Avoiding Adverse Drug Events in Seniors:
A Workshop to Improve Prescribing at Hospital Discharge

Program Evaluation

We appreciate your participation in this continuing education activity. Your responses to our survey will allow us to improve our program offerings and services. Thank you for your time!

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* How would you rate this educational activity overall?

	Poor 1	2	3	4	Excellent 5
Overall Rating	Overall Rating Poor 1	Overall Rating 2	Overall Rating 3	Overall Rating 4	Overall Rating Excellent 5

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* Did you find that the activity was balanced, promoted improvements and/or quality in healthcare/public health, and was not unduly biased toward a specific commercial interest?

Yes

No

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* If no, please explain:

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* How will information that you received during this activity impact your practice behavior?
Please list 1-3 changed that you will make.

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* Besides time and/or money, what barriers do you anticipate encountering as you make changes in your practice?

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* How well were the overall learning objectives of this activity met?
After attending this activity, I feel that I am better able to:

	Strongly Disagree 1	2	3	4	Strongly Agree 5
Develop individual strategies and system improvements to enhance patient safety through safe prescribing practices	Develop individual strategies and system improvements to enhance patient safety through safe prescribing practices Strongly Disagree 1	Develop individual strategies and system improvements to enhance patient safety through safe prescribing practices 2	Develop individual strategies and system improvements to enhance patient safety through safe prescribing practices 3	Develop individual strategies and system improvements to enhance patient safety through safe prescribing practices 4	Develop individual strategies and system improvements to enhance patient safety through safe prescribing practices Strongly Agree 5
Identify errors and hazards in care by understanding best practices in prescribing to older adults (e.g. EQUIPPED: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department)	Identify errors and hazards in care by understanding best practices in prescribing to older adults (e.g. EQUIPPED: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) Strongly Disagree 1	Identify errors and hazards in care by understanding best practices in prescribing to older adults (e.g. EQUIPPED: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) 2	Identify errors and hazards in care by understanding best practices in prescribing to older adults (e.g. EQUIPPED: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) 3	Identify errors and hazards in care by understanding best practices in prescribing to older adults (e.g. EQUIPPED: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) 4	Identify errors and hazards in care by understanding best practices in prescribing to older adults (e.g. EQUIPPED: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) Strongly Agree 5
Acquire knowledge to avoid pitfalls in prescribing in commonly encountered clinical scenarios	Acquire knowledge to avoid pitfalls in prescribing in commonly encountered clinical scenarios Strongly Disagree 1	Acquire knowledge to avoid pitfalls in prescribing in commonly encountered clinical scenarios 2	Acquire knowledge to avoid pitfalls in prescribing in commonly encountered clinical scenarios 3	Acquire knowledge to avoid pitfalls in prescribing in commonly encountered clinical scenarios 4	Acquire knowledge to avoid pitfalls in prescribing in commonly encountered clinical scenarios Strongly Agree 5

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* How would you rate the presenters overall (knowledge, organization, effectiveness, etc)?

	Poor 1	2	3	4	Excellent 5
Dr. Elizabeth Goldberg	Dr. Elizabeth Goldberg Poor 1	Dr. Elizabeth Goldberg 2	Dr. Elizabeth Goldberg 3	Dr. Elizabeth Goldberg 4	Dr. Elizabeth Goldberg Excellent 5
Dr. Lynn McNicoll	Dr. Lynn McNicoll Poor 1	Dr. Lynn McNicoll 2	Dr. Lynn McNicoll 3	Dr. Lynn McNicoll 4	Dr. Lynn McNicoll Excellent 5
Dr. Camille Vaughan	Dr. Camille Vaughan Poor 1	Dr. Camille Vaughan 2	Dr. Camille Vaughan 3	Dr. Camille Vaughan 4	Dr. Camille Vaughan Excellent 5
Dr. Defilo- Draiby	Dr. Defilo- Draiby Poor 1	Dr. Defilo- Draiby 2	Dr. Defilo- Draiby 3	Dr. Defilo- Draiby 4	Dr. Defilo- Draiby Excellent 5

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* How much did you learn as result of this activity?

	Very Little 1	2	3	4	Great Deal 5
Select one:	Select one: Very Little 1	Select one: 2	Select one: 3	Select one: 4	Select one: Great Deal 5

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* Which of the following core competency areas do you feel have been improved as a result of this activity?
Check all that apply

Patient Care

Professionalism

Practice Based Learning

Medical Knowledge

System Base Practice

Communication Skills

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* What is the most important thing you learned by attending this activity and how will it affect you and your practice?

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* Please share any additional comments and suggestions. Your feedback is extremely valuable to us.

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* Please indicate what type of CE credit you are requesting:

Nursing

Social Work

Pharmacy

Certificate of Attendance

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* Please list your information below so we may send you a Certificate:

Name and Credentials

Company

State

Email Address