Sync template from atomicqms-style deployment
This commit is contained in:
0
Forms/Assessment-Tools/.gitkeep
Normal file
0
Forms/Assessment-Tools/.gitkeep
Normal file
@@ -0,0 +1,332 @@
|
||||
# Nursing Admission Assessment
|
||||
|
||||
| Form ID | FRM-INP-001 | Revision | 1.0 |
|
||||
|---------|-------------|----------|-----|
|
||||
|
||||
---
|
||||
|
||||
## Patient Information
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Patient Name | |
|
||||
| MRN | |
|
||||
| Date of Birth | |
|
||||
| Admission Date | |
|
||||
| Admission Time | |
|
||||
| Admitting Physician | |
|
||||
| Unit/Room | |
|
||||
| Admitting Diagnosis | |
|
||||
| Source of Admission | ☐ Home ☐ ED ☐ Transfer ☐ Other: _______ |
|
||||
| Mode of Arrival | ☐ Ambulatory ☐ Wheelchair ☐ Stretcher |
|
||||
|
||||
---
|
||||
|
||||
## Vital Signs
|
||||
|
||||
| Parameter | Value | Time |
|
||||
|-----------|-------|------|
|
||||
| Temperature | °F / °C | |
|
||||
| Heart Rate | bpm | |
|
||||
| Respiratory Rate | breaths/min | |
|
||||
| Blood Pressure | / mmHg | |
|
||||
| SpO2 | % on ☐ RA ☐ O2 ___L/min | |
|
||||
| Pain Level | /10 | |
|
||||
| Height | | |
|
||||
| Weight | | |
|
||||
|
||||
---
|
||||
|
||||
## Allergies
|
||||
|
||||
☐ No Known Allergies (NKA)
|
||||
☐ No Known Drug Allergies (NKDA)
|
||||
|
||||
| Allergen | Type | Reaction |
|
||||
|----------|------|----------|
|
||||
| | ☐ Drug ☐ Food ☐ Environmental ☐ Other | |
|
||||
| | ☐ Drug ☐ Food ☐ Environmental ☐ Other | |
|
||||
| | ☐ Drug ☐ Food ☐ Environmental ☐ Other | |
|
||||
|
||||
**Allergy band applied?** ☐ Yes ☐ N/A
|
||||
|
||||
---
|
||||
|
||||
## Current Medications
|
||||
|
||||
| Medication | Dose | Frequency | Last Taken | Continue? |
|
||||
|------------|------|-----------|------------|-----------|
|
||||
| | | | | ☐ Yes ☐ No |
|
||||
| | | | | ☐ Yes ☐ No |
|
||||
| | | | | ☐ Yes ☐ No |
|
||||
| | | | | ☐ Yes ☐ No |
|
||||
| | | | | ☐ Yes ☐ No |
|
||||
| | | | | ☐ Yes ☐ No |
|
||||
| | | | | ☐ Yes ☐ No |
|
||||
| | | | | ☐ Yes ☐ No |
|
||||
|
||||
**Medication source:** ☐ Patient/Family ☐ Pharmacy Records ☐ PCP Records ☐ Other: _______
|
||||
|
||||
**Medications brought to hospital?** ☐ Yes (inventory attached) ☐ No
|
||||
|
||||
---
|
||||
|
||||
## Medical History
|
||||
|
||||
### Past Medical History
|
||||
☐ None significant
|
||||
|
||||
| Condition | Notes |
|
||||
|-----------|-------|
|
||||
| ☐ Hypertension | |
|
||||
| ☐ Diabetes | Type: ☐ 1 ☐ 2 |
|
||||
| ☐ Heart Disease | |
|
||||
| ☐ COPD/Asthma | |
|
||||
| ☐ Stroke/TIA | |
|
||||
| ☐ Cancer | Type: |
|
||||
| ☐ Kidney Disease | |
|
||||
| ☐ Liver Disease | |
|
||||
| ☐ Seizures | |
|
||||
| ☐ Psychiatric | |
|
||||
| ☐ Other: | |
|
||||
|
||||
### Past Surgical History
|
||||
☐ None
|
||||
|
||||
| Surgery/Procedure | Year |
|
||||
|-------------------|------|
|
||||
| | |
|
||||
| | |
|
||||
| | |
|
||||
|
||||
---
|
||||
|
||||
## Review of Systems
|
||||
|
||||
### General
|
||||
- ☐ Fatigue/Weakness
|
||||
- ☐ Fever/Chills
|
||||
- ☐ Weight Change
|
||||
- ☐ Night Sweats
|
||||
|
||||
### Cardiovascular
|
||||
- ☐ Chest Pain
|
||||
- ☐ Palpitations
|
||||
- ☐ Edema
|
||||
- ☐ Shortness of Breath with Activity
|
||||
|
||||
### Respiratory
|
||||
- ☐ Cough
|
||||
- ☐ Shortness of Breath at Rest
|
||||
- ☐ Oxygen Use at Home
|
||||
- ☐ CPAP/BiPAP Use
|
||||
|
||||
### Gastrointestinal
|
||||
- ☐ Nausea/Vomiting
|
