Sample Implementation Planning Template Page 2
ADVERTISEMENT
1
2
3
4Sample Implementation Planning Template
Target
To be
Start
Activity
Finish
carried
Status/Comments
Date
Date
out by
Unit based health care providers:
•
nurses
•
physicians
•
allied health professionals
•
personal care assistants
•
management
•
transporters
•
Purchasing
Infection Control Professionals
Communications
1.18
Agree on a method for securing support
from key individuals and groups
1.19
Prepare a letter for distribution to senior
managers seeking their support for
program
2.0
Baseline Evaluation
2.1
Complete senior and middle management
perception survey (baseline)
2.2
Complete health care providers
perception survey (baseline)
2.3
Complete unit structure survey (baseline)
2.4
Collect soap and hand rub consumption
data (monthly)
2.5
Complete hand hygiene observations
(baseline)
2.6
Complete health care providers
knowledge survey (baseline)
2.7
Input data
2.8
Analyze data
2.9
Write report
2.10
Schedule health care provider education
and training
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business