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 * Female Male 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. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree When the ward is busy I forget to make a report. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree I am worried about litigation. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree I don’t know whose responsibility it is to make the report. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree My colleagues may be unsupportive. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree I do not want the case discussed in meetings. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree I do not know which incidents should be reported. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree The circumstances/outcome of the case make reporting unnecessary. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree As long as the staff involved learn from incidents it is unnecessary to discuss them further. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree Adverse incident reporting makes little contribution to the quality of care. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree Junior staff are often unfairly blamed for adverse incidents. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree 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. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree I am more comfortable disclosing errors to a patient /family. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree I will report incidents in the future because of this program. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree I will be a champion for patient safety in my career going forward. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree I will consider the safety record and/or culture of the hospital, clinic, or health care organization I choose for my practice. * SELECT ANSWER 5- Strongly Agree 4- Agree 3- Neither Agree or Disagree 2- Disagree 1- Strongly Disagree