Ebola Preparedness Survey

Attention ALL Michigan RNs - whether you work in a hospital or other setting, such as home health, whether you are in a union or not - please fill out this survey to help us gauge how employers are doing in preparing you to safely deal with Ebola!

Question Title

* 1. Contact information:

Name:

ZIP:

Email Address:

Phone Number:

Question Title

* 2. Hospital and facility information:

Hospital/facility:

Unit:

Question Title

* 3. Shift:

Question Title

* 4. Are you an MNA member?

Yes

Question Title

* 5. Has your hospital/facility communicated to you any policies regarding potential admission of patients with Ebola?

Yes

Don't know

Question Title

* 6. Which of the following policies have been communicated?

Safety measures for treating suspected patients?

Instructions on proper donning and doffing technique of personal protective equipment?

Question Title

* 7. Does your hospital/facility adjust/reduce the number of patients assigned to you to reflect the additional workload and safety considerations when you are caring for an “isolation” patient?

Yes

Sometimes

Rarely

Don’t know/not applicable

Question Title

* 8. Does your hospital/facility currently have a sufficient quantities of basic personal protection equipment and supplies on hand for current daily use on your unit? Check all that apply.

	Sufficient	Insufficient
Gloves	Gloves Sufficient	Gloves Insufficient
Double Gloves	Double Gloves Sufficient	Double Gloves Insufficient
Latex Free Exam Gloves	Latex Free Exam Gloves Sufficient	Latex Free Exam Gloves Insufficient
Sterile Surgical Gloves	Sterile Surgical Gloves Sufficient	Sterile Surgical Gloves Insufficient
Eye protection (Face shields with side shield or goggles)	Eye protection (Face shields with side shield or goggles) Sufficient	Eye protection (Face shields with side shield or goggles) Insufficient
Fluid resistant/Impermeable Isolation Gowns	Fluid resistant/Impermeable Isolation Gowns Sufficient	Fluid resistant/Impermeable Isolation Gowns Insufficient
Basic Surgical Masks	Basic Surgical Masks Sufficient	Basic Surgical Masks Insufficient
N 95 particulate filtering respirator masks	N 95 particulate filtering respirator masks Sufficient	N 95 particulate filtering respirator masks Insufficient

Share additional information if you wish:

Question Title

* 9. Do you have haz mat suits in your facility?

Yes

If so, have you been trained in the protocol for donning and doffing them?

Question Title

* 10. Does your hospital/facility have a policy in place that requires you to re-use “single use” items during your shift, such as N-95 masks, surgical mask w/face shield, and/or gowns during the course of your shift? (For example, remove mask after being in patient room, place it in a paper bag and hang outside patient room for reuse upon next entry into room?)

Yes

Question Title

* 11. How many isolation rooms (with a private – not shared -- bathroom and anteroom) are prepared?

Question Title

* 12. Are there plans to equip isolation rooms with plastic covered mattresses and pillows, and to discard all linens after use?

Yes

Don't know

Question Title

* 13. Has your hospital educated you about using the buddy system to put on personal protective equipment and how to dispose of contaminated materials?

Yes

Don't know/not applicable

Question Title

* 14. Has your hospital/facility provided education on Ebola with an opportunity to interact and ask questions?

Yes

Don't know/not applicable

Question Title

* 15. Is there any other information that you would like to share?

Question Title

* 16. Sharing these comments with the media is very powerful, can we contact you about that?

Yes