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I.hello everyone we wanted to send me.presented originally in April we.apologize for the delay in getting this.posted there was some difficulty with.the formatting so thank you for bearing.with us and hopefully this will help for.anyone that has any questions related to.the health care associated infections.quality improvement activity that we.started in April first of all I'd like.to say thank you this was Kristin.gruffalo the quality improvement.director for the network of New England.and I just wanted to run through the.quality improvement activity and fellow.the questions and concerns that have.come up along the way so what I'm going.to go through this morning are the.network quality improvement activities.which includes the audits submission of.summary data and our report of summary.of progress to CMS I'll also review some.of the suggestions for facilities using.audit tools the facility hand hygiene.surveillance options and some of the.questions and answers that came up.during our previous webinars so the.network quality improvement activities.the network has several quality.improvement activities going on.simultaneously the first of which you're.involved in currently through this.webinar which is the healthcare.associated infections quality.improvement activity for this is.activity twenty percent of network.facilities were selected to compete.internal monthly audits for greater than.or equal to 30 hand hygiene observations.greater than or equal to 10 catheter.connection disconnection observations.and greater than or equal to 10 official.graph kenya cannulation observations.please note that fistula graphs d.cannulation is not part of this quality.improvement activity facilities will.then telling the numerators and.denominators and report those to the.network we then will report monthly.progress from facilities to see a mask.so some of the objectives from the cdc.for this activity includes using the.audit tools to assess and reinforce.experience the CDC recommended practices.the audit tools are very good examples.of some excellent ways to really look.through and monitor and surveil your.infection control practices some of the.CDC objectives include increasing.familiarity with CDC recommended.practice encouraging habitual attention.to it.and the practices and identifying and.addressing barriers to those practices.network will focus on audit.implementation so what I want everyone.to be very mindful of is that we're not.looking for you to change your numbers.it's not about changing the audit scores.it's truly about implementing the audits.and seeing what information that helps.you gather for your facility for.infection control through the audits.moving forward hopefully we can do some.more meaningful surveillance or help you.and doing more meaningful surveillance.with your clinics so really the.importance of correctly doing the audits.and not so much the results is really.what we're looking for and we really.encourage you to regularly review your.audit results and share these with staff.I'm sharing the feedback from the audits.and the results from the audits can.really help identify areas for.improvement and help engage staff by.allowing and to provide regular feedback.around what you're observing so the hand.hygiene observations are the first.audits that will be done you can see the.link there that can get you some.additional hand hygiene audit tools.although those should have been received.by your facility by now we did some bout.laminated tools to every auditor we did.receive a name for if you need any.additional tools laminated sent to you.please feel free to reach out to us if.the networks and we'll make sure that.you receive those so the hand hygiene.observations are greater than or equal.to 30 observations per facility per.month on what I'd like to point out is.that 30 opportunities actually is only.watching six patient interactions with.every patient interaction there are five.opportunities and look that's without a.little bit later with the hand hygiene.tool but just to diminish some of the.overwhelming feeling that may come with.seeing the number 30 in terms of.observations it's really observing.opportunities for hand hygiene not hand.hygiene itself so it's not watching.people perform hand hygiene 30 times but.rather watching for 30 opportunities for.hand hygiene which again each patient.opportunity represents five each patient.interaction excuse me represents five.opportunity so six patients could.actually get you to your 30 observations.the audit tool has two pages the auditor.will collect and tally the observations.then the second page also includes a.guide to the opportunity seeing the.dialysis unit a unit of observation for.hand hygiene is an opportunity not.necessarily the actual act of performing.hand hygiene so please be mindful of.that at the end of the month is part of.this survey facilities will submit to.the network what the summer and data was.from those hand hygiene tools so the.facility will use it the audit tools.request a minimum of 30 observations and.then tally the numerator and denominator.and either submit this to the network by.email or you can also use the NHSN hand.hygiene module which is available if you.choose to use the NHSN hand hygiene.module please let us know that by email.so that you can pull those results we.understand that this is two separate.entry systems and we completely.appreciate if you would prefer to just.email us all three results at this time.this is the only module available on the.CDC NHSN site for hand hygiene so.degeneration d cannulation and catheter.connection disconnection modules are