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Response posted as requested. -----Original Message----- From: Park, Cathy [mailto:[EMAIL PROTECTED] Sent: Friday, March 24, 2006 8:47 AM To: Roger Allen Subject: Magic: Forms Committee Here is our policy - hope it helps. 1.0 PURPOSE * To provide guidelines for hospital staff and external suppliers to meet the criteria for development of forms, medical directives, pre-printed orders, hand posted signage and pre-printed labels (previously self-inking stamps) for nursing only. * To provide guidelines for hospital staff regarding the revision and/or deletion of forms, medical directives, pre-printed orders, hand posted signage and pre-printed medical labels. 2.0 MATERIALS REQUIRED 2.1 DEVELOPMENT * Request for New, Revised, Deleted Form (s) - NB 555 ("P" drive) * Checklist for Pre-Printed Orders - NB 909 * Print Shop Requisition - NB 517 2.2 REVISION / DELETION * Request for New, Revised, Deleted Form (s) - NB 555 ("P" drive) * Print Shop Memo - Revision/Deletion - NB 1132 (Print Shop only). ñ Back to top 3.0 PROCEDURE 3.1 Drafting of Forms When requesting a New/Revised Form 1. Prior to development, revision or deletion of any form, it should be investigated whether: New Forms - * An existing form could be used without change. * A similar form could be used with modification. * There is no similar form and development of a new form is necessary. * The form could be an internal departmental form. * The requested form has a major effect on other forms. * There are cost implications. Revised Forms - * Determine if the revision is necessary and/or urgent. Research the cost implications. NOTE: Forms shall not be tabled again with a revision for a period of one year (exception at the discretion of the forms team). Deleted Forms - * Determine if a deletion has a major effect on other forms or departments. 2. When a new form must be designed, or an existing form revised, it is imperative that all stakeholders be consulted, e.g. medical departments/services, paramedical departments, community agencies, etc. If you need to revise a form developed by another department, you must consult with the originating department. LIST THE STAKEHOLDERS YOU HAVE CONSULTED ON THE FORM REQUISITION AND AUTHORIZATION (SEE ATTACHED FORM) NOTE: NOTICES OF RE-ORDER ARE IDENTIFIED BY THE PRINTER AND INVENTORY CONTROLLER AND WILL BE UTILIZED FOR INITIATING THE REVISION OF EXISTING EXTERNAL FORMS. 3. Any patient instruction material or brochures must adhere to Section 3.11 of this policy. 4. All forms/pamphlets/educational material/other material which will be read by patients/families/visitors must be available in French & English (see Section 3.11 & 3.5). 5. Whenever possible, Clinical Records forms will be designed using white bond paper with black print. NOTE: THE FORMS MANAGEMENT TEAM WILL RECOMMEND THE USE OF WHITE BOND STOCK PAPER (20 LB) FOR ALL FORMS DUE TO THE FINANCIAL IMPLICATIONS OF USING COLOURED STOCK. IT WILL BE AT THE DISCRETION OF THE FORMS TEAM WHETHER AN ALTERNATE COLOUR CAN BE UTILIZED. 6. Once the form is drafted, it will be forwarded to the Forms Management Team for review at their next scheduled meeting. If the forms originator requests to attend the meeting, the Forms Co-ordinator will confirm their attendance. 7. Upon approval of the form, the Forms Management Team will assign a number to the form and will return the form to the originating department. The department will be responsible for adding the assigned number to the form and the original package should be returned to the Forms Coordinator. The Forms Coordinator ensures that the Printer receives all the information required to process new / revised / deleted forms. 8. The form is then sent along with a copy of the old form, and a completed Forms Requisition and Authorization to the Coordinator of the Forms Management Team. All sections of the Request for New/Revised/Deleted Form (s) must be completed. The Program Manager/Coordinator/Delegate should provide guidelines where applicable and may be requested to attend the Forms Management Team meeting to present an explanation and complete justification. 9. For discontinuation of forms, a Request for New/Revised/Deleted Forms must be completed and sent to the Forms Management Team in order to remove from stock and update the forms catalogue. Only forms generated by the direct user may be deleted pending the effect on other areas. A "Print Shop Memo" - Revision/Deletion #NB1132 - from the Print Shop will be sent to appropriate areas advising of the deletion. 