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Address the following questions/statements in each section. When addressing each section make sure your submission provides details and examples. Please provide supporting documentation to further explain your program and its success.

Documentation/Supporting MATERIALS are provided to help with understanding the criteria. Please note examples are NOT inclusive. Supporting documentation/examples that are unique, creative and represent “out of the box” thinking is strongly encouraged.

Please note! It is NOT required to include documentation for each example given

1) Program Objective and Overview

a) What problem was observed?

b) Provide insights to the root cause anaysis that was conducted. 

c) What targets did your program set to accomplish?

d) Provide a brief overview of your program (name, structure, ect.) 

  • Measurable goals
  • Documentation charts
  • Charts, graphs, team materials, images, ect.,

2)  Program Strategy

a) Who led the program charge (i.e., skin champion)? 

b) How did the clinical champion exhibit leadership of the program? 

c) Describe your interdisciplinary skin team, what allocation of time they dedicate to the program and how they work with front line and other facility staff.

d) What role has your senior leadership played

  • CV/resume of program leader(s)
  • Awards or recognition relevant to the program
  • Org charts
  • Team communications
  • Reference/support letter from senior leadership, facility publications, etc.

3) Program Protocol 

a) Describe the protocols you have put into place with your program. (Product manufacturer’s copyrighted program are not eligible for submission)

b) Explain the comprehensiveness of your product formulary (please describe generically by product category).

  • Decision making tools to facilitate appropriate product
  • Description of process for annual review of tools and formulary
  • Policies and procedures (e.g., risk assessment, procedure for skin inspection)

If your formulary list includes both skin and wound care products, you can submit as is. There is no need to create a separate list of skin care products. 

4)  Program Engagement and Education

a) What unique ways have you used to engage your facility team in your program?

b) How do you deliver ongoing education to your team?

c) How do you deliver patient education?

  • Education tools (i.e., videos, brochures, take home information for families)
  • New employee orientation materials
  • Staff communications
  • Content/methods for educating other disciplines
  • Results of post-tests or alternative evaluation method
  • Patient case study –please ensure any sensitive or confidential information is removed

5) Program Effectiveness

a) Describe the sustained results your program has had for at least one-year post implementation.

  • Data that illustrates a decrease in nosocomial skin injury and maintenance of improvements
  • Results of P&I Skin Damage surveys (i.e., incidence studies/surveys for pressure ulcers, IAD, skin tears, etc.)