Adverse Event Disclosure 2024 Survey

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* 1. Please indicate the date of the session you attended (not the date you are completing this survey)

Date / Time

Date

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* 2. A 25 year old patient underwent a cholecystectomy complicated by an injury to the bile duct. An additional surgery is needed to repair. Is this an event that requires disclosure?

No, this is a known complication of a cholecystectomy.

Yes, this should be disclosed to the patient as soon as possible.

Yes, but wait to disclose until after the repair surgery.

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* 3. When should the disclosure be made?

As soon as possible after the event is identified

Once a thorough investigation is completed

Disclose after the repair surgery

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* 4. Who should take the lead in disclosing the event to the patient/family?

Attending MD or another involved MD

Primary nurse

Risk representative

All of the above

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* 5. What are the elements that need to be included in a disclosure?

Date and time of disclosure

Name, title, and relationship of all staff and family present

Content of disclosure, including treatment, if any, to mitigate harm

Any future plan of care related to the adverse event or unanticipated outcome

All of the above

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* 6. Please indicate how this activity meets and fulfills the mission of continuing professional education. Check all that apply.

Focuses on quality, patient safety, and better patient outcomes

Fosters teamwork, connections, and professional excellence

Improves the skills, strategies, and performance of the healthcare team

Supports the staff in fulfilling state licensing and other requirements

Embraces the future through the use of technology to share content throughout the system

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* 7. The educational activity was:

	Yes	No	N/A
Un-biased, free from commercial influence	Un-biased, free from commercial influence Yes	Un-biased, free from commercial influence No	Un-biased, free from commercial influence N/A
Balanced and evidence-based	Balanced and evidence-based Yes	Balanced and evidence-based No	Balanced and evidence-based N/A
Effective in changing provider skills, strategies, or performance	Effective in changing provider skills, strategies, or performance Yes	Effective in changing provider skills, strategies, or performance No	Effective in changing provider skills, strategies, or performance N/A
Has the potential to improve patient outcomes	Has the potential to improve patient outcomes Yes	Has the potential to improve patient outcomes No	Has the potential to improve patient outcomes N/A

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* 8. Faculty Rating (Please rate only those speakers for your session)

	Excellent	Very good	Average	Fair	Needs improvement
Astrid Wrightman (Nov. 9, 2023)	Astrid Wrightman (Nov. 9, 2023) Excellent	Astrid Wrightman (Nov. 9, 2023) Very good	Astrid Wrightman (Nov. 9, 2023) Average	Astrid Wrightman (Nov. 9, 2023) Fair	Astrid Wrightman (Nov. 9, 2023) Needs improvement
Lynn Hamilton (Nov. 9, 2023)	Lynn Hamilton (Nov. 9, 2023) Excellent	Lynn Hamilton (Nov. 9, 2023) Very good	Lynn Hamilton (Nov. 9, 2023) Average	Lynn Hamilton (Nov. 9, 2023) Fair	Lynn Hamilton (Nov. 9, 2023) Needs improvement
Amber Wright (Nov. 9, 2023)	Amber Wright (Nov. 9, 2023) Excellent	Amber Wright (Nov. 9, 2023) Very good	Amber Wright (Nov. 9, 2023) Average	Amber Wright (Nov. 9, 2023) Fair	Amber Wright (Nov. 9, 2023) Needs improvement
Becky Bailey RN	Becky Bailey RN Excellent	Becky Bailey RN Very good	Becky Bailey RN Average	Becky Bailey RN Fair	Becky Bailey RN Needs improvement
Lacey Byrd RN, MSN	Lacey Byrd RN, MSN Excellent	Lacey Byrd RN, MSN Very good	Lacey Byrd RN, MSN Average	Lacey Byrd RN, MSN Fair	Lacey Byrd RN, MSN Needs improvement
Christopher Edwards MD	Christopher Edwards MD Excellent	Christopher Edwards MD Very good	Christopher Edwards MD Average	Christopher Edwards MD Fair	Christopher Edwards MD Needs improvement
Deborah Moses, JD	Deborah Moses, JD Excellent	Deborah Moses, JD Very good	Deborah Moses, JD Average	Deborah Moses, JD Fair	Deborah Moses, JD Needs improvement
Allison Richardson, JD	Allison Richardson, JD Excellent	Allison Richardson, JD Very good	Allison Richardson, JD Average	Allison Richardson, JD Fair	Allison Richardson, JD Needs improvement
Matthew Smith, JD	Matthew Smith, JD Excellent	Matthew Smith, JD Very good	Matthew Smith, JD Average	Matthew Smith, JD Fair	Matthew Smith, JD Needs improvement
Palma Young, RN, EJD	Palma Young, RN, EJD Excellent	Palma Young, RN, EJD Very good	Palma Young, RN, EJD Average	Palma Young, RN, EJD Fair	Palma Young, RN, EJD Needs improvement
Other faculty not listed	Other faculty not listed Excellent	Other faculty not listed Very good	Other faculty not listed Average	Other faculty not listed Fair	Other faculty not listed Needs improvement

