Att G14 RP

Monthly Reporting Plan

Patient Safety Monthly Reporting Plan
The Patient Safety Monthly Reporting Plan Form (CDC 57.106) is used by NHSN
institutions to inform CDC which Patient Safety modules are used during a given month.
This allows CDC to select the data that should be included in the aggregate data pool for
analysis. Each participating institution must enter a monthly Plan to indicate the module
used, if any, and the events, locations and/or procedures they monitored.
There must be a Plan completed for every month that data are entered into NHSN
although a facility may choose “No NHSN Patient Safety Modules Followed this Month”
as an option. The Instructions for Completion of Patient Safety Monthly Reporting Plan
Form (Chapter 14 Tables of Instructions, Table 1) includes brief instructions for
collection and entry of each data element on the form. A minimum of 6 months of data
from at least one component is required during each calendar year to remain an active
participant in NHSN. States and other entities (e.g., CMS) using NHSN as their reporting
platform may have additional reporting requirements.

January 2012

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