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Infusion Solutions Patient Satisfaction Survey
1.
The home infusion equipment:
Yes
No
I did not use equipment.
Was clean when it was delivered.
Yes
No
I did not use equipment.
Worked properly.
Yes
No
I did not use equipment.
Comments:
2.
The home infusion medications and supplies arrived before I needed them.
Always
Very Often
Sometimes
Rarely
Never
Not Applicable
Comments:
3.
I knew who to call if I needed help with my home infusion therapy.
Yes
No
Comments:
4.
The response I received to phone calls for help on weekends or during evening hours met my needs.
Always
Very Often
Sometimes
Rarely
Never
Not Applicable
Comments:
5.
The home infusion nurse or pharmacist informed me of the possible side effects of the medication.
Yes
No
Comments:
6.
I understood the explanation of my financial responsibilities for home infusion therapy.
Yes
No
Comments:
7.
How often was each staff courteous?
Always
Very often
Sometimes
Rarely
Never
N/A
Nursing staff:
Always
Very often
Sometimes
Rarely
Never
N/A
Pharmacy Staff:
Always
Very often
Sometimes
Rarely
Never
N/A
Billing staff:
Always
Very often
Sometimes
Rarely
Never
N/A
Delivery staff:
Always
Very often
Sometimes
Rarely
Never
N/A
Comments:
8.
How often was each staff helpful?
Always
Very often
Sometimes
Rarely
Never
N/A
Nursing staff:
Always
Very often
Sometimes
Rarely
Never
N/A
Pharmacy staff:
Always
Very often
Sometimes
Rarely
Never
N/A
Billing staff:
Always
Very often
Sometimes
Rarely
Never
N/A
Delivery staff:
Always
Very often
Sometimes
Rarely
Never
N/A
Comments:
9.
I understood instructions provided for:
Yes
No
N/A
How to wash my hands
Yes
No
N/A
How to give home infusion medications
Yes
No
N/A
How to care for IV catheter
Yes
No
N/A
How to store home infusion medications
Yes
No
N/A
How to use home infusion equipment
Yes
No
N/A
Comments:
10.
Satisfaction:
Strongly Agree
Agree
Uncertain
Disagree
Strongly Disagree
I was satisfied with the overall quality of services provided.
Strongly Agree
Agree
Uncertain
Disagree
Strongly Disagree
I would recommend Infusion Solutions to my family and friends.
Strongly Agree
Agree
Uncertain
Disagree
Strongly Disagree
Comments: