QAPI Report Builder Form

QAPI REPORT FORM

The Report Builder will ask you detailed questions about your Quality Study. We will review your submission and send you an edited version within 2 business days.
Your Name:*

First NameLast Name
Your email address:*
example@example.com
Enter the name of your facility:*
Please enter your passcode to access the form:*
If you do not have an access code, please contact support at 770-325-0140, for assistance.** Please note: passcode is case-sensitive **
QAPI study:*
Enter the name of your QAPI Study
Statement of Purpose: *
State your known or suspected problem. Describe why improvement is important. Be sure to use complete sentences
Performance Goal: *
What is the facility goal? Provide a % or number. Be sure to use complete sentences
Data Methodology: *
What data is needed to measure or determine where we are now? What do we need to do to verify whether a problem exists, its frequency, and severity? Be sure to use complete sentences
Evidence of Data Collection: *
Describe exactly what data was collected. Do NOT list your results yet. Be sure to use complete sentences
Data Analysis: *
List your findings. What were the data collection results? You will compare your findings to your goal in the next step. Simply state here the data that was collected. Be sure to use complete sentences
Comparison to Goal:*

Goal was metGoal was not metGoal was not met. The study was ended.
If your goal was met without the need to implement any corrective action, this will not qualify as a QAPI study.

Here is a list of ten QAPI study ideas for you to consider:
- Patient Wait Times
- Actual versus Scheduled Case Times
- Patient Satisfaction Survey Response
- Counter Payment Collections
- IV Start Effectiveness
- Turnover Times
- Hand Hygiene Effectiveness
- Expired Inventory
- Emergency Response Readiness
- Staff Training and Orientation
- Timely Antibiotic Administration
- Fall Risk
Please reach out to us at 770-325-0140 if you need any assistance.
Hit NEXT to continue or SAVE to receive a link by email to return and complete later

QAPI REPORT - 1st Corrective Action

Here you will implement a corrective action, repeat previous steps to determine if your corrective actions improved processes to meet your initial goal and describe the new data collected this time.
Here you will implement a corrective action, repeat steps above to determine if your corrective actions improved processes to meet your initial goal and describe the new data collected this time.
Corrective Action:
Describe what activities will be performed this time to improve process to meet identified goal. Here is where you problem solve again. Be sure to also include activity implementation goal date. Be sure to use complete sentences
Evidence of Data Collection - Re-Measurement:
Describe exactly what data was collected. Describe what information was collected this time. Do NOT list your results yet. Be sure to use complete sentences
Data Analysis - Re-Measurement:
List your findings. What were the data collection results? You will compare your findings to your goal in the next step. Simply state the data that was collected. Be sure to use complete sentences
Comparison to Goal:

Goal was metGoal was not metGoal was not met. The study was ended.
Hit NEXT to continue or SAVE to receive a link by email to return and complete later

QAPI REPORT - 2nd Corrective Action

Here you will implement another corrective action, repeat previous steps to determine if your corrective actions improved processes to meet your initial goal and describe the new data collected this time.
Corrective Action 2:
Describe what activities will be performed this time to improve process to meet identified goal. Here is where you problem solve again. Be sure to also include activity implementation goal date. Be sure to use complete sentences
Evidence of Data Collection - Re-Measurement 2:
Describe exactly what data was collected. Describe what information was collected this time. Do NOT list your results yet. Be sure to use complete sentences
Data Analysis - Re-Measurement 2:
List your findings. What were the data collection results? You will compare your findings to your goal in the next step. Simply state the data that was collected. Be sure to use complete sentences
Comparison to Goal:

Goal was metGoal was not metGoal was not met. The study was ended.
Hit NEXT to continue or SAVE to receive a link by email to return and complete later

QAPI REPORT - 3rd Corrective Action

Here you will implement another corrective action, repeat previous steps to determine if your corrective actions improved processes to meet your initial goal and describe the new data collected this time.
Corrective Action 3:
Describe what activities will be performed this time to improve process to meet identified goal. Here is where you problem solve again. Be sure to also include activity implementation goal date. Be sure to use complete sentences
Evidence of Data Collection - Re-Measurement 3:
Describe exactly what data was collected. Describe what information was collected this time. Do NOT list your results yet. Be sure to use complete sentences
Data Analysis - Re-Measurement 3:
List your findings. What were the data collection results? You will compare your findings to your goal in the next step. Simply state the data that was collected. Be sure to use complete sentences
Comparison to Goal:

Goal was metGoal was not metGoal was not met. The study was ended.
Hit NEXT to continue or SAVE to receive a link by email to return and complete later

QAPI REPORT - 4th & Final Corrective Action

Here you will implement a final corrective action, repeat previous steps to determine if your corrective actions improved processes to meet your initial goal and describe the new data collected this time.
Corrective Action 4:
Describe what activities will be performed this time to improve process to meet identified goal. Here is where you problem solve again. Be sure to also include activity implementation goal date. Be sure to use complete sentences
Evidence of Data Collection - Re-Measurement 4:
Describe exactly what data was collected. Describe what information was collected this time. Do NOT list your results yet. Be sure to use complete sentences
Data Analysis - Re-Measurement 4:
List your findings. What were the data collection results? You will compare your findings to your goal in the next step. Simply state the data that was collected. Be sure to use complete sentences
Comparison to Goal:

Goal was metGoal was not met. Study was ended.
Hit NEXT to continue or SAVE to receive a link by email to return and complete later

Summary:
You did not fix the problem with your attempt(s) to correct it. It's ok. Not all studies will meet the desired goal. Now summarize the study. Be sure to state that your goal of _____ was not met and none your process improvement activities were successful. Be sure to use complete sentences
Summary:
Congratulations! You fixed the problem. Now summarize the study. Be sure to state that your goal of _______ was met and your process improvement activities were successful. Be sure to use complete sentences
Communication:*
Report activities to Governing Body and team and make sure you document that in the GB meeting minutes. Indicate your reporting activities here. Ongoing QAPI activities should be a routine part of GB meetings and minutes. Be sure to use complete sentences
Hit SUBMIT REPORT when finished or SAVE to receive a link by email to return or review at a later time
Should be Empty:

QAPI REPORT FORM

QAPI REPORT - 1st Corrective Action

QAPI REPORT - 2nd Corrective Action

QAPI REPORT - 3rd Corrective Action

QAPI REPORT - 4th & Final Corrective Action