MNA Ebola Preparedness Survey Question Title * 1. What facility do you work in? Local Unit #1 - Community Hospital of Anaconda Local Unit #2 - Billings Clinic Local Unit #4 - Bozeman Deaconess Hospital Local Unit #5 - St. James Healthcare Inc. Local Unit #7 - Montana State Hospital - Warm Springs Local Unit #8- Dept of Health/Human Services - Helena Local Unit #11 - Cascade City/County Health - Great Falls Local Unit #12 - Northern Montana Hospital - Havre Local Unit #13 - St. Peter's Hospital - Helena Local Unit #15 - Community Medical Center - Missoula Local Unit # 16- Big Sky Surgery Center- Missoula Local Unit #17 - St. Patrick's Hospital - Missoula Local Unit #21 - Glendive Medical Center Local Unit #22 - St. John's Hospital - Libby Local Unit #24 - Sweet Medical Center - Chinook Local Unit #25 - Northern Rockies Medical Center - Cut Bank Local Unit #26 - MSU Student Health - Bozeman Local Unit #27 - MT Veterans Home - Columbia Falls Local Unit #32 - Partners In Home Care - Missoula Local Unit #33 - Fresenius Medical Care - Missoula Local Unit #34 - Clark Fork Valley Hospital - Plains Local Unit #35 - Marcus Daly Memorial Hospital - Hamilton Local Unit #36 - MT Chemical Dependency Clinic - Butte Local Unit #37 - Butte/Silver Bow City County Health Local Unit #38 - Rosebud Health Care Center, Clinic and Nursing Home - Forsyth Local Unit #39 - Sidney Health Center , Clinic & ECF Local Unit #43 - Missoula City/County Health Dept Local Unit #44 - Holy Rosary Hospita, Clinic and ECU - Miles City Question Title * 2. What kind of unit do you work in? Emergency Department Pre-operative Care OR PACU Critical Care Rehabilitation Radiology Endoscopy Dialysis Medical Floor Surgical Floor TCU Cardiac Floor Observation/ Short Stay Unit I/P OB Unit I/P Cancer Care Float Nurse Peds Unit NICU O/P infusion O/P Cancer care O/P Adult Clinic O/P Peds Clinic Other (please specify) Question Title * 3. Does your facility have a plan for a potential Ebola patient? Yes No I do not know Question Title * 4. Do you feel prepared about caring for a patient with Ebola? Very prepared Prepared Not very prepared Not prepared Question Title * 5. Has your facility met with nurses to discuss their response plan in the event of an Ebola patient presenting for care? Yes No (go to question 8) Do not know (go to question 8) Question Title * 6. If yes, what type of plan is in place? Adding questions to intake forms/questions Setting up separate screening areas for potentially infected patients Appropriate PPE is immediately available to staff Training staff on current infection control practices Training staff on current recommended practice of PPE Educating staff on signs/symptoms and management of Ebola Posting CDC checklist for evaluating Ebola patients in your unit Other (please specify) Question Title * 7. If your facility is conducting training, has it included ancillary staff like nursing assistants, phlebotomists, respiratory therapists, housekeepers etc? Yes No Do not know Question Title * 8. What type of training or education has occurred in your facility, if any? None Written materials provided Webinar Video In- Service In-Service with return demonstration Review of PPE procedures Do not know Other (please specify) Question Title * 9. Have you personally received training regarding Ebola? Yes No Question Title * 10. Are you aware of what the signs/symptoms of Ebola are? Yes No Question Title * 11. Please provide any additional comments or recommendations you may have. Question Title * 12. Your response to this survey is confidential. If you choose to provide your contact information (including email and cell#) , we will be able to follow up with you if appropriate. Done