AHRQ Safety Program for Long-term Care: CAUTI

Organizational Lead Monthly Status Report

Purpose

This monthly status report provides information to the national project team on your facilities’ progress. The report should be completed and submitted after each month’s coaching call. Please answer all questions below.

Date of Assessment:____/____/______

Name: ______

Lead Organization: ______

1. Please indicate any changes in the status of your facilities

 No changes [Skip to Question 2]

 New facilities added

 Facilities withdrew from project

 Facilities became inactive (lack of data submission, not participating in coaching calls, onboarding/training/content webinars, in-person meetings)

 Facility team members changed

 Other (please specify)______

1.1 If you checked a box other than “No changes,” please select the action(s) you have taken to inform the National Project Team

 I have not taken action(s) to notify the National Project Team

 I have sent an e-mail to

 I have informed an HRET staff member

 Other (please specify)______

2. Have you reviewed each of your facilities’ data submissions for the month being assessed?

  • Yes
  • No

3. Select the action(s) you have taken with non-submitting facilities

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AHRQ Safety Program for Long-term Care: CAUTI

Organizational Lead Monthly Status Report

 All facilities are submitting data

 Called facility team leaders

 Emailed facility team leaders

 Site visit

 Addressed on Coaching Call

 No Action

 Other (please specify)______

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AHRQ Safety Program for Long-term Care: CAUTI

Organizational Lead Monthly Status Report

4. Please provide your state/region’s current reporting month CAUTI rate per 1,000 catheter days (i.e. 2.43)

______CAUTIs per 1,000 catheter days

5. Identify the facility(s) that you are most concerned about and why?

______

______

______

______

6. Name your most successful facility and share one or two of their best practices:

______

______

______

______

7. What action(s) are you taking to ensure the greatest degree of participation on national content and state/region coaching webinars?

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AHRQ Safety Program for Long-term Care: CAUTI

Organizational Lead Monthly Status Report

 All facilities are actively participating

 Called facility team leaders

 Emailed facility team leaders

 Site visit(s)

 Addressed on Coaching Call

 No Action

 Other (please specify)______

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AHRQ Safety Program for Long-term Care: CAUTI

Organizational Lead Monthly Status Report

8. What aspects of the project would you like to see improved:

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AHRQ Safety Program for Long-term Care: CAUTI

Organizational Lead Monthly Status Report

 No improvements needed

 Website

 Newsletter

 Dashboards

 CDS

 Webinars

 Tools/Resources

 Other (please specify)______

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AHRQ Safety Program for Long-term Care: CAUTI

Organizational Lead Monthly Status Report

8.1 Please comment on any specific improvements:

______

______

______

______

9. Please provide any other information you’d like to share:

______

______

______

______

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