Patient Safety Education Program for Residents Brookdale Final Post Assessment

If you are human, leave this field blank.

Participant Demographics

First Name *

Last Name *

Email Address *

Gender *

Age *

Position (Resident, Faculty, Nurse, Pharmacist, etc.) *

Hospital *

Years of Experience/Resident Year *

Program/Specialty *

Please rate the following statements on a 5 point scale:

5 - Strongly agree
4 - Agree
3 - Neither agree nor disagree
2 - Disagree
1- Strongly disagree

I MAY NOT BE WILLING TO REPORT AN ADVERSE EVENT BECAUSE:

I am worried about disciplinary action. *

When the ward is busy I forget to make a report. *

I am worried about litigation. *

I don’t know whose responsibility it is to make the report. *

My colleagues may be unsupportive. *

I do not want the case discussed in meetings. *

I do not know which incidents should be reported. *

The circumstances/outcome of the case make reporting unnecessary. *

As long as the staff involved learn from incidents it is unnecessary to discuss them further. *

Adverse incident reporting makes little contribution to the quality of care. *

Junior staff are often unfairly blamed for adverse incidents. *

Please give any other reason(s) for not reporting incidents: *

How have your perceptions about reporting adverse incidents, near misses, or unsafe conditions changed (or not changed) since being a part of the patient safety education program? *

Overall, the Patient Safety Education Program is valuable. *

I am more comfortable disclosing errors to a patient /family. *

I will report incidents in the future because of this program. *

I will be a champion for patient safety in my career going forward. *

I will consider the safety record and/or culture of the hospital, clinic, or health care organization I choose for my practice. *