Patient Safety - Reporting Plan

Monthly Reporting Plan and Annual Surveys

Patient Safety Monthly Reporting Plan and Annual Surveys
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(s) 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.
Upon enrollment into NHSN and/or activation of an NHSN component, one or more
surveys must be completed. Thereafter, at the beginning of each year, the survey(s) must
be updated to reflect data from the calendar year just completed. For example, upon
NHSN enrollment in May 2013, the hospital completes a Hospital Survey reflecting data
for 2012. Then at the beginning of 2014, the hospital completes a Hospital Survey
containing data for 2013.
In the Patient Safety Component there are separate surveys for the following types of
facilities:
• Hospital (includes general, acute care hospitals; surgical; oncology; orthopedic;
pediatric; women’s; women’s and children’s; military; psychiatric; and Veterans
Affairs): Patient Safety Component – Annual Hospital Survey (57.103)
• Long-term Acute Care (LTAC) Hospital: Patient Safety Component – Annual
Facility Survey for LTAC (57.150)
• Inpatient Rehabilitation Facility: Patient Safety Component – Annual Facility
Survey for IRF (57.151)
Instructions for completing the Patient Safety Monthly Reporting Plan form and the
Annual Survey forms can be found in this chapter and include brief instructions for
collection and entry of each data element on each of the forms.

January 2013

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