Shining Star application 2011

Document Sample
Shining Star application 2011 Powered By Docstoc
					                      APIC WEST VIRGINIA
  APPLICATION FOR 2011 SHINING STAR AWARD FOR EXCELLENCE IN
             INFECTION CONTROL AND PREVENTION


The application consists of:
   1. This completed application form.
   2. The nominator’s (who must be a member of APIC WV) written explanation for
       choosing the candidate (candidates may nominate themselves).
   3. A written explanation (500 words or less) of how you or the individual you have
       nominated met the criteria for selection.


________________________________________________________________________

Candidate’s name and credentials:____________________________________________

Address: ________________________ __________________ ______ ___________
                Street Addresss                  City            State      Zip Code

Employer:_____________________________          Business Phone___________________

E-mail__________________________

Current Position:__________________________________________________________

APIC WV member submitting nomination: ____________________________________

Address:_________________________ ____________________ ______ _________
                Street Address                    City              State    Zip Code

Phone #:______________________________ Email____________________________



SELECTION CRITERIA:

   1. Must be a APIC West Virginia member
   2. Must be currently practicing in Infection Control and Prevention
   3. Promotes and advances the goals of APIC:
         a) Volunteers when the need arises
         b) Promotes Infection Control and Prevention in the community (example:
            drive by flu vaccinations)



                                  SEE BACK OF PAGE
c) Has developed Infection Control and Prevention related activities that
   impacts:

         1) Process/systems improvement, i.e., changed the way we do
            something that has improved outcomes.

         2) Educational programs: for your facility or the community—
            have you reduced adverse events by use of an educational
            program?

         3) Patient safety: What are you doing that has improved patient
            safety, i.e., reduced VAPs, BSIs, decubiti, SSIs, etc.

         4) Cost savings: What have you done to save dollars for your
            facility and at the same time maintain the quality of patient care?

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:6
posted:3/29/2012
language:
pages:2