10. All forms which will be used on a trial basis must be submitted before the trial begins. Department - generated photocopies are not acceptable AND ARE NOT COST EFFECTIVE. 11. All forms on trial will be centrally located and monitored by the Forms Co-ordinator during the trial period. The forms co-ordinator may be contacted via phone or email to obtain copies of the trial forms. 12. Allow enough lead time for the forms process (up to two months), allowing for translation process when required, as well as for the summer vacation period. (Internal printing 4 - 6 weeks, external printing 6 - 8 weeks). 13. The Printer will not circumvent the proper process and will not proceed without authorization from the Forms Coordinator. 14. The attached format for clinical record forms, general forms and patient instruction material must be adhered to. ñ Back to top 15. See attached Process and Flow charts for introducing new forms or revising existing forms. 16. All forms that will become part of the patient's chart, require formal Guidelines for Use. These guidelines must accompany the form when being brought forth to the Forms Management Team ( Section 3.9) 3.2 Drafting of Internally Hand Posted Signs When requesting a new / revised hand posted sign: Adherence to the guidelines will be mandatory. 1. All signage intended for patients / family / visitors must be posted in English and French and of the same style and size. 2. Once the signage is drafted, it is sent to the Forms Management Team for approval. Upon approval of the sign; the Forms Management Team will assign a number to the sign and will return the sign to the originating department. The department will be responsible for adding the number to the sign. Once completed, the original package should be returned to the Forms Coordinator. 3. A computer database of all approved signage has been developed and will be maintained by the Forms Coordinator. The Forms Coordinator will provide the Programs/Departments with a copy of the signage. NOTE: This process does not apply to permanent signs developed externally. They will continue to be processed through the Engineering Department. ñ Back to top 3.3 Copyright Law Copyright law must be respected. Copyrighted materials may be used as a resource but may not be duplicated or reproduced in whole or in part in any manner without a written agreement from the owner of the copyrighted material. A letter of agreement from the copyrighted body must accompany any request for reproduction. ñ Back to top 3.4 Legal Consultation It is the responsibility of the requestor to ensure that legal consultation has been obtained for consent/authorization/release forms before sending it to the Forms Management Team and a catalogue number has been obtained. This legal consultation letter must be retained by the requesting department and a copy attached to your request. 3.5 Disclaimer * Patient handouts that provide general non-specific advice will require the following disclaimer. * Patient specific or disease specific instructions do not require the addition of the disclaimer. " This flyer contains general information which cannot be construed as specific advice to an individual patient. All statements in the flyer must be interpreted by your personal physician or therapist who has the knowledge of the stage and the extent of your particular medical conditions. Any reference throughout the document on specific pharmaceutical products does not imply endorsement of any of these products." 3.6 French Language Health Services Translation * All forms/pamphlets/educational material/hand posted signs which will be read by patients/families/visitors must be sent to the Forms Team for approval and French translation. * Once the form has been approved and a number assigned by the Forms Coordinator, the submitting department will be contacted by the Forms Coordinator and arrangements "via email" will be made to have the document forwarded to the Forms Coordinator. The Forms Coordinator is then responsible for forwarding all documents to French Language Services for processing. C French Language Services will not accept forms for translation that have not been released by the Forms Coordinator. * Only official translation through French Language Health Services can be accepted as per the Ministry of Health and Long Term Care guidelines. * If the Forms Management Committee requires revisions to a submitted form/pamphlet/educational material/other material, the Forms Coordinator will resubmit the form to French Language Health Services. ñ Back to top 3.7 Medical Directives and Pre-Printed