Included in the Centers for Disease Control and Prevention’s “Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program” is a form for the surveying of device use. The information from this survey helps product evaluation teams identify the device-specific issues they must consider when selecting substitute products. Department heads, nursing units or their designees should complete this form.
To download this CDC-developed survey of device use, which includes a sample cover memo, for adaptation and use in your facility, click here (pdf). The example uses a hypodermic needle/syringe. The form will need slight modification if used for other types of devices, but the questions will be similar, if not the same.
Download other patient safety-related tools and resources:
– Sample Surgical Wound Classification Form
– Sample Hand Hygiene Observation Record
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.