Here you will find a variety of tools to assist nursing homes with quality improvement efforts in clinical topics identified by CMS as national priorities for the Quality Improvement Organization program: physical restraints and high-risk pressure ulcers.
Tools for Prevention and Treatment of Pressure Ulcers
Resident Intake Form Evaluate your patient for pressure ulcer intervention before they even get to your facility. This form allows staff to identify specific needs for each patient from their previous caregiver.
Pressure Ulcer Root Cause Analysis Form
Helps providers locate key factors in the identification of pressure ulcer formation.
Pressure Ulcer Brochure
Latest science and guidelines for pressure ulcer prevention and treatment. Targeted to primarily physicians.
Save Oklahoma's Skin - Toolkit for Pressure Ulcer Prevention and Treatment
Provides health care facilities and caregivers with guidelines and resources to develop and improve systems for the prevention and treatment of pressure ulcers.
Pressure Ulcer Crossword Puzzle
Unique staff learning tool about pressure ulcer prevention and treatment.
MDS Pressure Ulcer Crosswalk & MDS Tip Sheet
Helps coding staff reduce coding errors that can negatively impact pressure ulcer rates.
"Tip the Waiter"
Patients are waiting for you to "touch, tip and talk" with them. This tool assists CNAs and front-line staff in a repositioning technique in order to reduce pressure ulcer development.
Tools for Reducing Physical Restraint Use
Guidelines for Fall Prevention in Older Persons - January 2011 - (link to American Geriatrics Society)
Upright/Hendrick II Risk Fall Model (link to AHI of Indiana website)
Assessment Tools
Falls Self-Assessment (PDF)
Physical Restraint Self-Assessment (PDF)
Physical Restraint Comprehensive Assessment (PDF)
Facility Management Tools
What You Need to Know About Choice, Falls & Restraints in Nursing Homes (PDF)
A Family's Guide to Bed Safety (PDF)
Decision Tree for Physical Restraint Elimination (PDF)
Facility Assessment Checklists (PDF)
Organization Commitment to Physical Restraint Elimination (PDF)
Overview of Training and Education for Physical Restraints (PDF)
Physical Restraints Knowledge & Attitude Survey (PDF)
Process Tools
Development of Physical Restraint Plan of Care (PDF)
Physical Restraints Data Tracking Tool (PDF)
Physical Restraint Elimination Process (PDF)
Siderail & Alternative Intervention Tree (PDF)
Patient/Caregiver Resources
Planning for your discharge (PDF)
A checklist for patients and caregivers preparing to leave a hospital, nursing home, or other health care setting.