Remove all [bracketed] and/or red text before publishing! And also the purple note panels!
[Bracketed] text should be replaced with actual content.
Red text is instructional.
Header Case
Title of page and response option headers should be sentence case (to match how they display in the online system).
Page Properties | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
| |||||||||||
|
Labels
Use form_field and any relevant segment labels (asc, hospital, nursingfacility, pharmacy)
Use the relevant section label (e.g., surgical_event, event_information)
Note: event-specific fields should be tagged with the associated event type (e.g., surgical_event, fall_event) and NOT with overarching header “event_information”)
Use required if the field is required to submit for all reports.
For example, “it is required if it appears” should not be labeled “required.”
Use essential if the field is a top priority for transferring the data dictionary.
Note: if the field is required, it will already be considered “essential” and doesn’t need a second label.
All “essential” labels will need to be removed before the data dictionary goes live.
Description
[Brief description of what this field is collecting]
On-Screen Instructions
[Prompt text as it appears in the user interface.]
Prompt Text
If none or if field does not appear on-screen, put “n/a.” Use “include page” macro where possible (see examples below).
Description
Determination of which contributing factor(s) related to devices, equipment, or supplies are known.
On-Screen Instructions
Include Page | ||||
---|---|---|---|---|
|
Field Type
[Type of field, but really type of interaction user will have: clicking a checkbox or radio button, choosing from a dropdown, filling in a date number, or text field, etc.]
Field Type
Use standard language below and delete the others. Use include page macro where possible (see examples, below).
Checkbox (multiselect)
Date (mm/dd/yyyy)
Number (minimum value: x; maximum value: x) [Delete min &/or max values if irrelevant]Text (maximum length: x) [Delete maximum length if irrelevant]
Time (hh:mm)
Include Page | ||||
---|---|---|---|---|
| ||||
Include Page | Dropdown excerpt | Dropdown excerpt | ||
Include Page | ||||
|
Anchor | ||||
---|---|---|---|---|
|
OPTION ONE: Answer options with content (definition and/or inclusions, exclusions)
Add an anchor in front of the H1 “Responses” heading and name the anchor “Top.”
Include a table of contents, which should be limited to the answer option headers and displayed as a list.
Add a dividing line macro below the table of contents.
Table of Contents | ||||||
---|---|---|---|---|---|---|
|
Anchor |
---|
Answer Option Anchors and Headings
Each answer option gets an anchor and an H2 heading in sentence case.Definition
Copy/paste the “description” text from the data dictionary.
Includes
Excludes
Inclusions and Exclusions
Add a page layout of two equal columns below the definition. Inclusions go in the left column, exclusions in the right.
Event-Type Specific Questions
Filter by label (Content by label) | ||||||||
---|---|---|---|---|---|---|---|---|
|
Additional Support
Filter by label (Content by label) | ||||||||
---|---|---|---|---|---|---|---|---|
|
Event-Type Specific Questions
If the answer option triggers additional question, add a content by label macro to display all pages that share the form_field label plus the relevant answer option label, possibly plus the relevant segment label, depending on the situation. The macro goes in a single cell table with a light gray fill. The title above the macro should just be table text, bold (no header level), that reads: Event-Type Specific Questions.
Additional Support
If the answer option is associated with an “faq” item, add a second row to the table and paste in a content by label macro to display all pages that share the faq label plus the relevant answer option label, possibly plus the relevant segment label, depending on the situation. Macro should have title “Additional Support” in the table cell, above it, as with the “Event specific questions” macro.
Return to Top Links
Below the page layout or Content by Label macro(s) (if relevant), include a link to the “top”anchor to take the user back to the responsestable of content.Dividing Line
Add a dividing line after the “return to top” link and before the next answer option, or the next section (probably “Guide for Use”).
OPTION TWO: Answer options without content
Just list the available answer options without the answerID and answerCode.
[Answer option 1]
[Answer option 2]
[Answer option 3]
Guide for Use
[If there is a adequate information about each answer option, this section may not be necessary. But if there is guidance that isn’t about the specific responses, then this is where you would put it, including instructions for how to use this field. If there is no guidance, you can use the “No additional guidance” excerpt: ]
In Option 2, this is where one would put an “Additional Support” or “Event-type Specific Questions” Content by Label macro in a single-cell table with light gray fill.
If the page should include “additional support” content that is is only relevant to this one question, move the content into the guide for use. If there are multiple pages for the question because of differences between segments, leave the content in a separate page and use the “include page” macro to include it (so we only have to edit in one place but it will still appear in multiple places).
Additional Support
|
The availability, or lack thereof, of a device, equipment, or supply contributed to the event.
