Patient Safety Project - data submission form

Patient Safety data collection submission form

To take part in our data collection, please complete the form below.

Please note:

You don’t have to submit all of one quarter’s data in one go. It is possible to submit partial data and return to the form, but you must remember to hit 'submit' at page end to ensure the data entered so far is retained.
If you resubmit this form it will overwrite any previous submissions.

Guidance for how to complete this form and metrics definitions can be found on the Patient Safety webpage.

Hospice Name*
Business Year*
Month*
Days in month
encrypted
Category*
Full Name
Email*
example@example.com
Bed Data
Number of beds (size of bedded unit)*
Please only use whole numbers
Month days x number of bed days
Available bed days*
Please check that your available bed days is correct, you seem to have submitted more than a month's worth of available bed days for your number of beds?!
Occupied bed days*
Occupied bed days cannot be higher than available bed days!
Number of discharges*
Number of deaths*
Throughput
(Auto-calculated)
Falls
No harm*
Low harm*
Moderate harm*
Total falls*
Severe harm*
Death*
Pressure Ulcers
PUOA/POA
Moisture Associated Skin Damage (MASD)*
Category 1: non-blanchable erythema*
Total number of PU on admission*
Category 2: partial thickness skin loss*
Category 3: full thickness skin loss*
Category 4: full thickness tissue loss*
Unstageable: depth unknown*
Suspected Deep Tissue Injury (DTI)*
Medical Device Associated*
New PU
Moisture Associated Skin Damage (MASD)*
Category 1: non-blanchable erythema*
Total number of new PU*
Category 2: partial thickness skin loss*
Category 3: full thickness skin loss*
Category 4: full thickness tissue loss*
Unstageable: depth unknown*
Suspected Deep Tissue Injury (DTI)*
Medical Device Associated*
Patients with a new PU (1 or more)*
Avoidable new / acquired pressure ulcers
Unavoidable new / acquired pressure ulcers
Medication Incidents
Level 0: no harm - incident prevented*
Level 1: no harm - incident not prevented*
Level 2: low harm*
Level 3: moderate harm*
Total number of medication incidents*
Level 4: severe harm*
Level 5: death*
Hospice submissions will be brought together and held securely and confidentially within Hospice UK's systems. Analysis will be by a small team of Hospice UK staff and specialist associates. Data will be aggregated and reported at UK, Country and, if there are sufficient numbers to ensure individual hospices cannot be identified, at regional level. No individual hospice data will be reported or publicly identified or shared with third parties. For further details, please review our full Privacy Policy (Privacy Policy | Hospice UK)
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