Standards for Writing Policies and Procedures Operating Guidelines Measure: 11.1.1 A Submitter: Columbus Public Health (OH) (ASI Site, 2011-2012) Demographic Information: • Population served: 790,000, urban • FTEs: 330 • State structure: decentralized • Board authority: Board of Health Governing Board Required documentation: 1. 2.
Policy and Procedure Manual or individual policies Health department organizational chart
3. Report of review at least every five years or proof of regular updating process 4.
Description of methods for staff access to policies
Submitter justification: This is a written standard for Columbus Public Health Policies and Procedures Operating Guidelines
Note: none of the NACCHO demonstration sites received accreditation status or an indication of the likelihood of accreditation status through the grant process, and therefore this documentation does not reflect items that have officially been approved by PHAB for the purposes of meeting a standard or measure.
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Appendix A: Policy and Procedure Template POLICY AND PROCEDURE SUBJECT/TITLE:
Appendix A Policy and Procedure Template
SCOPE:
Description of staff impacted by this document
CONTACT PERSON & DIVISION: Laurie Dietsch, MPH ‐ Planning & Peak Performance/Accreditation ORIGINAL DATE ADOPTED:
##/##/##
LATEST EFFECTIVE DATE:
##/##/##
REVIEW/REVISION DATE(S):
##/##/##
REVIEW FREQUENCY:
Every 2 years
TOTAL # OF PAGES:
2
BOH APPROVAL DATE:
N/A
REFERENCE NUMBER:
N/A
PURPOSE The intent of this document is to … 1. Asdfjkl; 2. Asdfjkl; and 3. Asdfjkl. POLICY Policy statement... BACKGROUND Include text; leave blank or state “N/A”. GLOSSARY OF TERMS Include text; leave blank or state “N/A”. PROCEDURES & STANDARD OPERATING GUIDELINES I. OUTLINE 1 FORMAT Text goes here. A. Outline 2 Format: Can have text. 1. Outline 3 Format ‐ Can have text here. i. Outline 4 Format for text CITATIONS Use American Psychological Association [APA] format CONTRIBUTORS The following staff contributed to the authorship of this document: 1. Name, Job Title, Primary Author
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2. Name, Job Title APPENDICES Appendix A: Title of Document Appendix B: Title of Document Include text; leave blank or state “N/A”. REFERENCE FORMS Include text; leave blank or state “N/A”. SIGNATURES ______ Teresa Long, MD, MPH Health Commissioner ______ Mysheika LeMaile‐Williams, MD, MPH Assistant Health Commissioner/Medical Director ______ Nancie Bechtel, RN, BSN, MPH Assistant Health Commissioner/Chief Nursing Officer ______ Roger Cloern Assistant Health Commissioner/Chief Operations Officer
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Appendix A: Clinical Protocol Template CLINICAL PROTOCOL SUBJECT/TITLE:
Appendix A Clinical Protocol Template
SCOPE:
Description of staff impacted by this document
CONTACT PERSON & DIVISION: Laurie Dietsch, MPH Planning & Peak Performance/Accreditation ORIGINAL DATE ADOPTED:
9/15/2011
LATEST EFFECTIVE DATE:
##/##/##
REVIEW/REVISION DATE(S):
##/##/##
REVIEW FREQUENCY:
Every 2 years
TOTAL # OF PAGES:
2
BOH APPROVAL DATE:
N/A
REFERENCE NUMBER:
N/A
SIGNS AND SYMPTOMS OF [fill in] The signs and symptoms of [fill in] are: 1. Fill in; 2. Fill in; and 3. Fill in. STANDING ORDERS 1. Fill in; 2. Fill in; and 3. Fill in. CONTRAINDICATIONS 1. Fill in; 2. Fill in; and 3. Fill in. Include text; leave blank or state “N/A”. SIGNATURE OF PHYSICIAN Mysheika LeMaile‐Williams, MD, MPH Assistant Health Commissioner/Medical Director ADDITIONAL PROCEDURES I. OUTLINE 1 FORMAT Text goes here.
_______/_______/________ Date
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A. Outline 2 Format: Can have text. 1. Outline 3 Format ‐ Can have text here. i. Outline 4 Format for text CITATIONS Use American Psychological Association [APA] format CONTRIBUTORS The following staff contributed to the authorship of this document: 1. Name, Job Title, Primary Author 2. Name, Job Title APPENDICES Appendix A: Title of Document Appendix B: Title of Document Include text; leave blank or state “N/A”. REFERENCE FORMS Include text; leave blank or state “N/A”.