Orders (PPO) (See ADM policy # 1-132) 1. All Medical Directives, and PPO's will be co-ordinated and issued an assigned number by the Administrative Secretary, Quality Improvement, Risk Management & Education only. 2. The Administrative Secretary, Quality Improvement, Risk Management and Education will send a memo to notify all appropriate nursing units of the availability of the new/revised order and/or the discontinuation of orders. Back to top 3.8 Forms Management Team Process The Forms Management Team will determine, where possible if: a) An existing form/hand posted sign can be used without change. b) A similar form/hand posted sign can be used with modification. c) There is no similar form/hand posted sign and development of a new form is necessary. d) The form/hand posted sign will be an internal departmental form. e) The requested form/hand posted sign has a major effect on other forms. f) The requesting parties need may be satisfied by either: (a) or (b) above, as will be recommended to the requesting party, otherwise the requesting party will be informed that the form/hand posted sign can be designed according to the required specifications and presented to the Forms Management Team for approval. During the monthly meeting of the Forms Management Team, each form/hand posted sign will be discussed and a decision will be made whether to approve, approve with changes or reject the form/hand posted sign. APPROVED: 1) The Forms Coordinator will note the Forms Management Team's approval with a signature on the Request for New/Revised/Deleted Form(s). 2) If the form is approved, pending changes, the Forms Coordinator will notify the submitting program/department. The program/department will make the changes and return the form to the Forms Coordinator. 3) The Forms Coordinator will arrange to have the form printed in house or printed by an external source. 4) The Printer will notify the requesting party of the approval of the form by returning the second copy of the request form. The original will be retained in Printing with the master of the approved form. ñ Back to top 5) The Printer will send a memo to notify all appropriate departments of the availability of the new/revised form with a sample attached for ordering purposes and the discontinuation of any forms, if appropriate. 6) Hand posted signage, once approved, is included in the database by the Forms Coordinator of the Forms Management Team. REJECTED 1) The Forms Coordinator will note the Forms Management Team's rejection of the form and give the reason (s) for this rejection. 2) If the requesting party or a representative is present at the Forms Team Meeting, no further notification will be necessary. Otherwise, the appropriate Forms Management Team member will give notification of the Team's decision to the requesting party. ñ Back to top FORMS ON TRIAL 1) Forms to be used for a trial period must be submitted to the Forms Team prior to implementation, accompanied by a Request for New/Revised/Deleted Form (s), and guidelines for use if necessary. 2) A trial period of 3 months is recommended. This will be monitored by the Forms Coordinator. 3) If a trial period is approved, the master will be kept in a trial file in the Forms Coordinator's office. When the trial period is over, the Forms Coordinator will notify the requisitioner and a decision must be made whether or not to submit to the Forms Team for final approval. ñ Back to top REQUISITIONING OF FORMS 1) Upon final approval of a form, they will be assigned a number and become a catalogue item. Forms are to be requisitioned from stock using the Stores Requisition NB 517, or your unit specific pre-printed requisition (pink in colour) - only forms that are approved and assigned a number. ñ Back to top 2) The user department is to requisition forms to meet current usage only. Sufficient quantities will be stocked in the Print Shop (McLaren site) based on the annual usage and economic production quantities so that there will be little danger of stockouts. For this reason, there is no need for departments using the form to maintain large quantities. AUDITS Random audits of forms in use at the department level will be performed at intervals set out by the Forms Management Team. The department to be audited will receive appropriate notice time. ñ Back to top ñ Back to top FLOW CHART FOR FORMS INITIATED BY DEPARTMENT HEADS FORMS INITIATED BY HOSPITAL/PROGRAM/DEPARTMENT HEAD STAKEHOLDERS FOR INPUT/APPROVAL LEGAL CONSULTATION - IF NECESSARY FORMS MANAGEMENT TEAM FOR APPROVAL PROCESSING, ALONG WITH APPROVAL SIGNATURE