OSHP Medication Safety Award
To recognize an Ohio Health-System project that has made outstanding effort/progress toward furthering medication safety
Nominee Information
Team Lead Name
*
First Name
Last Name
Team Lead Email Address
*
example@example.com
Are any members of the team a member of OSHP? If yes, please list the number of years.
Please describe the initiative that your organization implemented within the last 5 years and include the following details: Conception of the project and project scope and impact. As warranted, please attach additional evidence in links at end of the application.
Please describe resulting practice changes from your initiative. As warranted, please attach additional evidence in links at end of the application.
Estimated number of patients impacted by this initiative.
Did this initiative include collaboration with other disciplines or departments? If yes, please list and describe the extent of collaboration.
Did the results of this initiative lead to other related projects/initiatives at the health system?
Could this project be implemented at other health systems? Please give at least one specific example (if selected as award winner, this is required to be included in CE presentation) ?
Please list up to 5 additional medication safety related projects the nominee/team has participated on in the last 5 years.
Has the initiative increased engagement of staff with medication safety reporting/initiatives or improved culture of reporting medication events? Please list at least one specific example
Please list any additional details related to this project initiative.
Nominator Information
Organization Name
*
Nominator Name
*
Nominator Phone
*
-
Area Code
Phone Number
Nominator Email Address
*
example@example.com
By checking below, I hereby: Attest that all information I have provided in conjunction with this application is true and completed by myself as the nominator. Acknowledge and agree that if during the application process, I make any false or misleading statements—including material omission—that this may be considered grounds for removal of the application from award consideration.
*
I have read and agree with the above statement
Attachments
Please upload a letter of recommendation or attestation from your supervisor or director of pharmacy noting support for this application including verification of project and dates. The letter can be brief ~1 paragraph to serve as confirmation of these initiatives.
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Additional Evidence #2:
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