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Policies and Procedures
Posted by: Juni Muhota on June 29, 2009 at 10:07AM EST

What system does your hospital use to catalog and share policies in a way that makes it easy for staff to access them and find things easily. We have an intranet system where we post all policies under the Joint Commission Chapters such as Medication Management, Provision of Care, Patient Rights etc but have also created an online matrix that cross references into an alphabetical form. Managers can then print hard copies of all policies and place binders on nursing units and other locations where computer access is not routine. We continue to hear that staff would like more innovative ideas of sharing policies so any thoughts would be much appreciated.  

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(3) Comments
Posted by: Moishe Singer on June 29, 2009 10:55AM EST
We currently have everything online on our intranet. All policies are listed in PDF format in a standard template that includes the last date of revision.

There is also a master list showing all Policies/Procedures by number with corresponding last updated dates.

We do not keep printed copies, but employees are welcome to print on their own.

Posted by: Sue Beaulieu on July 1, 2009 8:17PM EST
We too, like Moishe, keep our policy and procedures on the intranet. Policies are broken down by department. We maintain one master copy of all policy and procedures in case of computer failure and they are maintained in our nursing office.

We are currently looking at a new program that will allow us to search policy by word, which would make it much easier for the staff to find the policy.

Also, each time a policy is created or revised all staff are sent a mox ( our internal communication, the Meditech users will recogonize mox) letting them know that there has been a change so they can review the policy.

Posted by: Revati Komandur on July 6, 2009 8:47PM EST
We too have our policies and Procedures on the intranet so that they are easily accessible to all our employees

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