||||
- ☐ Abdominal Pain
|
||||
- ☐ Diarrhea
|
||||
- ☐ Constipation
|
||||
- ☐ Blood in Stool
|
||||
|
||||
### Genitourinary
|
||||
- ☐ Incontinence
|
||||
- ☐ Dysuria
|
||||
- ☐ Urgency/Frequency
|
||||
- ☐ Foley Catheter
|
||||
|
||||
### Neurological
|
||||
- ☐ Numbness/Tingling
|
||||
- ☐ Weakness
|
||||
- ☐ Confusion
|
||||
- ☐ Dizziness/Vertigo
|
||||
|
||||
### Skin
|
||||
- ☐ Rash
|
||||
- ☐ Open Wounds
|
||||
- ☐ Bruising
|
||||
|
||||
---
|
||||
|
||||
## Pain Assessment
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Pain Present? | ☐ Yes ☐ No |
|
||||
| Location | |
|
||||
| Character | ☐ Sharp ☐ Dull ☐ Aching ☐ Burning ☐ Stabbing |
|
||||
| Intensity (0-10) | |
|
||||
| Duration | ☐ Constant ☐ Intermittent |
|
||||
| Aggravating Factors | |
|
||||
| Relieving Factors | |
|
||||
| Current Pain Management | |
|
||||
|
||||
---
|
||||
|
||||
## Fall Risk Assessment
|
||||
|
||||
**Morse Fall Scale** (or institutional tool)
|
||||
|
||||
| Risk Factor | Score |
|
||||
|-------------|-------|
|
||||
| History of falling | ☐ No (0) ☐ Yes (25) |
|
||||
| Secondary diagnosis | ☐ No (0) ☐ Yes (15) |
|
||||
| Ambulatory aid | ☐ None/Bed rest/Nurse assist (0) ☐ Crutches/Cane/Walker (15) ☐ Furniture (30) |
|
||||
| IV/Heparin Lock | ☐ No (0) ☐ Yes (20) |
|
||||
| Gait | ☐ Normal/Bed rest/Immobile (0) ☐ Weak (10) ☐ Impaired (20) |
|
||||
| Mental Status | ☐ Oriented to own ability (0) ☐ Overestimates/forgets limitations (15) |
|
||||
| **Total Score** | |
|
||||
|
||||
**Risk Level:**
|
||||
- ☐ Low Risk (0-24)
|
||||
- ☐ Moderate Risk (25-44)
|
||||
- ☐ High Risk (≥45)
|
||||
|
||||
**Fall precautions initiated?** ☐ Yes ☐ N/A
|
||||
|
||||
---
|
||||
|
||||
## Pressure Ulcer Risk Assessment
|
||||
|
||||
**Braden Scale**
|
||||
|
||||
| Category | Score (1-4) |
|
||||
|----------|-------------|
|
||||
| Sensory Perception | |
|
||||
| Moisture | |
|
||||
| Activity | |
|
||||
| Mobility | |
|
||||
| Nutrition | |
|
||||
| Friction/Shear | |
|
||||
| **Total Score** | |
|
||||
|
||||
**Risk Level:**
|
||||
- ☐ Mild Risk (15-18)
|
||||
- ☐ Moderate Risk (13-14)
|
||||
- ☐ High Risk (10-12)
|
||||
- ☐ Very High Risk (≤9)
|
||||
|
||||
**Skin interventions initiated?** ☐ Yes ☐ N/A
|
||||
|
||||
---
|
||||
|
||||
## Skin Assessment
|
||||
|
||||
☐ Skin intact, no abnormalities noted
|
||||
|
||||
**Abnormalities (document location and description):**
|
||||
|
||||
| Location | Description | Size | Stage/Type |
|
||||
|----------|-------------|------|------------|
|
||||
| | | | |
|
||||
| | | | |
|
||||
|
||||
---
|
||||
|
||||
## Nutritional Screen
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Diet at Home | |
|
||||
| Recent Weight Loss? | ☐ Yes (____lbs in ____weeks) ☐ No |
|
||||
| Difficulty Swallowing? | ☐ Yes ☐ No |
|
||||
| Dentures? | ☐ Yes ☐ No |
|
||||
| Food Allergies/Intolerances | |
|
||||
| Special Diet Needs | |
|
||||
|
||||
**Dietitian Referral Needed?** ☐ Yes ☐ No
|
||||
|
||||
---
|
||||
|
||||
## Functional Assessment
|
||||
|
||||
### Mobility
|
||||
- ☐ Independent
|
||||
- ☐ Assistive Device: _______
|
||||
- ☐ Requires Assistance
|
||||
- ☐ Bed Bound
|
||||
|
||||
### Activities of Daily Living
|
||||
|
||||
| Activity | Independent | Needs Assistance | Dependent |
|
||||
|----------|-------------|------------------|-----------|
|
||||
| Bathing | ☐ | ☐ | ☐ |
|
||||
| Dressing | ☐ | ☐ | ☐ |
|
||||
| Toileting | ☐ | ☐ | ☐ |