not.currently available although they are.anticipated to be available by January.of next year so this is what the in.hygiene observation tool looks like as.you can see your first column has 13.rows the first column allows you to.record the discipline that you're.observing be a physician nurse.technician dietitian social worker or.however you would like to designate that.you see 13 rows there so it does require.two sheets to get to the minimum of 30.observations you have your first column.for discipline your second shows the.opportunity so observing you know for.example one patient interaction would be.five opportunities so you have five.opportunities there and then whether or.not the opportunity was successful so.while observing this person for hand.hygiene did they in fact perform hand.hygiene at the opportunities that Ian.hygiene would have been intended and.then in that last column you can.describe any missed attempts for example.was their medication preparation was.between patients was there possibly some.other intervening factor that would have.precluded the ability for the person to.complete the hand hygiene again your.first column shows your offer.knees and the number of opportunities.observed becomes your denominator this.number should be a minimum of 30 there.can be as many observations as you've.performed or throughout the month I I.wanted to point out that at the top you.can see it says facility means the start.time observer day things like that those.are helpful pieces of information for.you but please be mindful that none of.these oddities need to be performed all.in the same day you could certainly.perform several arm one day several on.another the three separate audit tools.they'll all have to be done on the same.day so don't feel as though that that.top line indicates that all of these.audits must be performed all in the same.day your opportunity successful is the.number of opportunities that are.observed successfully completed and.these become your numerator so if you.have a check in the first column and the.second column that would indicate a.check towards your numerator the second.page of the hand hygiene opportunities.to lift the five opportunities that are.available with each patient interaction.and you can read through these prior to.touching a patient's a prior to entering.a station contact with a desk or access.prior to adjusting or removing needles.and it goes on from there again with.each patient interaction there are five.opportunities at the bottom of this.section there are also notes about what.you're observing so was there a.sufficient supply of hand sanitizer a.sufficient supply of stopa hand-washing.stations paper towels things like that.that may be may be indicative of issues.into the address or stocking or a prior.to turn over that may make it more.difficult in or easier for hand hygiene.opportunities to be completed.successfully our next set of.observations are the catheter connection.disconnection observations not a tool.can be found at that website and has.also been sent out to the clinics again.this is 10 observations / facility per.month and the audit tool has one page.that would need two copies to reach the.10 observations again with this tool you.will collect and tally the observations.the monthly process will be to perform.those 10 observations Callie the.numerator and denominator and submit the.information to the network via email if.you have any questions about how to.submit this the numbers can be submitted.very simply with just the three.types of audits and the numbers listed.numerator or denominator we've also send.out in Excel spreadsheet that can be.used whatever method is easier for you.feel free to do so the only thing we ask.is if these numbers are emails and not.faxed this is intended to be an email.the reporting system and the only time.you'll need to fax us anything is if.you're chosen each month we'll be.choosing five facilities at random to.submit their audit tools for review just.to see how people are doing with the.audits so the audit tool corresponds to.the connection and disconnection.checklists my suggestion to you is that.you use these checklists initially when.you start doing your audits some of the.difficulties with the counselor.connection and disconnection audit tool.is that the connection and disconnection.are all on one tool and so when looking.across and we'll get there in one moment.you'll see that there are some columns.that apply solely to connection and.other columns that apply solely to this.connection so to avoid confusion when.you first start doing this process if.you're unfamiliar with the Tom checklist.of steps please use these checklist as a.means to properly capture the data and.report that on the auditing tool excuse.me I'm also please note that on the.catheter connection and disconnection.there are notes about removing paths or.connecting caps aseptically if your.facility's pego cast for example please.just note that when you submit your.audit results so that we're aware if you.are audited as one of the random side.for the month but that would be why that.column was not checked off so this is.the audit tool and as you can see it is.um pretty uh pretty busy tools are a.number of columns and they are mixed.together between connection and.disconnection again at the top of the.page you have some information about.when you're collecting the data if you.so choose to fill that in some of the.reasons that may be helpful is if you.start to notice that there are common.practices that are not happening or are.happening as best practices if you've.noticed the start time the day the.location who's observing those kind of.things you need be able to find a.pattern and use those for quality.improvement within the facility what I.want you to know is that there is no.total column.this particular audit tool we were not.able to modify this but you are welcome.to when you receive at your facility so.again you have seven rows on this tool.so it required two sheets to complete.the monthly audits your first column.again denotes whether you're observing.connection or disconnection and it can.be either you can serve the same patient.connection disconnection multiple.patients connection multiple patients.disconnection and so on your next column.is your discipline which you can note.physician nurse technician etc and the.number of procedures observe becomes.your denominator again for this.particular tool the minimum number of.observations and investor denominators.should be at least 10 but it can.certainly be more than that also.consider with the audit tools having.peers audit each other so a nurse.auditing and nurse a technician on a.technician but please be mindful that.anyone can observe anyone so a nurse can.observe a technician a technician a.nurse and so on and so forth but again.hygiene tool it may be it may be.beneficial to involve your patients in.the process if you have patients that.might want to be involved in helping.audit that's also a great way to engage.patients in the process and help them.understand the importance of hand.hygiene and holding the staff.accountable as well as scaffolding.patients accountable for their hand.hygiene since they all tie in together.so this is an example of how to complete.job tool in this particular example the.procedure observed was a connection it.was a nurse that was observed and.hygiene was performed new gloves were.worn the catheter hub was scrubbed the.hub antiseptic was allowed to drive.catheter was connected to bloodlines.aseptically clubs were removed in hand.hygiene is performed and as you can see.off to decide there's an equal to check.with the catheter connection.disconnection as well as the fistula.graft cannulation if all of the checks.that are applicable for that autók are.not in the column then the number of.procedures performed correctly would not.get a check so to further explain this.particular example all observations were.all opportunities were performed.correctly so that one observation of.that connection would become part of.your numerator if for example in the.same opportunity.the hand hygiene performed at the end.was not checked off then because all.check marks applicable to that.particular observation or not there then.you would not add that observation into.your numerator so the only numbers going.into your numerator are those procedures.that are performed one hundred percent.correctly if that needs further.explanation please feel free to reach.out to me I know that can be a confusing.example for people also please note that.each column across really only becomes.one observation so you're not going to.count each check mark for example if you.do 10 observations you can only have a.maximum number of ten procedures for.form correctly so if you do not get.affected for example hand hygiene.performed at the end is not checked off.and you don't have that final equals.check mark then your numerator would be.9 out of 10 for example if you were.doing 10 observations please understand.the recommended steps using that.checklist tools as a guide followed by.the audit tool know what applies for.connection versus disconnection again I.think that those checklists help to.identify the process for each and make.it a little bit easier to identify what.applies for each set of steps and then.tools device for counselors without.clothes connector devices for example.pego for example tego caps and things.like that please be mindful to always.follow your own policies and procedures.and provide us with feedback that we can.provide to the CDC in CMS tools for the.prop for this project must be used no.alternate tools can be used and we want.to ensure that you're still following.your own policy and procedure so again.if you have pego caps please just note.that when you submit your data so that.we can beat that information back to the.CDC these tools were intended to be used.more widespread and so may not be.applicable to your current practice but.just let us know what your current.practices so that we can denote that in.our feedback so our last set of.observations are the fistula graphic.annulation observations again that the.website is there if you need additional.tools for the month you need to perform.10 or more observations purpose.and again this has two pages page one is.cannulation observations page 2 D.cannulation for the purposes of this.quality improvement activity D.cannulation auditing is not counted is.not part of the following improvement.activity so when we have mailed you your.materials you only have the cannulation.observations if you go to the cdc.website different additional tools.please note that you only need the.cannulation observations portion of the.page if your facility is uses alcohol as.its prepping agent a wet step adjustment.which we'll get to in a moment on the.audit tool is fine please notify the.network when you submit so the process.again for the month is to collect a.minimum of 10 observations tally the.numerator and denominator and submit.this information to the network by email.this is a checklist that corresponds to.the cannulation observation again it's.helpful to start with a checklist if.you're unfamiliar with audits or you're.unsure which steps should be completed.for each observation we have sent these.in a laminated format so you can.certainly use a dry erase marker and.wipe them down allowing for infection.control with the tool itself and it may.be something that you want to use when.you're doing your initial observations.to ensure that you're looking for all of.the steps that are necessary again the.note about allowing skin antiseptic to.be applied and dry if that is not a.place for applicable in your facility.please edit that accordingly and just.let the let the network now so this is.the audit tool for cannulation.observations much like the catheter.observations it is a longer tool and.that there's more columns to check off.however this is a little bit simpler in.that it's either All or Nothing all of.the check marks are there equaling your.numerator or if a check mark is missed.for example generation performed.aseptically or connect to bloglines a.festively if something happens in that.process and those aren't checked off and.that would come out of your numerator so.once again on this tool you have a.column for discipline you have seven.rows you need two sheets to complete the.ten audits.your first column denotes a discipline.you're observing and the number of.observations performs becomes your.denominator again for each month the.minimum number should be 10 although it.can certainly be more there is no tally.town on this tool either but you are.more than welcome to add I know some.people have used the Collins the.comments column rather as their tally.poem again this is an example of an.audit performed this person was observed.it was a technician that was observed.all audits were performed correctly and.so there's a check mark at the end again.it's all or nothing so if any of those.check marks are missed outside of.allowing skin interceptors to drive.that's not part of your policy that.column then becomes not applicable if.any other column is mists then the check.mark is not there and thus that number.wouldn't go into your numerator again.your maximum numerator if your.denominator is 10 your maximum numerator.result of 10 we have had some people.submitting audits that's a 27 out of 30.because they're counting the check marks.individually it's truly each row is.counted so the final tally at the end.that equals check so if all the check.marks are there you would get a final.check is what becomes your numerator as.opposed to all the individual checks.finally the submission of your results.to the network includes these three.selections so your numerator and.denominator for hand hygiene catheter.connection disconnection official a.graph accumulation at the bottom there.is a comment section and again if you.send me by email without using the Excel.spreadsheet which is completely fine you.have any comments about common breaches.that you've identified challenges in.implementing the audits adjustments that.you've made based on your on policy.procedure and or what's going on within.your facility or things that you've even.identified through the audits through.your surveillance on can be noted either.within the email or again within this.section of the comments and you're in.the Excel document you should be sent by.the fifth of the following month so for.example for me.they were due on May 5th for the month.of April for May audits they will be due.due by June cysts and please send those.to my email address which is noted below.k brickell at end of you one esrd net.again you can use the audit tool.comments that are on the actual audit.tools to complete that comment section.to give us feedback we really do want to.pass on both positive and negative that.we can share with the CDC and CMS since.this is a new process we definitely want.to collect as much information as we.possibly can please note to that will be.discussing these on the healthcare.associated infections learning in action.network all of you are invited to attend.though not required it may be a helpful.Avenue for everyone to discuss what's.going on within the clinics what's.working well what's being implemented.what may be challenging amongst one.another so on a monthly basis once we.receive the information from the clinics.we then report monthly progress to CMS.on what we call our dash dash board.input form our goal is to achieve a.hundred percent of facility submitting.all three correctly completed audit.tools now correctly completed indicates.that the audits were performed the.number were performed and they were.performed correctly so our goal is.ultimately to get to all twenty percent.of facilities submitting those audit.tools to us and to get there obviously.we need your help in submitting the data.on time so that we can get that to CMS.if the information doesn't come to us on.time then we're reporting to the.dashboard that they'll all facilities.that are not reporting in a timely.manner again this is this is what we're.submitting essentially to CMS I think.believe the numbers have changed just.slightly but it's a number of facilities.that have correctly reported over the.goal number of facilities as the.denominator with any questions comments.or feedback in a different location to.our Contracting Officer so in terms of.selection for criteria for this quality.improvement activity we use two separate.selection criteria people were selected.either based on blood stream in.generates in the third quarter of 2013.so if you would have been included had.we done a quality improvement activity.on bloodstream infection reduction which.was the initial concept that was brought.up in 2013 and that was based on your.third quarter data from 2013 the.facility was selected for this project.additionally if the facility was already.completing notice audits excuse me as.noted on the facility audit scan.performed in January that was also part.of our selection criteria so that it was.a mix of people that were doing very.well in terms of blood stream infections.some that were not performing out some.that were for that it was a nice mix of.facilities across the area so.suggestions for using the audit tools.first understand the recommended steps.and practice using the tools as I stated.earlier try using the checklist on there.a good way to understand what steps.you're looking for to identify the.things that you should be looking for a.while performing an audit as well as.giving you a good step by step means to.track what you're observing you should.try to ensure that observations of.representative of normal practice so.observe different staff members on.different days and shifts this goes back.to my initial point about not all the.oddest having to be performed on the.same day for hand hygiene consider.observing during busy times such as.shift change which we all call turnover.try to select an area where staff.interactions are clearly visible so if.you're in an area that may be a little.bit more difficult to see what if a fem.or may be doing in terms of camp hygiene.that may not be the best place to be.standing additionally there's multiple.ways to implement the audit classes you.can focus on one or two patient stations.or you can monitor the entire treatment.for whatever works best for you.ultimately we want you to adapt this and.use this in a means that is most useful.and streamlined for you what I would.like to say though is try to be.consistent with whatever you decide is.your auditing method this will help to.facilitate drawing conclusions based on.the results that you obtain the CDC.recommends.monitoring which may provide a more.realistic assessment of practice but we.obviously understand that this is.sometimes impossible depending on the.vascular access audits that you're doing.that may not be something that is.obviously possible depending on where.you need to stand to observe that and.you really do have to experiment to find.what observations work best for you we.encourage you to create a system that.works best for you and your clinic and.that gives you the most meaningful.results possible so in summary the.monthly facility actions include.performing 30 hand hygiene observations.and collecting that data using the CDC.audit tool and reporting that data to.the network by email using either the.table sent by Excel NHSN or just regular.email and submitting the facility name.Medicare number and free audits with.their numerator and denominator the i.scrub app is listed there we did not.review this because it does require a.phone to be used to record an iphone to.record and since in the majority of.facilities phone jemima on the floor due.to infection control we certainly didn't.want to cause a problem with that the.catheter connection and disconnection.and Vista graft observations again or 10.or more observations per month.collecting that information via the.audit tool and then reporting it to the.network by email here's some additional.resources for facilities and i truly.encourage you to use some of these.resources they are fantastic examples of.ways to implement surveillance and audit.practice within your facility there.specific to dialysis which is really.nice the best practices video mirrors.the steps in the checklist so they can.help to train auditors on what to.observe describe the hub protocol I.think everyone is familiar with but it.is available the checklist tools are.also available on the CDC as is the hand.hygiene observation and there's many.more resources available including a.training that can obtain one see you.credit for anyone that may need to use.it is free see you credit so I encourage.you to look through this and provide us.a feedback throughout the process so.again some of the CDC objectives for.this process are to increase familiarity.with recommend.practice encourage habitual attention to.an assessment of practice identifying.address barriers to recommended.practices submit those audit tools to.the network on a monthly basis we're.using twenty percent of the network.facilities to conduct these observations.we will forego kisan supporting.implementation and please know that.anything you need be it a question some.more materials guidance or resources.please reach out to the network because.we will support you in this and we do.understand how hectic and busy it is on.the floor both myself and how they're.keen from units so we do understand what.turnovers like and how busy it can be.during a regular day in the unit on so.please don't hesitate to reach out to us.even if it's just to kind of give us.some feedback about the challenges that.you're having and implementing the.audits or even the best practices you're.identifying along the way we really do.want to hear about it we will report to.CMS on a monthly basis the number of.facilities and met the requirements for.each audit types and the CDC is.interested in feedback so please provide.us with any feedback or resources and.materials that you think would be.helpful for us or for the CDC and.implementing or changing these tools.moving forward so I did send out a.survey monkey link prior to when I did.the previous webinar dates if anyone is.interested in completing that to provide.feedback around the survey it will be.listed below this webinar posting on on.the website and I do encourage you to.complete that survey monkey it's a very.short one but it will help us to edit or.change any materials that we need to get.out to to better understand these audits.thank you very much for your time and we.look forward to working with you.

