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* 1. Please enter your contact information below:

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* 2. Type of health care setting?

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* 3. Title of the project:

Instructions: The abstract narrative should not exceed 500 words.  The Patient Safety Best Practice must be a recent project within the past 2-3 years.

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* 4. The application may be considered for the Best Practice Award, the Patient Engagement Award or both. Check the box(es) to indicate the award for which you are applying:

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* 5. Patient Safety Best Practice Project Summary and Identification of the Patient Safety Issue:  Project summary should include a description of the project and the patient safety issue that was addressed.  The description should include the goal(s) of the project, rationale for the project, disciplines involved, project time frames and summary of the outcome(s) of the project. 5 pts

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* 6. Patient and Family Engagement:  Describe how patients and families were engaged in the project.  The description should include the factors that influenced patient and family engagement, the characteristics and perspectives of the patients and families and the methods and materials used to engage patients and families in the safety and quality of care.  Outline the process and strategies used to: Encourage patients and family members to participate as advisors; Promote better communication among patients, family members, and health care professionals. 5 pts

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* 7. Performance Improvement Process:  Outline the process, quality or change management processes used to obtain measurable change (for example PDCA). 5 pts

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* 8. Data Analytics:  Describe the approach to analyzing results over time.  Include the projects measure of success, use of benchmarks and target setting.  Email up to two figures, graphs, charts (i.e. run chart, control chart, Pareto chart) or tables, with each axis labeled to Dorothy Aldridge. 5 pts

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* 9. Results: 
9a. Describe the results that were achieved and the outcome of the initiative. 5 pts.

9b. Describe the sustainability of the best practice and how you were able to maintain and continue to sustain performance.  The results must demonstrate sustainable improvement for a minimum of six months. 5 pts

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* 10. Lessons Learned:  Detail one lesson learned from this initiative and how other Ohio organizations can benefit from your success.  Include an explanation of what your organization could have done differently, how other organizations could initiate and benefit from this type of project at their facility and what advice you have to offer based on the lesson(s) learned. 5 pts

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