Includes
Device, equipment or supply not adequately stocked
Device, equipment or supply not available when needed
Device, equipment or supply not accessible when needed
Device, equipment or supply correct size not available
Device, equipment or supply available when it should not have been
Excludes
Shortages (select “Shortage”)
Anchor | ||||
---|---|---|---|---|
|
The design of a device, equipment, or supply, regardless of how it functions, contributed to the event.
Includes
Device or equipment display or controls not well-designed, difficult to read, or difficult to program
Device, equipment or supply awkward to use correctly
Device, equipment, or supply did not have built in safety features
Excludes
Device, equipment, or supply was not designed for the task for which it was being used (select “Use or selection by a healthcare provider or staff”)
Anchor | ||||
---|---|---|---|---|
|
The function of a device, equipment, or supply, regardless of how it is designed, contributed to the event.
Includes
Defective or non-working device, equipment, or supply (including defective or dysfunctional alerts); device display or controls not functioning;
A, H, N Only: Broken or defective device, equipment, or supply that was awaiting repair contributed to the event
Excludes
Device, equipment, or supply that functioned as intended, but whose design contributed to the event (select “Design”)
Anchor | ||||
---|---|---|---|---|
|
Routine maintenance, or lack thereof, of a device, equipment, or supply contributed to the event.
Includes
Device, equipment, or supply did not meet code, specifications, or regulations
Inadequate maintenance log
Inadequate or delayed maintenance
Inadequate cleaning or sterilization
Excludes
Broken or defective device, equipment, or supply that was awaiting repair contributed to the event (select “Function”)
Anchor | ||||
---|---|---|---|---|
|
Manufacturer shortage of a device, equipment, or supply contributed to the event.
Includes
Device, equipment, or supply not readily available due to a manufacturer shortage
Medication supply shortages
Excludes
Failure to properly stock supplies (select “Availability”)
Anchor | ||||
---|---|---|---|---|
|
The incorrect use or inappropriate selection of a device, equipment, or supply by a healthcare provider or staff member contributed to the event.
Includes
Provider or staff member did not use the device, equipment, or supply correctly
Provider or staff member did not select the correct device, equipment, or supply for the task at hand
Excludes
Device, equipment, or supply did not function properly (select “Function”)
Design of the device, equipment, or supply prohibited the provider or staff from using the device correctly (select “Design”)
A, H only: Device, equipment, or supply was used incorrectly by a patient (select “Use by patient”)
A, H only: Wrong device, equipment, or supply was selected for use by a patient (select “Use by patient”)
N only: Device, equipment, or supply was used incorrectly by a patient or resident (select “Use by patient/resident”)
N only: Wrong device, equipment, or supply was selected for use by a patient or resident (select “Use by patient/resident”)
Anchor | ||||
---|---|---|---|---|
|
The use of a device, equipment, or supply for other than its intended purpose or the incorrect use of a device contributed to the event.
Includes
Anchor | ||||
---|---|---|---|---|
|
The selection of a device, equipment, or supply for use by a patient was incorrect or the patient used the device incorrectly.
Includes
Device, equipment, or supply was used incorrectly by a patient
Wrong device, equipment, or supply was selected for use by a patient
Excludes
Device or equipment did not function properly (select “Function”)
Design of the device, equipment, or supply prohibited the provider or staff from using the device correctly (select “Design”)
Provider or staff member did not use the device, equipment, or supply correctly (select “Use or selection by healthcare provider or staff”)
Provider or staff member did not select the correct device, equipment, or supply for the task (select “Use or selection by healthcare provider or staff”)
Anchor | ||||
---|---|---|---|---|
|
The selection of a device, equipment, or supply for use by a patient/resident was incorrect or the patient/resident used the device incorrectly.
Includes
Device, equipment, or supply was used incorrectly by a patient/resident
Wrong device, equipment, or supply was selected for use by a patient/resident
Excludes
Device did not function properly (select “Function”)
Design of the device prohibited the provider or staff from using the device correctly (select “Design”)
Provider or staff member did not use the device, equipment, or supply correctly (select “Use or selection by healthcare provider or staff”)
Provider or staff member did not select the correct device, equipment, or supply for the task at hand (select “Use or selection by healthcare provider or staff”)
Anchor | ||||
---|---|---|---|---|
|
Any other factor related to the device, equipment, or supply, not included in the list above, contributed to the event.
Includes
Recalls
Excludes
P only: Problems with health information technology (HIT) (select from the Computer Systems contributing factors category)
Guide for Use
Function includes devices or supplies that are defective, non-working, or do not meet code.
History
Start Date | Spring 2012 |
---|---|
End Date | n/a |
Change History | n/a [Month yyyy: brief description of change] [Spring 2012: PSRP implementation]January 2016: Changed “Function” and “Function (including device failure)” to “Function (e.g., defective, non-working)”; added “Shortage”, “Use or selection by healthcare provider or staff”; “Use error changed to “Use or selection by pharmacist or staff” |