Skip to content
2017 AHRQ Patient Safety Culture Survey- Hospice
Section A: List of Patient Safety and Quality Issues
In your best estimate, how often did the following things happen in your agency OVER THE PAST 12 MONTHS?
1.
Please select your agency
(Required.)
Good Shepherd Home Health & Hospice
Hospice of Scotland Co.
Hospice of Union Co.
Hospice & Palliative Care of Cabarrus Co.
Roper St. Francis Hospice
Southeastern Hospice
2.
Select your primary location of work
(Required.)
Home Care
Inpatient
3.
A1: ACCESS TO CARE: A patient was unable to get admitted within 72 hours of hospital discharge or physician referral.
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Do Not Know
4.
A2: PATIENT IDENTIFICATION: The wrong chart/medical record was used for a patient.
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does Not Apply or Do Not Know
5.
A3: CHARTS/MEDICAL RECORDS: A patient's chart/medical record was not available when needed.
Daily
Weekly
Monthly
Several in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does not Apply or Do Not Know
6.
A4: CHARTS/MEDICAL RECORDS: Medical information was filed, scanned, or entered into the wrong patient's chart/medical record.
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does not Apply or Do Not Know
7.
A5: MEDICAL EQUIPMENT : Medical equipment was not available, working properly, or was in need of repair or replacement.
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does not Apply or Do Not Know
8.
A6: MEDICATION: I contacted a physician or pharmacy to clarify or correct a prescription.
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does not Apply or Do Not Know
9.
A7: MEDICATION: Medications needed were not available for administration as ordered.
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does not Apply or Do Not Know
10.
A8: MEDICATION: A patient's medication list was not updated during his or her visit by our staff.
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does not Apply or Do Not Know
11.
A9: DIAGNOSTICS & TESTS: The results from a lab or imaging test were not available when needed.
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does not Apply or Do Not Know
12.
A10: DIAGNOSTICS & TESTS: A critical abnormal result from a lab or imaging test was not followed up within 1 business day.
Daily
Weekly
Monthly
Several times in the past 12 months
Once or twice in the past 12 months
Not in the past 12 months
Does not Apply or Do Not Know