WMSD Activity File Documentation Checklist ANCC 2015 Criteria 1

Activity File Recordkeeping Checklist --2015 ANCC Criteria File Each item below must be documented in the activity file when using ANCC 2015 Criteria Page All activities created after July 1, 2016 must comply with ANCC 2015 Criteria Number  Activity Title and Location  Type of activity format: live, enduring or blended

 Date presented (live) and date first offered and expiration/review dates (enduring)

 Nurse Planner Name and Credentials:  Description of the professional practice gap (e.g. change in practice, problem in practice, opportunity for improvement.

 Evidence that validates the professional practice gap.

 Educational need that underlies the professional practice gap (e.g. knowledge, skills, and/or practices.

 Description of the target audience.

 Desired learning outcome(s).

 Description of evidence based content with supporting references or resources.

 Learner engagement strategies.

 Criteria for awarding contact hours.

 Description of evaluation method: Evidence that change in knowledge, skills, and/or practices of target audience was assessed.

 Assessment of content relevance to any Commercial Interest  Names and credentials of all individuals in a position to control content (must identify who fills the roles of Nurse Planner and content expert(s).

 Conflict of interest (COI) documentation for all individuals in a position to control content (e.g. planners, presenters, faculty, authors, and/or content reviewers) o Name of individual o Past 12 months o Spouse/significant other o Individual providing the information is provided a definition of a commercial interest organization  Evidence of a COI resolution process (if applicable).

 Number of contact hours awarded for activity, including method of calculation (Provider must keep a record of the number of contact hours earned by each participant). If the activity is

WMSD Activity File Documentation Checklist ANCC 2015 Criteria 1 longer than 3 hours, agenda was provided for entire activity.

 Documentation of completion and/or certificate. o Title and date of the educational activity o Name and address of the provider of the educational activity (web address is acceptable) o Number of contact hours awarded o Accreditation statement of provider awarding contact hours. o Participant name  Commercial supporters listed (if applicable). Commercial Support (CS) Agreement for each organization with signature and date (if applicable). o Name of the Commercial Interest Organization (CIO) o Name of the Provider o Complete description of all CS provided, including both financial and in-kind support o Statement that the CIO will not participate in Planning, developing, implementing or evaluating the educational activity o Statement that the CIO will not recruit learners from the educational activity for any purpose o Description of how CS must be used by the Provider (Unrestricted Use and/or Restricted Use) o Signature of a duly authorized representative of the CIO with authority to enter into binding contracts on behalf of the CIO o Signature of a duly authorized representative of the Provider with authority to enter into finding contracts on behalf of the Provider o Date on which the written agreement was signed  Joint Providership (if applicable). o Materials associated with the activity (marketing materials, advertising, agendas, and certificates of completion) must clearly indicate the Provider awarding contact hours and responsible for adherence to ANCC criteria  Documentation of Disclosures to Learner prior to start of activity: Activity files must include evidence of these required disclosures. Evidence may include such items as computer screen shots, slide from presentation materials, page from agenda book, marketing materials or similar that demonstrates how the required disclosure was provided to learners. 1. Accreditation (approval) statement of provider responsible for the educational activity. 2. Notice of requirements to receive contact hours:  Learners are informed of the criteria that will be used to award contact hours, which may include but are not limited to:  Actual time spent in the educational activity  Required attendance time at activity (e.g., 100% of activity, or miss no more than 10 minutes of activity)  Successful completion of post-test (e.g., attendee must score X% or higher)  Completed evaluation form, and/or Return demonstration. 3. Presence or absence of conflicts of interest for all individuals in a position to control content. And for individuals who have a relevant relationship, the following information must be provided to WMSD Activity File Documentation Checklist ANCC 2015 Criteria 2 learners:  Name of individual  Name of commercial interest  Nature of the relationship the individual has with the commercial interest.  If no relevant relationship exists, the provider must inform learners that no conflict of interest exists for any individual in a position to control the content of the educational activity. 4. Commercial Support: Learners must be informed if a commercial interest has provided financial or in-kind support for the educational activity. 5. Expiration of enduring materials: Educational activities provided through an enduring format (e.g., print, electronic, web-based) are required to include an expiration date documenting for how long contact hours will be awarded. 6. Joint providership: Learners are informed of the provider of the educational activity and all other organizations that participated in jointly planning the activity.  List of participant names and unique identifier (sample of data collected)

 Summative evaluation

WMSD Activity File Documentation Checklist ANCC 2015 Criteria 3