**EXAMPLE**

**[Sample]{.underline} Sharps Injury Prevention Program Action Plan:
*Prevention Initiatives***

  ------------------- ---------------------------------------------------
  **Problem:**        Disposal-related sharps injuries

  **Outcome Goal:**   Reduce to zero the number of injuries associate
                      with sharps disposal

  **Beginning         18 disposal-related injuries from 1/01/00 to
  Measure:**          12/31/00

  **Post Intervention 
  Measure:**          
  ------------------- ---------------------------------------------------

+--------+------+---------------------+----------+--------+-----------+
| **Pro  | **   | **Prevention        | **       | **\#   | **C       |
| blem** | Base | Strategies£**       | Implemen | In     | omments** |
|        | line |                     | tation\* | juries |           |
|        | \#   |                     | Statu    | Post   |           |
|        | Inj  |                     | s/Date** | In     |           |
|        | urie |                     |          | terven |           |
|        | s/** |                     |          | tion** |           |
|        |      |                     |          |        |           |
|        | **   |                     |          |        |           |
|        | time |                     |          |        |           |
|        | p    |                     |          |        |           |
|        | erio |                     |          |        |           |
|        | d±** |                     |          |        |           |
+========+======+=====================+==========+========+===========+
| Needle | 3/   | **A -** Memo to all | C 2/3/01 | 1/     | A         |
| sticks | year | department heads    |          | 1/01 - | dditional |
| among  |      | asking them to      |          | 4/1/01 | sharps    |
| l      |      | review sharps       |          | One    | c         |
| aundry |      | disposal with staff |          | sharp  | ontainers |
| w      |      |                     |          | re     | were      |
| orkers |      |                     |          | ported | placed in |
| due to |      |                     |          | in     | laundry   |
| n      |      |                     |          | l      | area      |
| eedles |      |                     |          | aundry |           |
| left   |      |                     |          | since  |           |
| in     |      |                     |          | i      |           |
| la     |      |                     |          | nterve |           |
| undry, |      |                     |          | ntion; |           |
| c      |      |                     |          | no     |           |
| hiefly |      |                     |          | in     |           |
| IV     |      |                     |          | juries |           |
| ca     |      |                     |          | to     |           |
| theter |      |                     |          | l      |           |
| st     |      |                     |          | aundry |           |
| ylets. |      |                     |          | staff  |           |
+--------+------+---------------------+----------+--------+-----------+
|        |      | **A -** Meeting     | C 2/5/01 |        |           |
|        |      | with laundry        |          |        |           |
|        |      | workers asking them |          |        |           |
|        |      | to be alert to      |          |        |           |
|        |      | problem and to      |          |        |           |
|        |      | encourage reporting |          |        |           |
|        |      | of sharps found in  |          |        |           |
|        |      | laundry, discuss    |          |        |           |
|        |      | what to do with     |          |        |           |
|        |      | sharps if found,    |          |        |           |
|        |      | and identification  |          |        |           |
|        |      | of laundry source   |          |        |           |
|        |      | if known            |          |        |           |
+--------+------+---------------------+----------+--------+-----------+
|        |      | **E -**             | P 4/1/01 |        |           |
|        |      | Implementation of   |          |        |           |
|        |      | safer IV catheters  |          |        |           |
+--------+------+---------------------+----------+--------+-----------+
| Needle | 6/   | **A -** Site        | C 3/6/01 | 1/     | Problem   |
| sticks | year | evaluation of       |          | 1/01 - | a         |
| asso   |      | sharps containers   |          | 4/1/01 | ssociated |
| ciated |      | in ER and ICU       |          | Two    | with      |
| with   |      |                     |          | in     | pick-up   |
| over   |      |                     |          | juries | frequency |
| filled |      |                     |          | due to |           |
| sharps |      |                     |          | over   |           |
| cont   |      |                     |          | filled |           |
| ainers |      |                     |          | sharps |           |
| in ER  |      |                     |          | rep    |           |
| and    |      |                     |          | orted, |           |
| ICU    |      |                     |          | one in |           |
|        |      |                     |          | ICU,   |           |
|        |      |                     |          | one in |           |
|        |      |                     |          | other  |           |
|        |      |                     |          | unit   |           |
+--------+------+---------------------+----------+--------+-----------+
|        |      | **WP/ET-** Review   | C        |        | Frequency |
|        |      | procedures for      | 3/15/01  |        | of        |
|        |      | collection of       |          |        | pick-up   |
|        |      | sharps containers   |          |        | not a     |
|        |      | with housekeeping   |          |        | problem.  |
|        |      |                     |          |        | Staff     |
|        |      |                     |          |        | reluctant |
|        |      |                     |          |        | to enter  |
|        |      |                     |          |        | rooms     |
|        |      |                     |          |        | when      |
|        |      |                     |          |        | p         |
|        |      |                     |          |        | rocedures |
|        |      |                     |          |        | are going |
|        |      |                     |          |        | on        |
+--------+------+---------------------+----------+--------+-----------+
|        |      | **A-** Set up       | P 4/1/01 |        |           |
|        |      | meeting with        |          |        |           |
|        |      | housekeeping and    |          |        |           |
|        |      | nursing staff to    |          |        |           |
|        |      | discuss possible    |          |        |           |
|        |      | solutions           |          |        |           |
+--------+------+---------------------+----------+--------+-----------+
| In     | 7/   | **A-** Investigate  | IP       | 1/     |           |
| juries | year | incidents to        | 4/1/01   | 1/01 - |           |
| with   |      | determine whether   |          | 4/1/01 |           |
| but    |      | injuries involved   |          | Three  |           |
| terfly |      | front or boot end   |          | but    |           |
| n      |      | butterfly needles   |          | terfly |           |
| eedles |      |                     |          | in     |           |
| [      |      |                     |          | juries |           |
| during |      |                     |          | re     |           |
| dis    |      |                     |          | ported |           |
| posal] |      |                     |          |        |           |
| {.unde |      |                     |          |        |           |
| rline} |      |                     |          |        |           |
+--------+------+---------------------+----------+--------+-----------+
|        |      | **E**- mplement     | IP       |        |           |
|        |      | safer butterfly     | 4/1/01   |        |           |
|        |      | devices             |          |        |           |
+--------+------+---------------------+----------+--------+-----------+
|        |      | **A-** In hospital  | P 4/1/01 |        |           |
|        |      | newsletter discuss  |          |        |           |
|        |      | safe ways of        |          |        |           |
|        |      | handling butterfly  |          |        |           |
|        |      | needles             |          |        |           |
+--------+------+---------------------+----------+--------+-----------+
| Other  | 2/   | **A-** Address      |          |        |           |
| im     | year | through injuries to |          |        |           |
| proper |      | laundry workers     |          |        |           |
| di     |      | described above     |          |        |           |
| sposal |      |                     |          |        |           |
| in     |      |                     |          |        |           |
| juries |      |                     |          |        |           |
+--------+------+---------------------+----------+--------+-----------+