FROM VICE PRESIDENT (Nursing forms only) FRENCH LANGUAGE SERVICES (if necessary) BY FORMS MANAGEMENT COORDINATOR MEDICAL ADVISORY COMMITTEE (if necessary) BOARD OF DIRECTORS (if necessary) FORMS MANAGEMENT COORDINATOR FOR FINAL PROCESSING ñ Back to top 3.9 Standard Format for Clinical Record Forms (Forms which become a part of the Patient's Clinical Record) and Guidelines for Use 1) Standard sizes - 8 1/2 x 11 2) Patient Identification: * Upper right hand corner * Spacing - 4 1/4 x 2 ½ (to accommodate the addressograph) * Double-sided or booklet (ledger) style forms generally do not require repeating patient identification on reverse side. 3) Hospital Identification: * Upper left hand corner. * Spacing - 1 1/2" from the top of the page (because of two-hole punch at top). * Capitalized and in BOLD PRINT and on one line. (ie: NORTH BAY GENERAL HOSPITAL - Arial Font size 14pt.) * 1" from the left hand side of the page (because of three-hole punch). * Double-sided forms generally do not require repeating hospital identification on reverse side. 4) Table Outline for #2 and #3: * Single lines to extend to edge of page - left, right and top. Note: Computer may not extend lines to edge of page and typist must manually finish lines. 5) Department / Care Center Name: One space below hospital Identification, CAPITALIZED and not bold. (ie: REHABILITATION DEPARTMENT - Arial font, size 12 pt.) 6) Title of Form: One space below the department/care center name. * CAPITALIZED AND UNDERLINED - Arial Font size 12 pt. 7) Form Number, New/Revision Date, Typist's Initials: C Font size should be Arial 10 pt., C Bottom left hand corner of first page. C 1" from the left hand side of the page and 1" from bottom of the page. C Form number - first line - bold and date/revision date - also on the first line (month & year for new forms, Rev.month and year for revised forms - NOTE: short form for months may be used eg: Jan., Feb.). C Typist's initials - second line. ie: Form number & Date/Rev date (Month/Year) {NB 920 Rev January 2005 Typist's Initials (second line) { sa 8) Margins: * Left hand - 1" from side * Right hand - 1" from side * Top - 1" * Bottom - 1" (Provisions must be made for three-hole punch at the left and two-hole punch at the top). 9) Body of Form: This will vary depending on the information to be captured. A few points to be noted: * Margins should be uniform on both sides of the form (preferably 1"). The smallest margin that can safely be used and still allow for adequate reproduction is 3/4" (.75) on the right hand side. C If the form is to be two-sided, printing must be from back to back on both sides. Again, remember the two-hole punching at the top and the three-hole punching on the side. Single/double sided forms do not require a page number. Multiple copies require a page number in the bottom right corner. C Justification - FULL. C No shading will be allowed within the body of a form that is not reproduced by an outside commercial printer, as it obliterates the text. ñ Back to top 10) Signature (if applicable): C The signature line should be in the bottom right hand corner, 1" - 2" from the bottom of the page (for physician signature). C No proper names, e.g. John Smith, Coordinator will be used. 11) Date (if applicable): * The date line should be parallel to the signature line on the left side of the page. 12) Page number: * Bottom right corner, if required ñ Back to top 13) Guidelines for Use (if applicable) * Instructions - To be drafted up for the nursing staff In a narrative format giving instructions as to the completion of the above form. * The form and it's Guidelines for Use will be placed into the Chart Documentation Manual once approved by the Chair of Nursing Practice Committee. * Instructions will be drafted with the title of the form and the form number at the top of the page. Should the form be a single page, the instructions will be inserted on the back. * (For further details please contact a Nurse Clinician) ñ Back to top 3.10 Standard format for General Forms 1) Standard sizes - 8 1/2 x 11 2) Hospital Identification: * Name of the Hospital/Program must be centered at the top of the page ie: NORTH BAY GENERAL HOSPITAL (Arial font size 14 pt.- bold) C 1" from top of page in capital letters C Uniquely sponsored program letterhead/format is acceptable ñ Back to top 3) Department / Center Name: * One space below the hospital name in the center of the page - Arial font size 12 pt. * In CAPITAL Letters. 