joint accreditation apw august 2016 for...

CONTINUING EDUCATION ACTIVITY PLANNING WORKSHEET

CE Activity Planning Worksheet – Aug 2016 of 16

Rutgers Biomedical and Health Sciences is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education for the healthcare team.

This CE Planning Process has been designed based on the Criteria for Joint Accreditation for Interprofessional Continuing Education™ and accepted adult learning principles. For this educational activity to be approved for AMA, ANCC or ACPE credit/contact hours, the planning process outlined in this document is required.

This CE Activity Planning Worksheet with all supporting forms and documents must be completed and submitted at least 90 days in advance of the proposed activity date. Incomplete worksheets will be returned.

Required Attachments:

Preliminary agenda (live event)

Supporting needs assessment sources (see page 4)

Signed Disclosure Forms for all individuals involved in the development and/or implementation of the activity. If not all disclosure forms are available at the time this worksheet is completed, they must be submitted to the CE unit in a timely manner in order to identify and resolve conflicts of interest.

Budget summary indicating anticipated income (including grants) and expenditures

Marketing PLEASE NOTE: The CE unit is required to review all marketing materials before they are made available to prospective participants. If any of the below methods will be used to generate an audience, please forward the draft versions to the CE unit for review.

Invitation/brochure/letter (mail, fax, email)

Web‐based announcements

Advertisements/journal announcements

Posters

Save‐the‐Date card (Note: A Save‐the‐Date card cannot be used as the only method to generate an audience.)

General Activity Information

Title:

Date(s):

Location(s):

Activity/Delivery Type

Live Event Enduring Material Journal‐based Performance/Quality Improvement

If live event, anticipated number of minutes of instruction (excludes meals, breaks, introductions):


Format

Audioconference Case Study Conference/Symposium DVD

Journal Meeting Monograph Newsletter

Podcast Satellite Webcast/Webinar

Other:

Target Audience

Physicians Nurses Advanced Practice Pharmacists

Pharmacy Technicians Physician Assistants Fellows Psychologists

Social Workers Dentists Podiatrists

Other Healthcare Professional(s):

Other Non‐healthcare Stakeholder(s):

Content Focus

All specialties Cardiology Dermatology Emergency Medicine

Family Medicine

Infectious Disease

Internal Medicine

Neurology OB/GYN Oncology

Orthopaedics Pain Management

Pathology Pediatrics Pharmacology

Psychiatry Public Health Radiology Radiation Oncology

Surgery

Other:

Geographic Area of Target Audience

Internal Local/Regional National International

Sponsoring School/Unit: NJMS RWJMS SN PHARM UBHC

Other:

Sponsoring Department:

Is the activity being jointly provided (planned and implemented with a non‐accredited organization)?

Yes No

If yes, joint provider(s):

Credits Requested Physician (AMA PRA) Nurse (ANCC) Pharmacist (ACPE) Pharmacy Technician (ACPE) Other:

Note: Planning committee must include professionals who are reflective of the target audience.


Activity Description (one paragraph description of overall purpose and goal of this activity)

Pharmacy (ACPE) Activity Type (select one) FOR PHARMACY ONLY Knowledge‐based (designed to acquire factual knowledge; minimum 0.25 contact hour) Application‐based (designed to apply information learned in time frame allotted; minimum 1 contact hour) Practice‐based (designed to acquire specific knowledge, skills, attitudes, and performance behaviors with

didactic and practice components; minimum 15 contact hours)

Pharmacy (ACPE) Topic Designator FOR PHARMACY ONLY 01: Drug Therapy Related (addresses drugs, drug therapy, and/or disease states) 02: AIDS Therapy Related (addresses therapeutic, legal, social, ethical, or psychological issues related to

understanding and treatment of patients with AIDS) 03: Law (addresses federal, state, or local laws and/or regulations affecting the practice of pharmacy) 04: General Pharmacy Topics (addresses topics relevant to the practice of pharmacy other than those

included in the classifications of drug therapy related, AIDS therapy related and law) 05: Patient Safety (addresses prevention of healthcare errors and the elimination or mitigation of patient

injury caused by healthcare errors)


Verification of Identified Learner Needs

INSTRUCTIONS: Learner needs will be identified through an analysis of a variety of sources. There are many sources of information that can be used for conducting a needs assessment and the table below is intended to guide you in the needs assessment process.

Select at least two sources by which you identified the need for the activity. You must submit documentation that supports each of the selections. Only select those sources for which you can provide documentation. You will be asked to interpret the information gleaned from the sources on the following page.

NOTE: Documentation is required for each selection made. For larger documents, please highlight the section(s) that specifically identifies the need.

Learner Identified Needs

Expert Identified Needs Data‐based Observations

Evaluation results from previous activities

National guidelines (NIH, CDC, AHRQ, etc.)