\* Pending (P) In Progress (IP) Completed (C)

**±** Year, Quarter, Month

**£** Describe then code by type of intervention: A= Administrative, E =
Engineering, WP = Work Practice, ET = Education/Training

**[Sample]{.underline} Sharps Injury Prevention Program Action Plan:
*Prevention Initiatives***

  ------------------- ---------------------------------------------------
  **Problem:**        

  **Outcome Goal:**   

  **Beginning         
  Measure:**          

  **Post Intervention 
  Measure:**          
  ------------------- ---------------------------------------------------

+---------+------+--------+---------------+------+--------------------+
| ##      | **   | **Prev | **I           | **   | ## Comments        |
| Problem | Base | ention | mplementation | Post |                    |
|         | line | S      | \***          | Inte |                    |
|         | \#   | trateg |               | rven |                    |
|         | Inj  | ies£** | **S           | tion |                    |
|         | urie |        | tatus/Date/** | \#   |                    |
|         | s/** |        |               | I    |                    |
|         |      |        | **Person      | njur |                    |
|         | **   |        | Responsible** | ies/ |                    |
|         | Time |        |               | Time |                    |
|         | Per  |        |               | Per  |                    |
|         | iod^ |        |               | iod^ |                    |
|         | ±^** |        |               | ±^** |                    |
+---------+------+--------+---------------+------+--------------------+
|         |      |        |               |      |                    |
+---------+------+--------+---------------+------+--------------------+
|         |      |        |               |      |                    |
+---------+------+--------+---------------+------+--------------------+
|         |      |        |               |      |                    |
+---------+------+--------+---------------+------+--------------------+

\* Pending (P) In Progress (IP) Completed (C)

**±** Year, Quarter, Month

**£** Describe then code by type of intervention: A= Administrative, E =
Engineering, WP = Work Practice, ET = Education/Training

**[Sample]{.underline} Sharps Injury Prevention Program Action Plan:
*Process Improvement***

  ------------- -------------- -------------- ----------------- --------------
  **Process of  **Problem**    **Action       **Status/Date**   **Outcome**
  Concern \***                 Items**                          

                                                                

                                                                

                                                                
  ------------- -------------- -------------- ----------------- --------------

\* Safety culture, sharps injury reporting, education, etc.