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Older Adults at Risk for Opioid-Induced Respiratory Depression 

Program Evaluation

Please take a few moments to answer the following questions, which will be used to assist us in meeting your educational needs. Your feedback will be kept private and confidential and only aggregate data will be shared. On behalf of the RI Geriatric Education Center, we thank you!
1.What was the purpose for your participation in this activity?(Required.)
2.What is your primary professional discipline? (Required.)
3.Please list all professional license/certificate/degree(s) you hold:(Required.)
PROGRAM SATISFACTION:
4.How satisfied with the activity were you overall?(Required.)
EVALUATION OF TRAINING:
Please use the scale below to rate the efficacy of the learning objectives, the presenters, and the instructional format:
        1=Totally ineffective    2=Somewhat ineffective     3=Somewhat effective    4=Effective    5=Highly effective
5.How effective was the activity in meeting the stated learning objectives?   
     Upon completion of this activity, participants will be able to:
(Required.)
1
Not at all Effective
2
3
4
5
Highly Effective
Identify older adults at risk of an opioid-involved breathing emergency.
Describe barriers that exist to accessing naloxone, buprenorphine and/or methadone in the community and long-term care settings.
Implement strategies to reduce harm from opioid dependence, withdrawal, and use of unregulated substances.
6.Rate the effectiveness of the presenter. 
 Consider presentation style, knowledge of subject, quality of material, and practical applicability or relevance of topic in your assessment. (Required.)
1
Not At All Effective
2
3
4
5
Highly Effective
Anita N Jacobson, PharmD
7.Rate the effectiveness of teaching strategies:(Required.)
1
Not At All Effective
2
3
4
5
Highly Effective
Teaching strategies:
8.What was the most significant thing(s) you learned as a result of participating in this activity?(Required.)
9.In your work with older adults, do you intent to implement at least one practice improvement learned as a result of this activity?(Required.)
RETROSPECTIVE ASSESSMENT:
10.Please indicate your perceived level of knowledge for each items listed below 1.) BEFORE completing the activity, and 2.) AFTER completing the activity. Rating Scale: 0% to 100% (no knowledge at all ... to most knowledge possible)
BEFORE
AFTER
Older adults at risk of an opioid-involved breathing emergency.
Barriers that exist to accessing naloxone, buprenorphine and/or methadone in the community and long-term care settings.
Strategies to reduce harm from opioid dependence, withdrawal, and use of unregulated substances.
11.Please indicate your perceived level of confidence to apply each of the items listed below 1.) BEFORE completing this activity and 2.) AFTER completing the activity. Rating Scale: 0% to 100% (no confidence at all... to most confidence possible)
BEFORE
AFTER
Identify older adults at risk of an opioid-involved breathing emergency.
Describe barriers that exist to accessing naloxone, buprenorphine and/or methadone in the community and long-term care settings.
Implement strategies to reduce harm from opioid dependence, withdrawal, and use of unregulated substances.
12.Please feel free to share any additional comments and suggestions for improvement. Your feedback is extremely valuable to us. 
13.What topics or issues related to older adult care would you like us to address in future programs?
14.Please indicate your preferred completion certificate:
15.Please complete the information below so we may send your certificate:
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