Scribd Logo
Upload

Welcome to Scribd!

  • Model of Care Survey Form

    Uploaded by

    Earl Kristoffer Pirante
    17 views1 page
    Survey Form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Survey Form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    17 views1 page

    Model of Care Survey Form

    Uploaded by

    Earl Kristoffer Pirante
    Survey Form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    NAME:

    DATE:

    Duration of Is this a Patient Handover was given to:


    Shift Handover in Fresh Case? Allocation? Same Nurse/
    Minutes Y/N Single/Double New Nurse


    1. Are you satisfied with the way we currently do our patient handovers?
    □Strongly Agree □Agree □Neutral □Disagree □Strongly Disagree
    2. Do you think our current handover process flow provide you with sufficient data?
    □Strongly Agree □Agree □Neutral □Disagree □Strongly Disagree
    3. Is it clear from this handover what your responsibilities are?
    □Strongly Agree □Agree □Neutral □Disagree □Strongly Disagree
    4. What are the usual challenges/interruptions that you face during handover?
    _______________________________________________________________________________
    _______________________________________________________________________________
    5. What are the commonly missed items during handover? (Charting, Patient Info)
    _______________________________________________________________________________
    _______________________________________________________________________________
    6. Do you have any suggestions to improve our handover?
    _______________________________________________________________________________
    _______________________________________________________________________________
    7. If we are to go with paper less endorsement, what data would you like to be included in the M-
    Page for you to be able to have an effective handover?
    _______________________________________________________________________________
    _______________________________________________________________________________


    NAME: DATE:

    Duration of Is this a Patient Handover was given to:


    Shift Handover in Fresh Case? Allocation? Same Nurse/
    Minutes Y/N Single/Double New Nurse


    1. Are you satisfied with the way we currently do our patient handovers?
    □Strongly Agree □Agree □Neutral □Disagree □Strongly Disagree
    2. Do you think our current handover process flow provide you with sufficient data?
    □Strongly Agree □Agree □Neutral □Disagree □Strongly Disagree
    3. Is it clear from this handover what your responsibilities are?
    □Strongly Agree □Agree □Neutral □Disagree □Strongly Disagree
    4. What are the usual challenges/interruptions that you face during handover?
    _______________________________________________________________________________
    _______________________________________________________________________________
    5. What are the commonly missed items during handover? (Charting, Patient Info)
    _______________________________________________________________________________
    _______________________________________________________________________________
    6. Do you have any suggestions to improve our handover?
    _______________________________________________________________________________
    _______________________________________________________________________________
    7. If we are to go with paper less endorsement, what data would you like to be included in the M-
    Page for you to be able to have an effective handover?
    _______________________________________________________________________________
    _______________________________________________________________________________

    You might also like