Patient Safety Project - benchmarking submission form

Inpatient Safety - benchmarking submission form

Please complete the form below. You will note the first three fields have been pre-filled. Please check that this information is correct before submission. If it is not, please contact clinical@hospiceuk.org.

All fields must be completed before submitting the form.
If you resubmit this form it will overwrite any previous submissions.
Guidance for the metrics can be found on our website.

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Organisation *
Category *
Business Year *
Month *
Full Name
Email *
example@example.com
Bed Data
Number of beds (size of bedded unit) *
Please only use whole numbers
Month 31 x number of bed days
Available bed days *
Please check that your available bed days is correct, you seem to have submitted more than a month's worth of available bed days for your number of beds?!
Occupied bed days *
Occupied bed days cannot be higher than available bed days!
Number of discharges *
Number of deaths *
Throughput
(Auto-calculated)
Falls
No harm *
Low harm *
Moderate harm *
Severe harm *
Death *
Total Falls
(Auto-calculated)
Pressure Ulcers
PUOA/POA
Moisture Associated Skin Damage (MASD) *
Category 1: non-blanchable erythema *
Category 2: partial thickness skin loss *
Category 3: full thickness skin loss *
Category 4: full thickness tissue loss *
Unstageable: depth unknown *
Suspected Deep Tissue Injury (DTI) *
Medical Device Associated *
Total number of PU on admission
(Auto-calculated)
New PU
Moisture Associated Skin Damage (MASD) *
Category 1: non-blanchable erythema *
Category 2: partial thickness skin loss *
Category 3: full thickness skin loss *
Category 4: full thickness tissue loss *
Unstageable: depth unknown *
Suspected Deep Tissue Injury (DTI) *
Medical Device Associated *
Patients with a new PU (1 or more) *
Total number of new PU
(Auto-calculated)
Avoidable new / acquired pressure ulcers
Unavoidable new / acquired pressure ulcers
Medication Incidents
Level 0: no harm - incident prevented *
Level 1: no harm - incident not prevented *
Level 2: low harm *
Level 3: moderate harm *
Level 4: severe harm *
Level 5: death *
Total number of medication incidents
(Auto-calculated)
Should be Empty:

Inpatient Safety - benchmarking submission form

Patient Safety Project - find out more

Hospice UK is the national charity for hospice and end of life care.