Trustname: Hospitalname

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Trustname: Hospitalname:

Wardname: Wardspeciality:

Numberofbeds:

Overthelastfourweeks,howmanypeopleaged65or overspent2 nightsorlongeronthewardandwere thendischargedortransferred?

Totalnumberofstaffworkingontheward(headcount): NumberofregisterednursingstaffWTE:

NumberofhealthcareassistantsWTE:

WardManager’sdetails

Name: Emailaddress:

Correspondence address:

Tel:

WardManager’sagreementtoparticipate:

Iconfirm:

IhavereadthememorandumofunderstandingforparticipatingintheQualityMarkfor

Elder-FriendlyHospitalWards(seepg3).

IagreetobethemaincontactforthiswardwhilstparticipatingintheQualityMark process.

IunderstandthatmywardwillbeinvoicedannuallyunlessIinformtheQualityMark

projectteamthatIwishtowithdrawfromtheschemebeforethecommencementofthe nextcalendaryear.

WardManager’ssignature:

Otherwardsparticipating fromthisTrust:

RoyalCollegeofPsychiatrists’CentreforQualityImprovement● 21PrescotStreet● London● E18BB

TheRoyalCollegeofPsychiatristsisa charityregisteredin EnglandandWales(228636)and inScotland(SC038369).

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LeadConsultant’sname:

LeadConsultant’semail:

Tel:

IconfirmIagreetobetheLeadConsultantworkingwiththeWardManagerthroughoutthe processoftheQualitymarkforElder-FriendlyHospitalWards.

Consultant’ssignature: ProjectLead’snameand

role(ifapplicable)*:

ProjectLead’semail

(ifapplicable):

ExtraCCs(ifapplicable):

*Pleasecompleteifthereistobesomeoneco-ordinatingallwardsparticipatinginyour hospital/Trust.Wewill copythispersonintoprojectcommunications.

Invoicedetails

Fortheattentionof:

JobTitle/Designation: Address:

Tel: Fax: Email:

PONumber(essentialfor subscriptionsover£5,000):

Subscription

Perwardfor12months:

StageI:AssessingQuality£1,200+VAT

Pleasegivedetailsofhowyouwishtobeinvoiced,e.g.separatelyforeachofthenominated wardsin yourTrust/hospital,orcollectively.

RoyalCollegeofPsychiatrists’CentreforQualityImprovement● 21PrescotStreet● London● E18BB

TheRoyalCollegeofPsychiatristsisa charityregisteredin EnglandandWales(228636)and inScotland(SC038369).

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ThefollowingrepresentstheexpectationsthattheQualityMarkProjectTeamandtheparticipatingwardsinyour

Trust willhaveof each otherduring the datacollection and reporting for the QualityMark.

TheProject Teamwillensure that itoffers an efficient and effectiveserviceby:

•Providing thetools and guidance to allward leads

•Providingguidanceandsupportonthecompletionofthequestionnairesandchecklistsandsubmissionof

dataonline viawritten guidance, emailand telephone support and updates

Updating ward leads at leastfortnightly on the progressof datacollection and dataoutstanding

Organisingprovision of PIEobservation workshops and informing leads of dates andrequirements

•Returning theward report within 8 weeks onceall datahas been received

•Acknowledging the receipt of ward action plansas finalsubmission forStageI– Assessing Quality

•Collating feedback from participants about the process

TheWard Leads and Trustwillsupport thisauditby:

•Ensuringthatstaffreturningdataareallocatedtimetodevotetotheprogrammeactivities,including supportingPatientQuestionnairedistribution,returningStaffQuestionnaires,and oneday’strainingfortwo members of staff for the observationmodule

•Ensuringthatstaffreturningdataareallocatedresourcestocarryoutprogrammeactivities(e.g.accessto computers, meeting rooms)

•ProvidingPIEobservationsandfeedbacktoapartnerward(N.B.PIEobservationsshould not becarried out by staff working on yourown ward)

•Monitoring the progress of datacollection (e.g. liaison with colleagues, and with ward nominated leads where

applicable)

•Responding to the Project Team regarding progress

•Submittingdataasperdeadlinesbelow.N.B.ifdataisnotsubmittedbythedeadlines,wewillbeunableto produce your report

•Ensuringthatallinformationsubmittedisprovidedingoodfaith,andiscompleteandaccurateandnot misleadinginanyrespect. N.B.thisdoesnotapplytothequestionnairesforstaff,patients/carers,which are anonymously submittedand represent the views of individuals

•Reviewingreports and developing localaction planning

Datareturn requirements

Unless variance is agreed, the start date for datacollection willbe specified by the Project Team and will take place over three months for alldataexceptPIE observations. Alldatarequestedmustbe returnedbytheagreeddeadlineinorderfora reporttobeproduced. DatareturnrequirementsincludeallQMtools,PIEobservationsandconfirmationofthenumber of patient questionnaires distributed on each ward.

Wards participating in QMagree to both providePIE observationsto another participating ward within the sameTrust andreceiveobservationsfromthesame. PIEobservationsrequirethattwomembersofstafffromeachwardhave received appropriate training.The training workshop isincluded inthe subscriptionfee and the workshop date for wardsfromyourTrustisnotifiedinthecoveringletter. PIEobservationsshouldbecarriedoutwithintwomonthsof attending theworkshop anddatareturned within four weeks of observations.

Participation and Transparency

ParticipatingwardswillbelistedontheQualityMarkwebpagesat Thiswillbeupdated with information about completion of Stage I– Assessing Quality.

Atinitialparticipation,yourStageIreportwillbesharedonlywithyourorganisationandmembersoftheQuality MarkProjectTeam andcommittees.Anyinformationthatwillidentifyyourwardwill notbe otherwise shared. Anonymousaggregated datawill be used in reporting, evaluation and journalarticles.

WardsengaginginfurtherroundsofStageI–AssessingQuality, or in Stage II – Award Stage, agreetoshare summarydatabasedonthe ward overallscores and feedback.

RoyalCollegeofPsychiatrists’CentreforQualityImprovement● 21Prescot Street● London● E18BB

TheRoyalCollegeofPsychiatristsisa charityregisteredin EnglandandWales(228636)and inScotland(SC038369).