Quality Improvement Assessment Template
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15Steps to Quality Improvement
Worksheet A:
Identifying Areas for Improvement
1. Select one question (from the Pain: Facility Assessment Checklist) to examine
further.
Ex: Does our facility complete a comprehensive assessment within 24 hrs of admission?
Question: _____________________________________________________________
______________________________________________________________________
2.
Randomly select five to ten (or more) medical records (or other data source,
depending on the question) to review. Determine a question that will be asked:
Example: Was a comprehensive pain assessment completed upon
admission/readmission?
Question: ____________________________________________________________
____________________________________________________________________
3. Collect data:
• Data can help you separate what you think is happening from what is really happening.
• Data will establish a baseline so you can measure improvement.
• Data will help you avoid putting solutions in place that will not solve the problem.
Record findings here:
Case #
Yes
No
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4. If data is not readily available from medical records, what sources did you use to
collect your data, and what steps did you take to collect this data?
_____________________________________________________________________
_____________________________________________________________________________
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Parent category: Business