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Medication Safety Contest Winner
Survey to solicit information about the culture of reporting
Allina Hospitals and Clinics

Hospital (circle one) ANW Mercy PEI United Unity
Department/Unit __________________________
Occupation (circle one) Nurse Physician Pharmacist Other ___________
Please rate the following: (circle one number on each line) Strongly Agree Agree Disagree Strongly Disagree Not Applicable
1) Senior managers at my hospital communicate to me that patient safety is a high priority 1 2 3 4 NA
2) My department/unit acts on reported information related to medical errors (near miss, incident, sentinel event) to improve patient safety 1 2 3 4 NA
3) Individuals are supported for reporting medical errors 1 2 3 4 NA
4) My department/unit places blame on individuals when an error is reported. 1 2 3 4 NA
5) I fear there will be negative consequences associated with reporting medical errors 1 2 3 4 NA
6) My workload interferes with my ability to practice patient safety 1 2 3 4 NA
7) I feel comfortable reporting medical errors made by co-workers 1 2 3 4 NA
8) The medication protocols in my hospital are too complex 1 2 3 4 NA
9) The process of reporting errors at my hospital is cumbersome 1 2 3 4 NA
10) I believe that a medical error is the result of a failure of a complex system 1 2 3 4 NA
11) New technologies, such as electronic medical records or Pyxis, are creating a safer environment for patients in my hospital 1 2 3 4 NA
12) New technologies available in my hospital are fully utilized to help prevent medical errors 1 2 3 4 NA
13) I work in an environment where I can openly communicate my opinions about patient care practices 1 2 3 4 NA
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