Mellott & Associates has made available a collection of forms, policies, procedures and other topics relating to the health care field.  This information is not to be relied upon for meeting regulations or accreditation standards as set forth by The Joint Commission® . 

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Mellott & Associates welcomes suggestions for additional documents to this web page for others to utilize.  If you would like to submit a document for consideration, please contact us. 

Age Appropriate Competencies

• Age Appropriate Competency Sample Format

• Age Appropriate Competencies – Communication

• Age Appropriate Competencies – Medication Administration

• Age Appropriate Competencies – Skin Care

• Age Appropriate Competencies – Cardiac Monitor

• Age Appropriate Competencies – Pharmacy Services

• Age Appropriate Competencies – Ward Clerk

• Age Appropriate Competencies – Housekeeping

• Age Appropriate Competencies – Social Work Services

• Age Appropriate Competencies – Respiratory Services

• Age Appropriate Competencies – Patient Education

• Age Appropriate Physical Therapy

• Age Appropriate Housekeeping Services

Assessment

• Pedi Assessment Tool

• Nursing Competency Form  

Care of Patients

• CPR Flowsheet

• Interdisciplinary Plan of Care

• Wound Healing – Push 3.0 Tool

Continuum of Care

• Interdisciplinary Assessment of Ongoing Discharge Planning Needs

Environment of Care

• Administrative Support Statement of EOC Program

• Area of Opportunity Form

• Environment of Care - Indicator Tracking Form (pdf)
    Contact mellottandassoc@att.net to obtain this form in Excel format

• Sample Orientation for Contract Workers (submitted by Sutter Health)  
  

Safety:

• Bomb Threat Plan

• Bomb Threat Checklist

• Environment of Care - Daily Construction Site Inspection Form

• Environment of Care - Daily Egress Route Inspection Form

• Environmental Safety Rounds

• Safety/Security Survey

Security:

• Security Crime Vulnerability Inspection Report

• Violence Management Policy

Life Safety:

• Construction Risk Assessment 

• Interim Life Safety Inspection Tool

Emergency Management:

Utilities:

• Energy Saving Strategies

• Utility Listing Worksheet

FPPE

• FPPE SIG Response  pdf    

Governing Body

Human Resources

• HR File Audit Form

• HR Personnel File Review Form for LTAC Facilities

• Hospital Nursing Staff Plan  

• HR File Audit form for Agency Contract, Travelers  

• New Hire Orientation Requirements (Example) 

• New Hire Checklist

• New Hire Orientation Agenda  

• Non-Hospital Employees HR Required Processes 

Infection Control

• Sharps Injury Prevention Program   

Leadership

• Ambulatory Summary Sheet  pdf  

• Clinical Practice Guidelines Policy

• Contract Tracking Form

• Disclosure of Unanticipated Outcomes Policies

• ED Hold Patients Data Collection Form  

• Scope of Care Form

• Sentinel Event Alert Response Form

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Medical Staff

• Medical Staff Coordinator Materials

OPPE

• OPPE SIG Response  pdf       

Patient Safety

• Healthcare FMEA  

• Medication Errors

• Partnership for Health & Accountability  

• Patient Safety Brochure 

• Patient Safety Plan Outline 

Performance Improvement

• Performance Improvement Project Report

• Quality Awareness Facilitator Evaluation

• Quality Awareness Facilitator Guide PowerPoint Presentation

• Quality Awareness Post Test

• Quality Initiative A Public Resource on Hospital Performance  

PI Tools

• Operative and Invasive Review  -
     Planning Grid for Procedures Review
     Tracking Procedures Reviewed

• Physician Performance Measurement Sets 

• Prioritization Matrix

• Tools and Techniques 

• Spider Diagram

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