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  1. Include the CocoSign app from Google Play Store.
  2. Login to your CocoSign account from your device or signup if you have not been pre-registered.
  3. Tick on the '+' option and add the document in which you want to write down your electronic signatures.
  4. Take the area you want to put your signatures.
  5. Personalize your e-signature in another pop-up window.
  6. Place it on the page and tick '✓'.
  7. Save changes and foward the file.
  8. You can also share this signed Quality Improvement Activity Qia Form Instructions with other people or upload it on the cloud.

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Quality Improvement Activity Qia Form Instructions FAQs

Here are some frequently asked questions along with their answers to clear up the doubts that you might have.

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How can I fill out an improvement form of the CBSE 2017?

IN the month of August the application form will be available on cbse official website which you have to fill online then it will ask in which you subject you want to apply for improvement…you can select all subjects and additional subjects also then you have to pay the amount for improvement exam which you have to pay at bank. take the print out of the acknowledgement and the e-challan and deposit the fees at bank… you also have to change your region when you type the pin code then according to that you will get your centre as well as new region means you region will change. it don't effect anything. after all these thing you have to send a xerox copy of your marksheet e-challan acknowledgement to the regional office which you get. the address will be returned on the acknowledgement after that you have to wait to get your admit card which you will get online on month of February…and improvement marksheet will be send to you address which you fill at time of applications form filling time. if you get less marks in improvement then old marksheet will be valid so All The Best

What's the best way to get users to read a set of instructions for filling out a form?

Short of sitting on their heads until they recite them back at you, there is no way to guarantee that users to read any instructions, ever. Therefore the best solution is the one that requires the least reading on the part of the user.

How can I fill out an improvement exam form for session 17-18 online?

CBSE improvement exam form will available from mid-week of October on CBSE website.Whole process is online only you have to post online filled applications form to CBSE regional office. All The Best

Can I fill out the improvement exam form online? If yes, then how?

Cbse improvement class 12th exam forms will be out probably in 1st wk. Of October 2017. Yes you can fill the form online on the official website of CBSE I.e www.cbse.nic.in just go on the mentioned website and check the news section if the forms are available then click on the link related to improvement exam. Then you must have to fill your previous details like Roll no, school no. , Subject selection {jee aspirant must go for all five subjects if, wants to appear} and for other general details please refer to your previous yr. Admit card. Then go for fee payment which is 200₹/subject by e-challan mode and after the completion of payment status get your reference copy. Or you can also fill the form by offline mode the forms will be available in regional Cbse office or syndicate bank branches near you.

What is quality improvement in healthcare system?

Quit using the fantasy of getting someone else (“the rich”) to pay your bills (“free healthcare”) - just in order to get votes. We already tax the rich more than the countries used as examples. No Country Leans on Upper-Income Households as Much as U.S. - Tax Foundation Quit trying to bypass the intentions of the Constitution by proposing a Federal single payer system. Again - not even all Democrats will vote for it. Use the power granted to the Federal government to tax to fund universal healthcare. Our income taxes inherently give advantage to foreign companies (too much to explain here). Elim Continue Reading

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