2015 ACNP Award for Quality Use of Medicines in Pain Management Have you made a difference to people with persistent pain through the quality use of medicines? We want to hear from you! The award recipient will receive a one year membership, and registration, travel and accommodation to attend ACNP 2015 Conference in Melbourne! In collaboration with Mundipharma Pty Ltd, ACNP will be recognising a Nurse Practitioner/Advanced Practice Nurse who is working effectively with patients/consumers with moderate or severe pain to optimise their health and wellbeing in the quality use of medicines. Please identify the strategies you have implemented which have made a difference (or been effective), and how these were measured in each patient, to contribute to achieving better outcomes . Nominations for the award can be made by anyone interested in QUM and Pain Management. Application form is overleaf or to download an application form please visit: http://acnp.org.au/scholarships Any enquiries please call Amal Helou (02) 9515 9739. This award has been supported by an educational grant from Mundipharma Pty Ltd 2015 ACNP Award for Quality Use of Medicines in Pain Management APPLICATION FORM Please complete and return this form by 6 July 2015 to: Jenny Pierson Secretariat, ACNP PO Box 637, North Sydney NSW 2059 Email: [email protected] Fax: 02 9954 0666 This award is to recognise a Nurse Practitioner/Advanced Practice Nurse who is working effectively with patients/consumers with moderate or severe pain to optimise their health and wellbeing in the quality use of medicines. Please identify the strategies you have implemented which have made a difference (or been effective), and how these were measured in each patient. Any enquiries please call Amal Helou (02) 9515 9739. The award recipient will receive a one year membership of the ACNP, registration, travel and accommodation to attend the 2015 ACNP Conference in Melbourne. ACNP will use the information in this application form to determine the award recipient and will handle all material in accordance with ACNP policy. The ACNP Award for QUM in Pain Management has been supported by an educational grant from Mundipharma Pty Ltd. APPLICANT DETAILS Date of application Applicant name Postal address Workplace name Email Phone Submission should be completed under the following headings: Title of project • An introduction or background explanation of the evaluated activity • An aim to indicate what was being measured • How the evaluation was undertaken (clearly defined methods) • Who was evaluated (program, clients, service) • What tools were used? Were they validated tools? How were they validated? • Results which must reflect the aim • A conclusion or recommendation that is related to the aim and the results The total submission should not exceed 2 A4 pages. Typed in Arial 11point with a 2cm margin all around. The winner will be required to submit an article for the ACNP newsletter and the prize will be presented at the ACNP Annual conference. DECLARATION I declare that, to the best of my knowledge, the information contained within my application is a true reflection of my practice. Signature: Date:
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