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Healthcare professionals for compensated interview
Pre-Screener
We are conducting compensated interviews with healthcare professionals. These will be a 60 minute teleweb interviews for those who qualify and participate. Please take the pre-screener to be considered:
*
1.
Please let us know how we may reach you
(Required.)
Name
Company
City/Town
Country
Email Address
Phone Number
2.
SQ01. Are you or an immediate family member currently employed by or under contract with any of the following?
Regulatory agency
A marketing or market research company
An advertising agency
A pharmaceutical company or medical device manufacturer
None of the above
3.
SQ02. Which of the following best describes your role at your facility/organization?
Chief Nursing Officer
Chief Executive Officer/General Manager – Hospital
Chief Operation Officer/Director of Operations
Chief Financial Officer – Hospital/Executive Director Finance
Chief Medical Officer – Hospital/Medical Director
Chief Information Officer [C-SUITE]
Chief Risk Officer/Director Quality & Safety
Chief Technical Officer/Director IT
Director Clinical Services/Clinical Governance
Director of Nursing
Nurse Manager
Nurse Supervisor
Staff Nurse
Director of Pharmacy
Pharmacy Manager
Medication Safety Team
Other (please specify)
4.
SQ03. Which of the following best describes the facility/organization at which you spend the majority of your professional time?
Public Hospital that is a teaching hospital
Public Hospital that is not a teaching hospital
Private For-Profit Hospital
Private Not-For-Profit Hospital
Private Day Clinic
Cancer Specialty Hospital
Pediatric Specialty Hospital
Outpatient Infusion Center/Clinic
TGA Licensed Third Party Compounder
Other (Please specify) ___________
Other (please specify)
5.
SQ04. Approximately how many beds are in your hospital?
(Please select one)
<50 beds
50-99 beds
100-199 beds
200-299 beds
300-399 beds
400-499 beds
500-999 beds
1000 beds or more
6.
SQ05. How many years of overall experience do you have in your current role?
7.
How many years in total have you been in practice
8.
Which best describes your role in purchasing medication management software solutions in your hospital?
I make decisions regarding the evaluation and purchase of medication management software solutions
I do not make the decisions alone, but I am a member of a committee dedicated to or have a direct role in evaluating and making decisions regarding medication management software solutions
I do not have a direct role in the process, but I do provide input to the people/committee who evaluate and make decisions regarding medication management software solutions
I am not involved in the evaluation and purchase and do not provide input into evaluations or decisions regarding medication management software solutions
9.
SQ07. Please indicate which of the following brands of infusion pumps are currently used at your hospital.
(Please select one)
[Randomize options except Other and None of the above]
BD Alaris Infusion Pump
B.Braun Space Infusion Pump
Hospira Plum A+ Infusion Pump
Fresenius Agilia Infusion Pump
CME BodyGaurd Infusion Pump
None of the above
Unsure
Other (please specify)
10.
SQ07b. Do you currently use Dose Error Reduction Software (DERS) for infusion pumps?sometimes also known as a Drug Library Software or a Medication Safety Software.
Yes
No
11.
How often do you use Dose Error Reduction Software is sometimes also known as a Drug Library Software or a Medication Safety Software.
Don’t have the software
Not at all
Annually
Monthly
Weekly
Daily
12.
SQ08. Please indicate which of the following brands of automated dispensing cabinets/systems (ADC/ADM) are currently used at your hospital.
Think only about ADC/ADM’s and not about any other product the below manufacturers might be providing.
(Please select one)
Pyxis MedStation (From CareFusion - now part of Becton Dickinson - BD)
OmniRx (From Omnicell)
Swisslog
None of the above – We do not currently use an ADC/ADM at our hospital but plan to adopt one in the next two years
None of the above – We do not use an ADC/ADM at our hospital and do not plan to adopt one in the next two years
Other (please specify)
13.
SQ09. Please indicate which of the following is being used as your central pharmacy inventory management system
AutoPharm (From Talyst)
WorkflowRx (From Omnicell)
I-Pharmacy (From DXC Technology)
Swisslog Inventory Management Software
I use the inventory management capabilities that come with my EMR /EHR
I use the inventory management capabilities that come with my Automated Dispensing Cabinet
We manage inventory manually
Other (please specify)
14.
SQ10. Please indicate which of the following brands of Electronic Medical/Health Records (EMR/EHR) is currently used at your hospital.
Allscripts (sunrise)
Meditech
Cerner (Millenium)
clinical works
epic
Telstra Health
Intersystems
EMH/EHR developed in house by my hospital
don't know/unsure
15.
SQ12. In which state or territory do you work?
NSW
ACT
VIC
TAS
QLD
WA
SA
NT
NZ - North Island
NZ - South Island
16.
If approved and scheduled for this study please let us know the easiest fastest way to reach you
Email
Whatsapp
Other (please specify)
17.
Please let us know if you agree with the following confidentiality agreement
Confidentiality I understand that I am being asked to participate in a market research study and that my participation is voluntary. I understand that I will be presented with information during the research which may or may not be factual or true and that I may be asked to accept certain representations or make certain assumptions about new products or new labeling to answer various questions for the market research study. I understand that such representations have been made for research purposes and no other purposes, and that information about any FDA-approved product should be obtained from the product prescribing information.I acknowledge that I may receive information during the market research study which is confidential information belonging to the study sponsor. I agree that I will not disclose or use this confidential information, nor discuss with any party, any of the information with which I have been provided or been made aware in connection with my participation in this market research study. The term of this non-disclosure will continue until such time, if ever, the information becomes publicly available.understand that I will be expected to provide honest feedback during the survey. I acknowledge and agree that the market research agency and the study sponsor will have access to my feedback for purposes related to the study objective. I understand that the market research agency and the study sponsor will not disclose any confidential information I provide.
I Agree
I Disagree
Current Progress,
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