Evidenced Based Literature

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Hospital Policy Template

(Under each heading, write the information needed for the section. Once each section is completed, delete all instructions in parentheses.)

Subject/Title of Policy:

Purpose:

(1–2 short paragraphs. Include the following: 

Summarize the patient safety issue. Explain the gap or a problem in a health care or public health situation that caused the issue.

Use supporting evidence from the literature to show how it determined the need. Explain how the evidence was gathered.

Include your revised PICO(T) question.

Explain why it was necessary to take action with the development of this policy.)

Population Affected by the Policy:

(2–3 sentences. Describe the target population to be addressed by an intervention in enough detail that it is clear what population is included or excluded.) 

Definitions:

(Explain any industry specific terms used throughout the document needed for the understanding of the policy. Define in a manner that is descriptive to non-industry personnel.)

Policy Statement:

(3–5 sentence paragraph. Include the following:

State the organization’s declaration of the plans, giving a timeframe and scope of the policy implementation.

Explain the organization’s intentions or goals regarding the patient safety issue.)

Procedure:

(Elaborate on the step-by-step procedure that was outlined in the policy statement above in enough detail that one could replicate the process based on your description alone.)

References:

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