4) Title of Form: * One space below the department/center name - Arial font size 12 pt. * CAPITALIZED AND UNDERLINED 5) Body of Form: C Will vary depending on the information to be captured - generally Arial font size to be used 12 pt. or 10 pt. C Margins 1" left and 1" right. C Justification - full C No shading will be allowed within the body of a form that is not reproduced by an outside commercial printer, as it obliterates the text. 6) Form Number, New/Revision Date, Typist's Initials: C Arial font size should be 10 pt. C Bottom left hand corner of first page. C 1" from the left hand side of the page (where possible) and 1" from the bottom of the page. C Form number - first line - bold - ie: NB 1433 (font 10pt. Bold). AND C Date/revision date - first line (month & year for new forms, Rev.month and year for revised forms - NOTE: short form for month may be used eg: Jan., Feb.). C Typist's initials - second line (no capitals). ie: Form number and Date/Rev date (Month/Year) { NB 1433 January 2005 Typist's Initials { sa 7) Signature: C Signature line must be at the bottom right corner, 1" from the bottom of the page. C Department designation to be used versus names or titles. Program Manager's Signature ñ Back to top 8) Page Number: C Bottom right corner - font size 12pt. ñ Back to top 3.11 Patient Instruction Material/Pamphlet/Booklet NOTE: 1) IF INSTRUCTIONS REQUIRE A PHYSICIAN SIGNATURE AND ARE PART OF THE CLINICAL RECORD, FOLLOW STANDARD FORMAT FOR CLINICAL RECORD FORMS - SEE 3.9) 2) IF COPYRIGHT RESTRICTION APPLIES, PERMISSION MUST BE REQUESTED FROM SOURCE AND LETTER OF APPROVAL ATTACHED TO THE FORMS REQUEST (SEE 3.3). 3) ALL APPROPRIATE MATERIAL MUST HAVE THE DISCLAIMER INCLUDED ON THE DOCUMENT (REFER TO 3.5) 4) ALL MATERIAL MUST BE SENT FOR FRENCH TRANSLATION (REFER TO 3.6) 5) ALL MATERIAL SHOULD BE REVIEWED ANNUALLY BY THE DEPARTMENT RESPONSIBLE FOR DEVELOPING. 1) Standard Size - C 8 1/2 x 11 - Triple fold to booklet style preferred. C 8 1/2 x 14 (legal) - Quadruple fold to booklet style preferred. 2) Hospital Identification: NORTH BAY GENERAL HOSPITAL - C The font will vary depending on the layout & size of form but size 16 font would be best suited. C Where space permits in booklets / pamphlets (only) - include the hospital's Vision Statement - "The North Bay General Hospital is Committed to Providing Compassionate, Quality, Patient Focused Care." Back to top Sites and Site addresses as they appear on the hospital letterhead should be used if appropriate. 3) Department / Center Name: C One space below the hospital name in the centre of page one and Arial font size 14 pt. to 16 pt. - bold C In CAPITAL letters. 4) Title of Material: One space below department/center name in the centre of page one to the front of your pamphlet. C In bold and underlined. C Font size 14 pt. and bold 5) Graphics: Graphics in your pamphlet (front page) or within can be used. 6) Body of Material: * Justification - full * No shading will be allowed within the body of a form - that is not reproduced by an outside commercial printer, as it obliterates the text. * Larger fonts should be used for improved patient readibility/visibility.(14 pt. if possible) * Will vary depending on the amount of information to be captured and font size used for hospital/department identification. * Where material is not in multiple pages, pamphlet format is preferred. * Simple vocabulary - Grade 6 comprehension level. Note: You may determine the grade level of your document by going into Microsoft Word, under Tools & Options. Choose Spelling & Grammar and click on "show readability statistics." After completing "spell check" it will show you the Grade Level Score. For patient education material your documents score should be aimed at approximately 6.0 to 7.0. * At the end of the body of the material - include the following statement in italics - Visit Our Website @ www.nbgh.on.ca. ñ Back to top SAMPLE: NORTH BAY GENERAL HOSPITAL EMERGENCY DEPARTMENT Body of Material - font size Arial 14 pt. C Margins 1" left and 1" right. C At the end of patient instructions, it should have the following disclaimer: "It is recommended that patients consult with their physician for any other symptoms or concerns that may apply to their particular case." C Single page forms should have the following at the bottom: "Français au verso" and C Should there be multiple pages, the following statement would read: "Disponible on français" 6) Form Number, New/Revision Date, Typist's Initials: C Arial font size should be 10 pt.. C Bottom left hand corner of the first page. C 1" from the left hand side of the page and 1" from bottom of the page. C Form number - first line - bold - ie: NB 1396 (font 10pt. bold). AND C Date/revision date - first line (month & year for new forms, Rev.month and year for revised forms - NOTE: short form for months may be used eg: Jan., Feb.). C Typist's initials - second line (no capitals). NOTE: We no longer require E & F after the form mumber. 