Planning/Advisory Committee members

QA/QI data or dashboards

Needs assessment survey

Specialty society guidelines

Department Chair/ leadership

Departmental quality metrics

Focus group/ discussion

Peer‐reviewed literature

Requested by institution(s) or health care professional group(s)

Publicly reported performance data

Request from relevant healthcare professionals

Regulatory requirements (Joint Commission, MOC, etc.)

Current research Database analyses (utilization, practice management, medication Rx, etc.)

Other, please specify:


Department/specialty case reviews that highlight potential problems


NOTE: A summary description of the data should be submitted in lieu of the actual data.


Needs Assessment and Intended Outcomes

INSTRUCTIONS: Please complete the table below in order to identify the specific educational needs of learners that this activity will address related to the specific practice gaps in learner knowledge and/or competence and/or performance.

Current Practice

Indicate the issues, problems, and/or practice gaps you want to address (Check all that apply)

Learners are not aware of new methods for diagnosis and treatment Learners do not know how to apply the new information into practice Learners are not applying evidence‐based guidelines into practice Learners are having difficulty managing patient care scenarios Patient problems or challenges that have not been adequately addressed Areas of patient care within the department or institution in need of improvement Gap identified by PI/QI process Broad variations of patient care among colleagues Issues reported by patients that need more attention Other (specify):

Describe the specific issues, problems, and /or practice gaps indicated above


List the specific sources you used to identify the practice gaps and provide documentation to support the existence of the gaps (list the specific sources selected on page 4)

Best Practice

Describe the quality, performance, and/or standards of care measures that highlight optimal expectations related to the practice gaps


List the specific sources that support these standards of care and provide documentation to support it (list the specific sources selected on page 4)

Educational Need(s)

Indicate the reason(s) the practice gaps exists related to the gap analysis above Knowledge (learners’ lack of understanding) Skills/Strategy (learners’ difficulty or inability to apply strategy) Performance (practice not meeting standard of care)

Desired Result(s) & Intended Outcome(s)

What will the learners be expected to do differently as a result of their participation in this activity that addresses the practice gaps above?

Classify the expected change(s) of the learners’ behavior as a result of their participation in this activity

Skills/Strategy (gain new abilities/strategies to apply to practice) Performance (practice modification as a result of application learned) Patient Outcomes (change in health status of patients due to change in practice behavior)


Learning Objectives

INSTRUCTIONS: Please check off the area(s) of improvement that this activity will address and provide a minimum of two (2) overall learning objectives. If you would like to use measureable action verbs not listed below, please write it in the text box.

Area(s) of Improvement

Knowledge (what learners need to know) Skills/Strategy (what learners need to know how to do)

Performance (what learners need to do)

Learning Objectives

As a result of this educational activity, learners should be better able to:



Choose one measurable verb below: Choose one measurable verb below: Choose one measurable verb below:

Define List Recognize Assess Integrate Outline Develop Apply Perform

Name Cite State Evaluate Distinguish Select Interpret Show Diagnose

Complete objective here:

Choose Compare Explain Implement Use Practice











Outcomes Assessment

INSTRUCTIONS: Please identify how you plan to assess the relevance and impact of the activity on practice application, clinician performance, and/or health outcomes. Check all that apply.

Skills/Strategy

Post‐activity evaluation (required) Pre/post‐assessments Report of skills/strategy changes Other (specify):

Performance

Report of performance or practice changes Track and identify new practices or policies as a result of activity Chart audits with analysis of results Participant focus group about actual change in practice Other (specify):

Patient Outcomes

Report of patient outcome changes Patient satisfaction survey Quality assessment data/review (departmental, institutional, external) Claims data/review with analysis of results Morbidity/Mortality data with analysis of results Other (specify):

Scope of Professional Activities

INSTRUCTIONS: Activity content must match the healthcare team or individual members of the healthcare team’s current or potential scope of professional activities. Please briefly describe below how the activity content will be relevant to each profession selected in the Target Audience section on page 2. In relation to the content focus, consider the daily practice of the profession, relevant practice parameters and practice guidelines, and how the profession participates as a member of the healthcare team.

Physicians

Not applicable

Nurses

Not applicable

Advanced Practice Nurses

Not applicable

Pharmacists

Not applicable


Pharmacy Technicians

Not applicable

Physician Assistants

Not applicable

Fellows

Not applicable

Psychologists

Not applicable

Social Workers

Not applicable

Dentists

Not applicable

Podiatrists

Not applicable

Other (specify):

Not applicable


Format and Design Related to Sustaining Results

INSTRUCTIONS: The purpose of continuing education is change in behavior or validation that changes already made are consistent with best practices. In the table below, indicate your choices for each element and the rationale for that choice: A. VENUE AND/OR MODE OF EDUCATIONAL INTERVENTION APPROPRIATE

TO THE TARGET AUDIENCE TO ACHIEVE DESIRED RESULTS RATIONALE APPROPRIATE TO OBJECTIVES/RESULTS: Live symposium Internet‐based activity

Print enduring material Electronic enduring material

Journal supplement Other:

B. METHODS TO ENGAGE LEARNERS (Click all that apply, but at least one): RATIONALE APPROPRIATE TO OBJECTIVES/RESULTS:

Case studies Audience response system

Reflection worksheet Small group work

Panel Discussion Role play

Question/Answer Return demonstration

Other:

C. ANCILLARY TOOLS TO REINFORCE AND SUSTAIN LEARNING GOALS: RATIONALE APPROPRIATE TO OBJECTIVES/RESULTS: Email reminder Pocket guide

Patient reminder Algorithm worksheet

Other: None


Competencies

INSTRUCTIONS: Identify the competencies that this activity is designed to address.

