PQI Audit Template
PLEASE READ: IMPORTANT INFORMATION:
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This template contains the information required regarding your PQI participation.
Your entries must match the entries in myABR. Screen shots of myABR will not be accepted.
It is not necessary to have a completed PQI project for audit compliance; project details need only be provided to
match the current progress in myABR for 2013 and 2014.
 If you have not started a project, please select one; provide just the title and enter the title into myABR.
 PQI project done as a group must be updated as with an individual project
 If you participate in a group PQI, please provide documentation of your “meaningful participation” in that project
using the format below.
 Please comply with your institutional HIPAA policies. Do NOT submit any documentation with Protected Health
Information (PHI). Documents in violation of HIPAA will be deleted and the audit status will be non-compliant
until corrected.
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1) Project Title:
2) Project Start Date:
3) Project Baseline Data: (What is being measured)
4) Project Root Cause Analysis: (What caused the problem)
5) Improvement Action Plan Creation and Implementation: (What will fix this and how was that done)
6) Project Re-Measure: (How does it compare now)
7) Project End Date: (If applicable)
8) Project Completion Summary: (Complete a brief project summary if you like)
NOTE: RADPEER™ Participants
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If you are in the process, but have not completed a RADPEER project, you must submit at least the following:
 RADPEER welcome letter
 RADPEER individual or group report
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If you completed a RADPEER project you must submit the following:
 RADPEER completion letter
 Improvement plan (description of additional education, specialty item, etc.)