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 | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| |||||||||||||
Approval Status |
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 patients are known.
Info |
---|
If the patient was non-compliant, please consider WHY the patient may not have complied. |
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
Filter by label (Content by label) | ||||||||
---|---|---|---|---|---|---|---|---|
|
History
Start Date
|
The patient’s behavioral status contributed to the event.
Includes
Patient responds with inappropriate anger
Patient demonstrates lack of engagement in care plan
Excludes
Dementia (select “Mental status”)
Cognitive impairment (select "Mental status")
Anchor | ||||
---|---|---|---|---|
|
The patient’s family dynamics or relationships contributed to the event.
Includes
Family contradicting staff instructions
Dysfunctional relationship between patient and patient's family
Excludes
Relationships or dynamics between staff and patient's family (select applicable Communication Factors)
Anchor | ||||
---|---|---|---|---|
|
The patient’s fragile health status (i.e., health status that resulted in the patient’s condition being less stable and more vulnerable to variations in care) contributed to the event.
Includes
Immunocompromised patients
Frail elderly
Multiple system failure
Excludes
Well-controlled multiple diagnoses (list in “Comorbidities”)
Anchor | ||||
---|---|---|---|---|
|
The patient’s mental status contributed to the event.
Includes
Alzheimer's Disease and other dementias
Cognitive impairments impacting patient's understanding of care and treatment requirements
Any other condition impacting a patient's mental status
Excludes
Behavioral problems (select "Behavioral status")
Anchor | ||||
---|---|---|---|---|
|
The patient’s physical limitations contributed to the event.
Includes
Speech
Gait disorders
Other limitations that impact a patient's abilities
Excludes
Sensory impairment (including hearing, vision, smell, feeling, or other impairments) that impact a patient's ability to react to stimuli (select "Sensory impairment")
Anchor | ||||
---|---|---|---|---|
|
The patient’s sensory impairment contributed to the event.
Includes
Impairments such as hearing, vision, smell, feeling, or other impairments that impact a patient's ability to react to stimuli.
Excludes
Physical limitations (select "Physical limitations")
Cognitive impairment (select "Mental status")
Anchor | ||||
---|---|---|---|---|
|
Any other factor related to the patient, not included in the list above, which contributed to the event.
Guide for Use
Include Page | ||||
---|---|---|---|---|
|
History
Start Date | 2006 |
---|---|
End Date | n/a |
Change History |
n/a [Month yyyy: brief description of change]
Spring 2012: PSRP implementation |
January 2016: Added “(vision, hearing, balance, etc.)” to “sensory impairment” | |
Field Name | cf_patient_f |
---|