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Every year all the following reports must be completed under the supervision of the Administrator/DON or delegate.

Administrator/DON: Survey Ready Check List

Survey Ready Check List

 

(The template must be updated with your discussion and Agency's reality data)

INFECTION PREVENTION 

ADD to Infection Control LOG, also discuss in BD meetings:

DON, Clinical Manager-QA Prioritized Infection Risk Report (Monthly)

Prioritized Infection Risk Surveillance of Infections Report                                                              

Infection Control Log       Prevention/Tx Log: Infection Prevention/Tx

DON:  Infection Control Risk Assessment Infection Prev. Risk Assessment   (Quarterly)

Infection Risk Goals Policy

DON-QA Infection Control program effectiveness Report (Quarterly)

Infection Control Effectiveness

Miami Dade EPI Report: Infection EPI Report   Request copy to: Vanessa.Villamil@flhealth.gov


DON, Clinical Manger-QA Hand Hygiene Improvement Intervention (to be posted in the Agency's Information Board) (Quarterly)

Handwashing Improvement

Hand Hygiene Patient Survey         Hand Hygiene Pt Survey Summary


FALL PREVENTION 

Add to Fall Prevention LOG, and BD meeting:

DON-QA Fall Prevention Intervention Plan (Monthly)

Fall Prevention Intervention Plan                      Monthly Fall Tracking

DON, Clinical Manager-QA Fall Prevention Program (Intervention Analyzes Report) (Quarterly)

Fall Prevention leadership Intervention          Agency Fall Prevention Evaluation

DON, Clinical Manager-QA

Fall Prevention Assessment (Quarterly)                   Fall Investigation Report(Quarterly)

Agency Fall Prevention Assessment                        Fall Investigation Report

DON, Clinical Manger-QA Fall Prevention Data Collection (Monthly)

Fall Prevention Data Collection

DON, Clinical Manager: Fall Prevention (Prioritized List) LOG (Must be completed monthly)

Fall Prioritized List


QAPI REPORTS 

QA/DON/Clinical Manger: Monthly report about hospitalization, emergency care prevention (results of risk assessment)

  (QAPI PROJECT)

DON: Hospitalization LOG (Must be completed monthly)     Hospitalization Log

Hospitalization risk analysis: Hospitalization risk analysis  Emergency care risk analysis: Emergency Care risk analysis

QAPI Project Hospitalization/Emergency Care:  Hospitalization/Emergency care services risk Project   

QAPI Plan-Do-Study-Act (PDSA) Hospitalization/Emergency Care PDSA

Decreasing Hospitalization, Improvement report: Decreasing hospitalization/Improvement Report

Cardio Vascular Disease Project: CVD Project                     CVD Plan-Do_Study (PDSA) CVD PDSA

(Complete the DC Planning control log, and have the Total DC patients with High BP)

DON, Clinical Manager/QA: Performance Levels, Patterns, Trends, Variations:  (Quarterly)

PI: Performance, Patterns, Trends

DON, Clinical Manager: OBQI Analyzes LOG (OBQI report must be analyzed by the Agency on Regular BD meeting, this log documented the review of the OBQI (Casper) reports) (Quarterly)

OBQI Analyzes Log                              Adverse Event (OBQI Analyzes)


MEDICATION MANAGEMENT 

DON, Clinical Manager: Medical Error Management Analyzes

Medical Error Management Analyzes  Quarterly         Medical Error Incident Report  Complete report as needed

Total Medical Error Incidents (%)    (Monthly)

Medication Management Analyzes   Quarterly            BEERS Criteria Medication List

DON: Patient on OXYGEN therapy LOG (Must be completed quarterly)    Patients on Oxygen Log

 

MULTIPLE REPORTS 

DON: Coordination of Care Compliance/Tracking LOG (Quarterly)        Coordination of Care

Administrator/DON: Complaints Log (Monthly)

Complaints Log Summary                            Complaints Log (detail) Summary

Administrator/DON/QA: Total of Incidents Summary/Occurrence Report  (Monthly)

Incidents/Occurrence Report

DON, Clinical Manager: Home Health Value Based Purchased report to CMS (Quarterly)

Value Based Purchased


DON, Clinical Manager: Total Monthly Discharge Patients by reasons Report Must be completed (Monthly)

Total Discharge Patients                    Discharge Planning Log


DON, Clinical Manager-Administrator Following Policy Log (Quarterly), Compliance Report  (Quarterly)

Following Policy Log                      Compliance Report                                        

Safety Tracking LOG (All year long)         Safety Tracking Log     (Complete all reports in Safety Minutes)


DON, Clinical Manager: Diabetes/Insulin Administration (PI Data Control List) LOG Must be completed (Quarterly)

Diabetes Control Log


Add to QAPI meeting (Quarterly)

DON, Clinical Manager/Administrator: INCIDENT Occurrence Report Must be completed (Monthly)

Incident Occurence Report

Administrator Financial and Billing Report to BD (Quarterly)       Financial/Billing Reports


DON, Clinical Manager: More Common Diseases report by counties: (Monthly)

Florida:

Any Foridal County

Miami Dade    Monroe County (Keys)    Broward

Palm Beach    Duval County    Indian River           

Seminole County    Orange County    Brevard County

Osceola County    Hardee County    Highlands County

Hillsborough County    Manatee County    Polk County

Charlotte County    Collier County    DeSoto County

Glades County    Hendry County    Lee County

Sarasota County    Pasco County    Pinellas County

California:

Los Angeles County CA

Illinois:

Cook County IL

Pennsylvania:

Bucks County PA

Texas:

Fort Bend County TX    Harris County TX

 


CMS Medicare Balance Report: Due on 1 - 30 of January, April, July and October (Quarterly)

  Medicare Balance Report   You can fax the report to: (803) 419-3277

 

Disclaimer: Every template is only your Guide/Agenda to complete each report, your Agency Officials must assure that the meeting occur, the quorum is acceptable, and every member had active participation in the discussion and confection of the Reports, Evaluations, Documents.

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