|
||||
| Feeding | ☐ | ☐ | ☐ |
|
||||
| Transfers | ☐ | ☐ | ☐ |
|
||||
|
||||
---
|
||||
|
||||
## Psychosocial Assessment
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Living Situation | ☐ Alone ☐ With Family/Spouse ☐ Assisted Living ☐ SNF ☐ Other: _______ |
|
||||
| Primary Caregiver | |
|
||||
| Emergency Contact | |
|
||||
| Contact Phone | |
|
||||
| Relationship | |
|
||||
| Barriers to Care | ☐ None ☐ Language ☐ Transportation ☐ Financial ☐ Other: _______ |
|
||||
| Interpreter Needed? | ☐ Yes (Language: _______) ☐ No |
|
||||
|
||||
---
|
||||
|
||||
## Advance Directives
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Advance Directive on File? | ☐ Yes ☐ No ☐ Unknown |
|
||||
| Healthcare Proxy/POA? | ☐ Yes (Name: _______) ☐ No |
|
||||
| Copy Obtained? | ☐ Yes ☐ No ☐ N/A |
|
||||
| Code Status | ☐ Full Code ☐ DNR ☐ DNR/DNI ☐ Comfort Care Only |
|
||||
| Physician Order for Code Status? | ☐ Yes ☐ Pending |
|
||||
|
||||
---
|
||||
|
||||
## Discharge Planning Screen
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Anticipated Discharge Disposition | ☐ Home ☐ Home with Services ☐ Rehab ☐ SNF ☐ Unknown |
|
||||
| DME Needs Anticipated? | ☐ Yes ☐ No ☐ Unknown |
|
||||
| Home Health Needs? | ☐ Yes ☐ No ☐ Unknown |
|
||||
| Case Management Referral? | ☐ Yes ☐ No |
|
||||
| Social Work Referral? | ☐ Yes ☐ No |
|
||||
|
||||
---
|
||||
|
||||
## Safety Measures Initiated
|
||||
|
||||
- [ ] Fall precautions per risk level
|
||||
- [ ] Skin precautions per risk level
|
||||
- [ ] Call light within reach
|
||||
- [ ] Bed in low position
|
||||
- [ ] Side rails per policy
|
||||
- [ ] Patient education on safety
|
||||
|
||||
---
|
||||
|
||||
## Orientation Provided
|
||||
|
||||
- [ ] Room orientation (call light, bathroom, bed controls)
|
||||
- [ ] Visiting hours
|
||||
- [ ] Unit phone number
|
||||
- [ ] Patient rights information
|
||||
- [ ] Advance directive information
|
||||
- [ ] Valuables policy
|
||||
|
||||
---
|
||||
|
||||
## Assessment Completion
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Assessment Completed By | |
|
||||
| Credentials | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
| Signature | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-INP-001 Rev 1.0 - Nursing Admission Assessment*
|
||||
0
Forms/Care-Plans/.gitkeep
Normal file
0
Forms/Care-Plans/.gitkeep
Normal file
64
Forms/FRM-001-Document-Change-Request.md
Normal file
64
Forms/FRM-001-Document-Change-Request.md
Normal file
@@ -0,0 +1,64 @@
|
||||
# Document Change Request Form
|
||||
|
||||
| Form ID | FRM-001 | Revision | 1.0 |
|
||||
|---------|---------|----------|-----|
|
||||
|
||||
---
|
||||
|
||||
## Section 1: Request Information
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Request Date | |
|
||||
| Requested By | |
|
||||
| Department | |
|
||||
|
||||
## Section 2: Document Information
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Document Number | |
|
||||
| Document Title | |
|
||||
| Current Revision | |
|
||||
|
||||
## Section 3: Change Description
|
||||
|
||||
### Type of Change
|
||||
- [ ] New Document
|
||||
- [ ] Revision to Existing Document
|
||||
- [ ] Document Obsolescence
|
||||
|
||||
### Description of Change
|
||||
*(Describe the proposed change in detail)*
|
||||
|
||||
|
||||
|
||||
|
||||
### Reason for Change
|
||||
*(Explain why this change is needed)*
|
||||
|
||||