Patient Care Including: compassionate, appropriate and effective treatment of health problems and/or health promotion

Medical/Clinical Knowledge Including: established and/or evolving biomedical, epidemiological, social‐behavioral knowledge as it applies to clinical medicine

Practice‐Based Learning and Improvement Including: appraisal of one’s own care patterns, knowledge, expertise and gaps; setting goals and addressing gaps in one’s own practice and implementing changes with the goal of practice improvement; locating appraising, and assimilating evidence from scientific studies to apply in own practice

Interpersonal and Communication Skills Including: effective communication with patients, families, other health professionals; effective collaboration leadership in a healthcare team

Professionalism Including: adherence to ethical principles; integrity; respect for others; responsiveness to patient needs; sensitivity and responsiveness to diverse populations

Systems‐Based Practice Including: coordination of patient care within a healthcare system with appropriate and effective use of system resources; system‐based quality assessment and improvement

INSTRUCTIONS: Check below if this activity will focus on any of the following Core Competencies for Interprofessional Collaborative Practice:

Values/Ethics for Interprofessional Practice Work with individuals of other professions to maintain a climate of mutual respect and shared values

Roles/ Responsibilities Use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and to promote and advance the health of populations

Interprofessional Communication Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease

Teams and Teamwork Apply relationship‐building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient‐/population‐centered care and population health programs and policies that are safe, timely, efficient, effective and equitable

INSTRUCTIONS: Check below if this activity will focus on any of the following National Academy of Medicine competencies:

Provide patient‐centered care Work in interdisciplinary teams Employ evidence‐based practice

Apply quality improvement Utilize informatics


Identified Barriers and Strategies to Address Them

INSTRUCTIONS: Planners are encouraged to give consideration to the system of care in which the learner will incorporate new or validate existing learned behaviors. Planners must be sure to (a) identify barriers that could block implementation and (b) attempt to apply strategies to address, discuss strategies to overcome or remove those barriers (if possible) in the content of the activity. Please indicate below the barrier(s) you have identified:

Clinician Barriers

Lack of time to assess or counsel patients Lack of consensus on professional guidelines Other (specify):

Patient‐Based Barriers

Insufficient adherence to treatment plan Communication/language barriers Other (specify):

Institutional Barriers

Institutional policies Insufficient administrative support/resources Insufficient clinical staff Insufficient technical resources Organizational culture Other (specify):

System Barriers

Insurance/reimbursement issues Cost of treatment Insufficient accessibility/availability of treatment Other (specify):

Not applicable No perceived barriers

If applicable, describe the strategies that will be employed in this activity to address or remove the identified barriers:

Planning Committee

INSTRUCTIONS: Please complete the table below for each planning committee member. When developing an interprofessional continuing education activity, the planning process must include health care professionals from two or more professions and include professionals who are reflective of the target audience members.

COMMITTEE MEMBER NAME

DEGREES/ CREDENTIALS

TITLE AND AFFILIATION ROLE ON COMMITTEE

Activity Director

Activity Director

Activity Director


Activity Director

Activity Director

Activity Director

Activity Director

Activity Director

Attach additional sheets if necessary

Faculty/Presenters/Authors

INSTRUCTIONS: Please complete the table below for each faculty/presenter/author.

FACULTY/AUTHOR/PRESENTER NAME

DEGREES/ CREDENTIALS

TITLE AND AFFILIATION

Attach additional sheets if necessary


Successful Completion of the Activity

INSTRUCTIONS: Indicate the criteria for verifying participation in and successful completion of the activity

Criteria for successful completion of the activity include: (Check all that apply) Attendance at entire event or session Attendance for at least % of event Attendance at 1 of more sessions Completion/submission of evaluation form Achieving a passing score of % on post‐test Other:

How will attendance be verified? Sign‐in sheets/registration form Signed attestation by participant verifying completion of entire or part of activity Collection of participation verification via computer log Other:

Attestation

I hereby certify that this worksheet was completed accurately and attest to the validity of the information contained within.

I agree to collaborate with RBHS to ensure that the planning and implementation of the series are consistent with the continuing education policies of RBHS other agencies that regulate continuing education.

Name (Please Print )

Signature Date

ADMINISTRATIVE REVIEWER, IF APPLICABLE

Name (Please Print )

Signature Date

joint accreditation apw august 2016 for...

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