
QRG 141 British guideline on the mngement of sthm Quik Referene Guide Otoer 2014 Evidene British Thori Soiety Sottish Interollegite Guidelines Network British guideline on the mngement of sthm Quik Referene
More informationA System Context-Aware Approach for Battery Lifetime Prediction in Smart Phones
A System Context-Awre Approh for Bttery Lifetime Predition in Smrt Phones Xi Zho, Yo Guo, Qing Feng, nd Xingqun Chen Key Lbortory of High Confidene Softwre Tehnologies (Ministry of Edution) Shool of Eletronis
More informationMATH PLACEMENT REVIEW GUIDE
MATH PLACEMENT REVIEW GUIDE This guie is intene s fous for your review efore tking the plement test. The questions presente here my not e on the plement test. Although si skills lultor is provie for your
More informationcontrol policies to be declared over by associating security
Seure XML Querying with Seurity Views Wenfei Fn University of Edinurgh & Bell Lortories wenfei@infeduk Chee-Yong Chn Ntionl University of Singpore hny@ompnusedusg Minos Groflkis Bell Lortories minos@reserhell-lsom
More informationSTATE OF MONTANA Developomental Disabilities Program Comprehensive Evaluation Hi-Line Home Programs, Inc Adult Services
Dtes of Review: FY '09 Evluttor(s): S. Crpenter DESK REVIEW: Accredittion: Acredittion is no longer required by the stte contrct. Significnt Events from the Agency: Developomentl Disbilities Progrm Comprehensive
More informationMorgan Stanley Ad Hoc Reporting Guide
spphire user guide Ferury 2015 Morgn Stnley Ad Hoc Reporting Guide An Overview For Spphire Users 1 Introduction The Ad Hoc Reporting tool is ville for your reporting needs outside of the Spphire stndrd
More information