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Harms to Patients Survey
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Harms to Patients Survey
Harms to Patients Survey
Christina
2019-02-04T20:53:44+00:00
Harms to Patients Survey
Unit or Service
*
Internal Medicine
Surgery
Pediatrics
OB / GYN
ICU
Other
Other Unit
*
Provider Type of Survey Respondent
*
Nurse
Advanced Nurse Practitioner
Third Choice
Resident Physician
Physician Fellow
Other
Other Provider Type
*
Over the past 7 days, how often did you receive a problematic handoff? (e.g., information that was clinically important was not given to you, or you received inaccurate information)
*
Never (0 times)
Rarely (1 or 2 times)
Sometimes (between 3 and 5 times)
Often (more than 5 times)
Please keep these definitions in mind when answering the next set of questions
Minor Harm-
Limited clinical consequence—such as a need for more frequent monitoring or transient discomfort, without prolongation of hospitalization, significant organ dysfunction or worsening of clinical condition.
Major Harm-
Significant clinical consequences such as deterioration in clinical status, organ dysfunction, prolonged hospitalization, disability beyond discharge, or death.
Harms to Patients
*
0
1
2
3
4
>4
Over the past 7 days, please estimate the number of your patients who experienced a MINOR harm as a result of a problematic handoff.
Over the past 7 days, please estimate the number of your patients who experienced a MAJOR harm as a result of a problematic handoff.
Over the past 7 days, how many days did you work?
0
1
2
3
4
5
6
7