Take 2 Use this form below to submit a nursing process or practice that needs to be reviewed that could improve safety and patient outcomes. Take Two Submission Form Employee Name: (optional) First Last Employee Workday ID: (optional) Employee Email: (optional) Unit/Area/Clinic:(Required) Supervisor/CS:(Required) CS (Clinical Specialist): Current Process/Practice(Required)Briefly describe the current process/practice that you want reviewed.Concerns about current process/practice:(Required)What are your concerns about the current process/practice?Impact:(Required)Do you have an example of the impact of this process/practice? (patient or nurse story)Department(s) Involved:(Required)What department(s) will be involved with this change? (Informatics, Pharmacy, Supply Chain, EVS, Agility, Interpreting Services, etc.)Policy # Affected:Please enter the policy number and name pertaining to the suggested Take Two suggestion. If you need help finding the policy, please talk with your CS or your CSM. PhoneThis field is for validation purposes and should be left unchanged.