|
||||
|
||||
|
||||
## Section 4: Impact Assessment
|
||||
|
||||
### Affected Areas
|
||||
- [ ] Training Required
|
||||
- [ ] Other Documents Affected
|
||||
- [ ] Process Changes Required
|
||||
- [ ] Validation Impact
|
||||
|
||||
### List Affected Documents
|
||||
|
||||
|
||||
## Section 5: Approvals
|
||||
|
||||
| Role | Name | Signature | Date |
|
||||
|------|------|-----------|------|
|
||||
| Requester | | | |
|
||||
| Document Owner | | | |
|
||||
| Quality Assurance | | | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-001 Rev 1.0*
|
||||
91
Forms/FRM-003-CAPA-Form.md
Normal file
91
Forms/FRM-003-CAPA-Form.md
Normal file
@@ -0,0 +1,91 @@
|
||||
# Corrective and Preventive Action (CAPA) Form
|
||||
|
||||
| Form ID | FRM-003 | Revision | 1.0 |
|
||||
|---------|---------|----------|-----|
|
||||
|
||||
---
|
||||
|
||||
## Section 1: CAPA Identification
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| CAPA Number | |
|
||||
| Date Initiated | |
|
||||
| Initiated By | |
|
||||
| CAPA Owner | |
|
||||
| Target Closure Date | |
|
||||
|
||||
## Section 2: Classification
|
||||
|
||||
### Type
|
||||
- [ ] Corrective Action
|
||||
- [ ] Preventive Action
|
||||
|
||||
### Source
|
||||
- [ ] Customer Complaint
|
||||
- [ ] Internal Audit
|
||||
- [ ] External Audit
|
||||
- [ ] Process Deviation
|
||||
- [ ] Nonconforming Product
|
||||
- [ ] Management Review
|
||||
- [ ] Other: ____________
|
||||
|
||||
### Priority
|
||||
- [ ] Critical (5 business days)
|
||||
- [ ] Major (15 business days)
|
||||
- [ ] Minor (30 business days)
|
||||
|
||||
## Section 3: Problem Description
|
||||
|
||||
*(Describe the nonconformity or potential nonconformity)*
|
||||
|
||||
|
||||
|
||||
|
||||
## Section 4: Immediate Containment
|
||||
|
||||
*(Actions taken to contain the immediate impact)*
|
||||
|
||||
|
||||
|
||||
|
||||
## Section 5: Root Cause Investigation
|
||||
|
||||
### Investigation Method Used
|
||||
- [ ] 5 Whys
|
||||
- [ ] Fishbone Diagram
|
||||
- [ ] Fault Tree Analysis
|
||||
- [ ] Other: ____________
|
||||
|
||||
### Root Cause Determination
|
||||
|
||||
|
||||
|
||||
|
||||
## Section 6: Corrective/Preventive Actions
|
||||
|
||||
| Action | Responsible | Due Date | Status |
|
||||
|--------|-------------|----------|--------|
|
||||
| | | | |
|
||||
| | | | |
|
||||
| | | | |
|
||||
|
||||
## Section 7: Effectiveness Verification
|
||||
|
||||
| Criteria | Method | Result |
|
||||
|----------|--------|--------|
|
||||
| | | |
|
||||
|
||||
Verification Date: ____________
|
||||
Verified By: ____________
|
||||
|
||||
## Section 8: Closure
|
||||
|
||||
| Role | Name | Signature | Date |
|
||||
|------|------|-----------|------|
|
||||
| CAPA Owner | | | |
|
||||
| Quality Approval | | | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-003 Rev 1.0*
|
||||
56
Forms/FRM-006-Audit-Checklist.md
Normal file
56
Forms/FRM-006-Audit-Checklist.md
Normal file
@@ -0,0 +1,56 @@
|
||||
# Internal Audit Checklist
|
||||
|
||||
| Form ID | FRM-006 | Revision | 1.0 |
|
||||
|---------|---------|----------|-----|
|
||||
|
||||
---
|
||||
|
||||
## Audit Information
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Audit Number | |
|
||||
| Audit Date | |
|
||||
| Area/Process Audited | |
|
||||
| Lead Auditor | |
|
||||
| Auditee(s) | |
|
||||
|
||||
---
|
||||
|
||||
## Checklist Items
|
||||
|
||||