Other (please specify)

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* 9. Please rate the overall quality of this educational activity

Superior

Excellent

Very good

Average

Needs improvement

Superior

Excellent

Very good

Average

Needs improvement

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* 10. What was done well with this activity?

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* 11. What can we do to improve this activity?

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* 12. As a result of participating in this activity:

	Strongly agree	Agree	Neutral	Disagree	Strongly disagree	N/A
My communication skills with other members of the team have improved	My communication skills with other members of the team have improved Strongly agree	My communication skills with other members of the team have improved Agree	My communication skills with other members of the team have improved Neutral	My communication skills with other members of the team have improved Disagree	My communication skills with other members of the team have improved Strongly disagree	My communication skills with other members of the team have improved N/A
I have acquired new strategies and skills to improve patient outcomes	I have acquired new strategies and skills to improve patient outcomes Strongly agree	I have acquired new strategies and skills to improve patient outcomes Agree	I have acquired new strategies and skills to improve patient outcomes Neutral	I have acquired new strategies and skills to improve patient outcomes Disagree	I have acquired new strategies and skills to improve patient outcomes Strongly disagree	I have acquired new strategies and skills to improve patient outcomes N/A
I better understand my role and that of other members of the team	I better understand my role and that of other members of the team Strongly agree	I better understand my role and that of other members of the team Agree	I better understand my role and that of other members of the team Neutral	I better understand my role and that of other members of the team Disagree	I better understand my role and that of other members of the team Strongly disagree	I better understand my role and that of other members of the team N/A
I am better able to integrate a team approach to caring for our patients	I am better able to integrate a team approach to caring for our patients Strongly agree	I am better able to integrate a team approach to caring for our patients Agree	I am better able to integrate a team approach to caring for our patients Neutral	I am better able to integrate a team approach to caring for our patients Disagree	I am better able to integrate a team approach to caring for our patients Strongly disagree	I am better able to integrate a team approach to caring for our patients N/A
I feel confident in my ability to identify, communicate, and document the disclosure of adverse events	I feel confident in my ability to identify, communicate, and document the disclosure of adverse events Strongly agree	I feel confident in my ability to identify, communicate, and document the disclosure of adverse events Agree	I feel confident in my ability to identify, communicate, and document the disclosure of adverse events Neutral	I feel confident in my ability to identify, communicate, and document the disclosure of adverse events Disagree	I feel confident in my ability to identify, communicate, and document the disclosure of adverse events Strongly disagree	I feel confident in my ability to identify, communicate, and document the disclosure of adverse events N/A

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* 13. An example of what our team will change is:

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* 14. What is your primary affiliation?

Piedmont Athens Regional

Piedmont Atlanta

Piedmont Augusta

Piedmont Cartersville

Piedmont Clinic

Piedmont Columbus Regional

Piedmont Eastside

Piedmont Fayette

Piedmont Henry

Piedmont Macon

Piedmont Mountainside

Piedmont Newnan

Piedmont Newton

Piedmont Rockdale

Piedmont Walton

Physician Enterprise

Other Piedmont

Other (please specify)

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* 15. What is your profession?

APRN

Nurse

Pharmacist

Physician

Social Worker

Other (please specify)

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* 16. Your information

Legal Name *

NPI Number *

Professional Credentials *

Email Address *

Completion date