Medication Safety Contest Honorable Mention

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

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?

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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