| # | Requirement/Question | Reference | C/NC/NA | Evidence/Notes |
|
||||
|---|---------------------|-----------|---------|----------------|
|
||||
| 1 | Are current versions of applicable procedures available? | SOP-001 | | |
|
||||
| 2 | Are personnel trained on applicable procedures? | SOP-003 | | |
|
||||
| 3 | Are training records current and complete? | SOP-003 | | |
|
||||
| 4 | Are records properly maintained and retrievable? | SOP-001 | | |
|
||||
| 5 | Are nonconformities being documented and addressed? | SOP-002 | | |
|
||||
| 6 | Are CAPAs being completed on time? | SOP-002 | | |
|
||||
| 7 | Is equipment calibrated and maintained? | | | |
|
||||
| 8 | Are process controls being followed? | | | |
|
||||
| 9 | Are quality objectives being monitored? | | | |
|
||||
| 10 | | | | |
|
||||
|
||||
**Legend:** C = Conforming, NC = Nonconforming, NA = Not Applicable
|
||||
|
||||
---
|
||||
|
||||
## Findings Summary
|
||||
|
||||
| Finding # | Type | Description | Clause Reference |
|
||||
|-----------|------|-------------|------------------|
|
||||
| | | | |
|
||||
| | | | |
|
||||
|
||||
---
|
||||
|
||||
## Auditor Signature
|
||||
|
||||
| Auditor | Signature | Date |
|
||||
|---------|-----------|------|
|
||||
| | | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-006 Rev 1.0*
|
||||
0
Forms/Incident-Reports/.gitkeep
Normal file
0
Forms/Incident-Reports/.gitkeep
Normal file
0
Forms/Medication-Records/.gitkeep
Normal file
0
Forms/Medication-Records/.gitkeep
Normal file
0
Forms/Safety-Checklists/.gitkeep
Normal file
0
Forms/Safety-Checklists/.gitkeep
Normal file
72
Forms/Training/FRM-004-Training-Record.md
Normal file
72
Forms/Training/FRM-004-Training-Record.md
Normal file
@@ -0,0 +1,72 @@
|
||||
# Training Record Form
|
||||
|
||||
| Form ID | FRM-004 | Revision | 1.0 |
|
||||
|---------|---------|----------|-----|
|
||||
|
||||
---
|
||||
|
||||
## Section 1: Employee Information
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Employee Name | |
|
||||
| Employee ID | |
|
||||
| Department | |
|
||||
| Job Title | |
|
||||
|
||||
## Section 2: Training Information
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Training Title | |
|
||||
| Training Date | |
|
||||
| Training Duration | |
|
||||
| Trainer Name | |
|
||||
| Trainer Qualification | |
|
||||
|
||||
### Training Type
|
||||
- [ ] Initial Training
|
||||
- [ ] Retraining
|
||||
- [ ] Refresher
|
||||
- [ ] Procedure Update
|
||||
|
||||
### Delivery Method
|
||||
- [ ] Classroom
|
||||
- [ ] On-the-Job
|
||||
- [ ] Self-Study
|
||||
- [ ] Computer-Based
|
||||
- [ ] Other: ____________
|
||||
|
||||
## Section 3: Training Content
|
||||
|
||||
*(List topics covered or attach training materials)*
|
||||
|
||||
|
||||
|
||||
|
||||
## Section 4: Assessment
|
||||
|
||||
### Assessment Method
|
||||
- [ ] Written Test
|
||||
- [ ] Practical Demonstration
|
||||
- [ ] Verbal Assessment
|
||||
- [ ] Observation
|
||||
|
||||
### Assessment Results
|
||||
|
||||
| Metric | Result |
|
||||
|--------|--------|
|
||||
| Score (if applicable) | |
|
||||
| Pass/Fail | |
|
||||
|
||||
## Section 5: Signatures
|
||||
|
||||
| Role | Name | Signature | Date |
|
||||
|------|------|-----------|------|
|
||||
| Trainee | | | |
|
||||
| Trainer | | | |
|
||||
| Supervisor | | | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-004 Rev 1.0*
|
||||
Reference in New Lab Ticket
Block a user