Baseline Self Assessment
THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA
Hospital Baseline Self‐Assessment Survey for
Pressure Ulcer Prevention and Early Stage Pressure Ulcer Treatment
The Pennsylvania Pressure Ulcer Partnership (PPUP) in conjunction with ECRI has developed this baseline survey to assess hospital processes covered in the PPUP initiative. All survey questions are based on the initiative’s Action Goals and evidence base for pressure ulcer prevention/treatment of early stage pressure ulcers. The Hospital & Healthsystem
Association (HAP) as a partner is fielding the survey to Pennsylvania hospitals on behalf of ECRI and the PPUP. The survey should be completed at the hospital’s multidisciplinary pressure ulcer team meeting, with the team using a consensus approach to answer each question.
Hospital/Health System:
Contact Name:
Title:
Phone:
Email:
Fax or email completed survey to Michelle Memmi at 717‐561‐5334 or mmemmi@haponline.org no later than September xx, 2008. 1.
The following staff at your hospital has demonstrated a commitment to improving patient safety through supporting the implementation of pressure ulcer prevention and early stage treatment strategies:
Strongly agree Agree
Neither agree or disagree
Disagree
Strongly disagree Senior leadership
The medical executive committee
Nursing leadership 2.
3.
4.
The hospital has identified skin‐care staff champions for units within the hospital. (check all that apply) For critical care areas
For entire hospital
For intermediate/step‐down care areas
Hospital has not yet identified skin champions for any areas
For medical/surgical areas Does your hospital require initial risk assessments for pressure ulcers on all patients upon admission? Yes
Policy is in development, implementation planned within 6 months
Policy is in development, implementation
Hospital Baseline Self‐Assessment Survey for
Pressure Ulcer Prevention and Early Stage Pressure Ulcer Treatment
The Pennsylvania Pressure Ulcer Partnership (PPUP) in conjunction with ECRI has developed this baseline survey to assess hospital processes covered in the PPUP initiative. All survey questions are based on the initiative’s Action Goals and evidence base for pressure ulcer prevention/treatment of early stage pressure ulcers. The Hospital & Healthsystem
Association (HAP) as a partner is fielding the survey to Pennsylvania hospitals on behalf of ECRI and the PPUP. The survey should be completed at the hospital’s multidisciplinary pressure ulcer team meeting, with the team using a consensus approach to answer each question.
Hospital/Health System:
Contact Name:
Title:
Phone:
Email:
Fax or email completed survey to Michelle Memmi at 717‐561‐5334 or mmemmi@haponline.org no later than September xx, 2008. 1.
The following staff at your hospital has demonstrated a commitment to improving patient safety through supporting the implementation of pressure ulcer prevention and early stage treatment strategies:
Strongly agree Agree
Neither agree or disagree
Disagree
Strongly disagree Senior leadership
The medical executive committee
Nursing leadership 2.
3.
4.
The hospital has identified skin‐care staff champions for units within the hospital. (check all that apply) For critical care areas
For entire hospital
For intermediate/step‐down care areas
Hospital has not yet identified skin champions for any areas
For medical/surgical areas Does your hospital require initial risk assessments for pressure ulcers on all patients upon admission? Yes
Policy is in development, implementation planned within 6 months
Policy is in development, implementation