Name of Requestor Facility Name * What is the problem you are trying to address? * Nurses/Physicians are not completing or doing... How do you know it is a problem? * Internal Needs Assessment, Direct Observation, Chart Reviews, etc What is contributing to the problem? * This is a problem because nurses/physicians do not know or do not know how to... Are you seeking to change strategies, skills, performance, or patient outcomes? * Skills (Competency) = Learner knows how to; Performance = Learner demonstrates in practice; Patient Outcomes = Learner does for a few; Community Outcomes = Learner does for many Skills (Competency) Performance Patient Outcomes Community Outcomes What type of activity do you think will best achieve the goal? * Live (virtual webinar or in-person) Enduring (recorded or reading activity) Both live and enduring Part Live, Part Enduring (learner completes enduring components before attending live) In what month/year will this activity take place? We require a minimum of 4 months' advanced notice for all educational presentations to be presented by a physician. Leave this field blank