7) Page Number: Bottom right corner - font size 12 pt. ñ Back to top 8) Instruction Material / Pamphlet / Booklet will be printed double-sided. 9) Instruction Material / Pamphlet / Booklet will be printed on ivory paper with black ink. 10) Instruction Material / Pamphlet / Booklet must have a catalogue number. ie: Form number Date/Rev Date (Month/year) {NB 1396 Rev January 2005 Typist's Initials { sa Where space permits in booklets/pamphlets only, include the hospital's Vision Statement and Core Values - "The North Bay General Hospital is Committed to Providing Compassionate, Quality Patient Focused Care." ñ Back to top 3.12 Internal Departmental Forms C Forms which are used exclusively within a department/center and are not found on a patient's chart, do not require a Forms Management number. (ie: NB - number). ñ Back to top C Departments/centers must develop an internal catalogue list and numbering system using the Department / Unit I.D. letters found in Administrative Policy "Policy & Procedure Manuals 1-20" i.e.: Facilities Service Center FSC.01 C all internal forms must follow the Forms Management Process 5-60 guidelines. All internal catalogue listings and forms will be reviewed by the Forms Management Team randomly. ñ Back to top 3.13 Business Cards Business cards will be ordered through the Forms Management Team who in turn will contact the outside printer to place the order. Business cards will be ordered in quantities of 250. Business Cards cannot be generated internally or ordered externally by the user. 3.14 Pre-Printed Medical Labels (previously - stamps) FOR NURSING ONLY (For the development of the Pre-Printed Labels, see Admin Policy # ADM 1-136) When requesting a new/revised pre-printed label, adherence to the guidelines will be mandatory. 3.15 Use of Drug Company/Equipment Supplier Forms/ Pamphlets/Booklets/Literature 1) Chart Forms If a form is utilized on the patients' chart, it must be redesigned inhouse and conform to the Forms Management Process - Standard Format (see 3.9). 2) General C No pamphlets/sheets/books are to be photocopied. Originals must be used. C If it is redone, a recognition of the source of information should be added to the last page - ñ Back to top i.e.: Printed with permission of................... C All must be available in French. C Departments must review to ensure the form contains appropriate information. C All Pamphlets/Booklets/Literature must be reviewed by the Forms Management Team prior to use. Submit form, pamphlet, or package with a completed Request for New/Revised/Deleted Forms. C Departments must review their "stock" annually and ensure the most recent printing (copy) is in use. C Departments must compile a list of current material and the year it was printed and reviewed. You may be asked to submit this to Forms Management Team. NOTE: Use of this printed material is not an endorsement of the product. Choice of product is a Purchasing/Product Evaluation Committee process. 4.0 REFERENCE SOURCE C Continuing Education - Patient Education Materials, by Elizabeth H. Winslow, PhD, FN, FAAN. (October 2001). C The SMOG Readibility Formula - www.utexas.edu/rp/ecs/commucations/smog.pdf C Administration Manual, North Bay General Hospital. C French Language Health Services (FLHS) - Revised Translation Service Guidelines - May 2003. C Nursing Practice Committee, North Bay General Hospital. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Roger Allen Sent: 23-Mar-2006 2:25 PM To: @Meditech-L Subject: [MEDITECH-L] Magic: Forms Committee All messages should be posted in plain text. HTML will be converted to attachments. The meditech-l web site is MTUsers.com ====================================== We are trying to raise the Forms Committee out of the ashes and would welcome samples of committee polices and procedures. --- Roger Allen HCIS Manager MRMC - Meadows Regional Medical Center 1703 Meadows Lane P.O. Box 1048 Vidalia, GA 30475-1048 Phone: 912-538-5860 Fax: 912-538-5351 E-Mail: [EMAIL PROTECTED] Web: www.meadowsregional.org _______________________________________________ meditech-l mailing list [email protected] http://mtusers.com/mailman/listinfo/meditech-l _______________________________________________ meditech-l mailing list [email protected] http://mtusers.com/mailman/listinfo/meditech-l