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Appendix B: Signature Page Templates TEMPLATE/EXAMPLE OF A CPH‐ONLY SIGNATURE PAGE: SIGNATURE PAGE: Endorsement: Bloodborne Pathogen Exposure Control Plan We hereby endorse the Columbus Public Health Bloodborne Pathogen Exposure Control Policy and Procedure, as a part of Columbus Public Health (CPH)’s Safety Program on behalf of the City of Columbus. The CPH Bloodborne Pathogen Exposure Control Policy and Procedure shall be used to protect CPH employees, visitors, and clients in accordance with the Occupational Safety and Health Administration’s (OSHA’s) bloodborne pathogens standard 29 CFR 1910.1030 as adopted by the Public Employment Risk Reduction Program (PERRP). Health Commissioner ______ _______/_______/________ Teresa Long, M.D., M.P.H. – Columbus Public Health Date Medical Director – Assistant Health Commissioner ______ _______/_______/________ Mysheika R. LeMaile‐Williams, M.D., M.P.H. – Columbus Public Health Date Chief Operations Officer ‐ Assistant Health Commissioner ______ _______/_______/________ Roger Cloern – Columbus Public Health Date Chief Nursing Officer ‐ Assistant Health Commissioner ______ _______/_______/________ Nancie Bechtel, RN, BSN, CEN, EMTB – Columbus Public Health Date
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EXAMPLE OF A MULTI‐AGENCY SIGNATURE PAGE: SIGNATURE PAGE: Endorsement: Cold Chain Vaccine Policy We hereby endorse the Cold Chain Vaccine Policy, as part of Columbus Public Health (CPH)'s and Franklin County Public Health (FCPH)’s plans for emergency response, on behalf of the City of Columbus and Franklin County’s corresponding jurisdictions. Pre‐event or emergency planning is crucial to the effective management of unexpected events. This Cold Chain Vaccine Policy is used with the Mass Vaccination Plan, an annex to the Emergency Response Plan (ERP) of each health department and is essential to maintain the integrity of vaccine pharmaceuticals Health Commissioners ______ _______/_______/________ Teresa Long, M.D., M.P.H. – Columbus Public Health Date ______ _______/_______/________ Susan Tilgner, MS, RD, LD, RS – Franklin County Public Health Date Medical Directors ______ _______/_______/________ Mysheika R. LeMaile‐Williams, M.D., M.P.H. – Columbus Public Health Date ______ _______/_______/________ Miller Sullivan, M.D. – Franklin County Public Health Date Assistant Health Commissioners ______ _______/_______/________ Nancie Bechtel, RN, BSN, CEN, EMTB – Columbus Public Health Date ______ _______/_______/________ Deborah Wright RN, – Franklin County Public Health, Director of Nursing Date Assistant Health Commissioners ______ _______/_______/________ Name, Columbus Public Health, Title Date ______ _______/_______/________ Name, Franklin County Public Health, Title Date Appendix_B_Signature_Page_Template_Draft_2012.01.11.doc
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TEMPLATE FOR AN ACCOUNTABILITY SIGNATURE PAGE: ACCOUNTABILITY SIGNATURE PAGE: ACCOUNTABILITY STATEMENT: I have read and reviewed the content of the following document: _______________________________________________________________________________. I have been given the opportunity to ask for clarification and my questions have been answered. DATE PRINT NAME SIGNATURE Appendix_B_Signature_Page_Template_Draft_2012.01.11.doc
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TITLE OF THE DOCUMENT
Program/Division SUBJECT: What is this about SCOPE: Columbus Public Health, All Staff
TOTAL NUMBER OF PAGES: 6 REVIEW FREQUENCY: Every 2 years ORIGINAL DATE ADOPTED: ##/##/2012 LATEST EFFECTIVE DATE: ##/##/2012 REVIEW/REVISION DATE(S): ##/##/2009; ##/##/2011 PRIMARY AUTHOR(S): Laurie Dietsch, Accreditation Coordinator DRAFT BOARD OF HEALTH APPROVAL DATE: N/A REFERENCE NUMBER: N/A
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SIGNATURE PAGE: Endorsement: Bloodborne Pathogen Exposure Control Plan We hereby endorse the Columbus Public Health Bloodborne Pathogen Exposure Control Policy and Procedure, as a part of Columbus Public Health (CPH)’s Safety Program on behalf of the City of Columbus. The CPH Bloodborne Pathogen Exposure Control Policy and Procedure shall be used to protect CPH employees, visitors, and clients in accordance with the Occupational Safety and Health Administration’s (OSHA’s) bloodborne pathogens standard 29 CFR 1910.1030 as adopted by the Public Employment Risk Reduction Program (PERRP). Health Commissioner ______ _______/_______/________ Teresa Long, M.D., M.P.H. – Columbus Public Health Date Medical Director – Assistant Health Commissioner ______ _______/_______/________ Mysheika R. LeMaile‐Williams, M.D., M.P.H. – Columbus Public Health Date Chief Operations Officer ‐ Assistant Health Commissioner ______ _______/_______/________ Roger Cloern – Columbus Public Health Date Chief Nursing Officer ‐ Assistant Health Commissioner ______ _______/_______/________ Nancie Bechtel, RN, BSN, CEN, EMTB – Columbus Public Health Date
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RECORD OF CHANGES TO THE PLAN: DATE
WHAT IS CHANGED
NAME
SIGNATURE
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TABLE OF CONTENTS:
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PURPOSE The intent of this document is to … 1. Asdfjkl; 2. Asdfjkl; and 3. Asdfjkl. POLICY Policy statement... BACKGROUND Include text; leave blank or state “N/A”. GLOSSARY OF TERMS Include text; leave blank or state “N/A”. PROCEDURES & STANDARD OPERATING GUIDELINES
OUTLINE 1 FORMAT Text goes here.
Outline 2 Format: Can have text. Outline 3 Format ‐ Can have text here.
Outline 4 Format for text CITATIONS Use American Psychological Association [APA] format CONTRIBUTORS The following staff contributed to the authorship of this document: 1. Name, Job Title, Primary Author 2. Name, Job Title APPENDICES Appendix A: Title of Document Appendix B: Title of Document Include text; leave blank or state “N/A”. REFERENCE FORMS Include text; leave blank or state “N/A”.
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