Sample Implementation Planning Template

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Sample Implementation Planning Template
Target
To be
Start
Activity
Finish
carried
Status/Comments
Date
Date
out by
1.0
Facility Preparedness
1.1
Complete Facility Level Situation
Assessment
1.2
Appoint coordinator
1.3
Identify key individuals and groups
1.4
Establish hand hygiene committee to
oversee implementation
1.5
Review the minimum recommended
requirements for implementation
1.6
Develop communications plan
1.7
Agree on hospital-wide versus phased
unit-based implementation
1.8
Complete Product Placement Tool
1.9
Select alcohol-based hand rub products
1.10
Plan hand care protection program
1.11
Establish process for collecting and
analyzing observational data
1.12
Identify trainers and observers
1.13
Arrange a date and venue to undertake
observer and trainer training
1.14
Develop system to collect data on costs
1.15
Ensure necessary funds are available for
purchase of alcohol-based hand rub
1.16
Complete and obtain sign off on
implementation plan
1.17
Assign roles to ensure project task
completion:
Occupational Health and Safety
Risk Management
Quality and Patient Safety
Housekeeping
Environmental services/facilities

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