Antimicrobial Drug Shortages: Examples of Patient Harm

 
The name of the study is: "Antimicrobial Drug Shortages: Examples of Patient Harm". The person in charge of the study is Marc Scheetz, PharmD, MSc. If you agree to participate, you will be asked to complete a survey. The survey should take approximately 5-10 minutes to complete. Your participation in this survey will help to better describe patient harm secondary to antimicrobial drug shortages. You will not be individually identified in the results of this survey, but we will ask for the name of your hospital. The name of your hospital will only be used to de-duplicate responses. De-identified information about instances of patient harm at your hospital secondary to antimicrobial drug shortages will be collected. All data elements garnered during the study will be held strictly confidential. Confidentiality will be maintained by the study authors.

Risks: There is the potential risk of a loss of confidentiality. In order to protect you confidentiality data will be stored on a password-protected site. Data used for analysis will be de-identified, and no participant names will be recorded or retained.

Benefits: Participating in this ongoing study will allow better quantification of patient harm secondary to antimicrobial drug shortages.

Confidentiality: This survey is being hosted by SurveyMonkey and involves a secure connection. Their Privacy Policy, addressing confidentiality, may be viewed at http://www.surveymonkey.com/privacypolicy.aspx. The results of the research study may be published, but your name or the name of your institution will not be used.

Subjects’ Rights: Your participation in this survey is voluntary and completion/return of the survey will constitute formal agreement to participate in the research. You may remove yourself from the study at any time, and you may request in the future that your data not be included in analyses. Your choice not to be in this study will not negatively affect any rights to which you are otherwise entitled. The Institutional Review Board (IRB) at Midwestern University has approved this study as exempt. If you have any concerns about your rights as a participant in this study, you may contact Dr. Marc Scheetz via email (mscheetz@nmh.org) or by telephone (630) 515-6116.
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1. I have read this consent form and understand the research. I have been told whom to contact if I have more questions. I agree to be in the research study described above. I understand that I may stop the survey at any time and request that my data not be included in any analyses without any penalty.
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