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ISMP Medication Safety Alert


Medication Safety Contest Honorable Mention
Survey to solicit information about the culture of reporting
Raleigh General Hospital in Beckley, WV

Medication Error Perception Survey (Employee)

Please mark a response for each of the following questions:

1. If you discovered a missed medication, would you complete an incident report for a medication error?
Yes     No

2. For what reasons would you NOT complete an Incident Report on a Medication Error that you or another co-worker has discovered?

_____ Takes too long to fill out the form.
_____ I am scared that someone would get even with me.
_____ Incident reports will just get me or someone else into trouble.
_____ No one cares if the Incident Report is filled out.
_____ Not applicable, I always fill out an Incident Report

3. If you made an error, would you expect someone else to report it?
Yes     No

4. Would you report an error you made? Yes     No

5. Do you feel Medication Error Incident Reporting is kept confidential? Yes     No

6. Do you know what happens with an Incident Report on a Medication Error?

  ______ Nothing
  ______ Used for Process Changes
  ______ Punitive Outcomes
  ______ Entertainment
  ______ Filed for future use
  Other Please Specify):____________________

7. Do you feel that completing an Incident Reporting is for your own protection?
Yes     No

8. How can we improve Incident Reporting?

9. Which of the following scenarios would you complete an Incident Report on?

  ______ An IV or Medication has infiltrated
  ______ A medication was given 2 hours after the time it was due.
  ______ The patient went down for an Xray and their Antibiotic was not given.
  ______ Order sheet was stamped wrong, resulting in the patient getting a medication that was not ordered for them.
  _______ A respiratory treatment was missed.
  _______ A patient developed a rash because of an antibiotic.
  _______ Medication is dropped on the floor and new meds requested from Pharmacy.

10. Do you know when you have been involved with a Medication Error ?

_______ Medication is dropped on the floor and new meds requested from Pharmacy. _____ Frequently (50-94%)
_____ Sometimes (10-49%) _____ Never (0-9%)
_____ Not applicable, I don't commit any medication errors.

11. Have you ever been involved in a medication error? Yes     No

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