MEADERS Follow-up Survey

Attachment 2 – MEADERS Follow-up Survey [DRAFT]

1) Please enter your Practice ID Number:

2) Please indicate your role in the practice:

□	MD, DO
□	NP, PA
□	RN, LPN, MA, Lab Tech
□	Pharmacist
□	Front office staff
□	Medical records staff
□	Billing/administrative staff
□	Other (please specify)

3) How many patients do you personally see during a typical week?

□	<25
□	25-50
□	51-75
□	76-100
□	101-125
□	>125

4) In the past six months, have you ever reported any event using MEADERS?

Yes

□

No

□

5) On a scale of 1 through 5, how well do you understand which events you should report?

(Select the number that most closely matches your level of understanding)

Not at All	Somewhat			Completely
1	2	3	4	5

6) How much difficulty did you have in accessing the MEADERS electronic reporting form and submitting a report?

□	No difficulty
□	A little difficulty
□	Moderate Difficulty
□	A great deal of difficulty
□	I was unable to access the reporting system due to technical difficulties

7) Did you receive any training in the use of MEADERS?

Yes

□

No

□

8) How effective was that training in preparing you for using MEADERS?

Not effective	Somewhat effective			Very effective
1	2	3	4	5

Do you have any suggestions for what should be included in future training?

9) Please evaluate MEADERS by checking the circle that most closely matches your experience in filing reports.

		Strongly Disagree	Disagree	Neither disagree orAagreet	Agree	Strongly Agree
		1	2	3	4	5
It is easy to use
It takes too much time to submit a report
It allows me to be candid when reporting errors
It has increased my own awareness of how errors affect patient care
It has helped me to improve patient care at my practice
It has not worked in this practice
It is viewed positively by this practice
It encourages me to learn from my mistakes and the mistakes of others
It has led to changes in how we practice medicine
It has increased the fear of repercussion in the practice
It made me feel like I was informing on my co-workers
It protected my anonymity when I was filing reports
Other (Specify)

10) Were there any specific errors or types of medication errors or adverse events that you did not feel comfortable reporting?

Yes

□

No

□

Please describe what prevented you from reporting an error or adverse drug event to MEADERS.

11) Please tell us of any additional concerns that you may have with the reporting system.

Did you have any concerns about…

		Yes	No
The privacy of your reports		□	□
The time it took to complete a report		□	□
The layout or format of the reporting system		□	□
The type of questions asked		□	□
Others in your practice finding out you had made a report		□	□
Knowing what should be reported		□	□
Knowing how to correctly make a report		□	□
How your practice might react to your making a report		□	□
Other (please specify)		□	□

Please express any other concerns that you may have had with regard to MEADERS.

12) Were there events that you reported in MEADERS that you elected not to forward to the FDA MedWatch database?

Yes

□

No

□

Proceed to Question 14

Did you elect not to forward to the FDA MedWatch a report of an adverse drug event that could not have been prevented(an observed event apparently related to the drug rather than human error)?

Yes

□

No

□

Proceed to Question 13

What were the reasons you elected not to forward your adverse drug event report to the FDA MedWatch system? (Please check all that apply)

□	Unclear on the procedure for reporting to MedWatch
□	Uncomfortable about the possibility that the FDA could contact me about the report I filed
□	Concerned about repercussions of reporting to MedWatch
□	Did not see any benefit to myself or my practice by reporting an error or adverse event to MedWatch
□	Worried about provider confidentiality (mine and/or others)
□	Worried about patient confidentiality
□	Other (please specify)

13) Did you elect not to forward to MedWatch a report of a medication error?

Yes

□

No

□

Proceed to Question 14

What were the reasons you elected not to forward your medication error report to the FDA MedWatch system? (Please check all that apply)

□	Unclear on the procedure for reporting to MedWatch
□	Uncomfortable about the possibility that the FDA could contact me about the report I filed
□	Concerned about repercussions of reporting to MedWatch
□	Did not see any benefit to myself or my practice by reporting an error or adverse event to MedWatch
□	Worried about provider confidentiality (mine and/or others)
□	Worried about patient confidentiality
□	Other (please specify)

14) What would it take for you to have used MEADERS more frequently?

		Very Unlikely	Unlikely	No difference	Likely	Very likely	N/A
		1	2	3	4	5
If more errors occurred
A better understanding of what should be reported
Less time required to file a report
Better feedback from system
A change in the attitudes of my practice towards reporting
Greater awareness of the system’s benefits
More time or opportunity to access the system
More assurance of the system’s confidentiality
Other (Specify)

15) How useful were the practice-level summaries generated by MEADERS in instituting changes in your practice to improve patient safety?

Not Useful	Somewhat Useful			Very Useful
1	2	3	4	5

Are there ways we can increase the usefulness of the summaries?

16) What other concerns do you have about the system that we haven’t asked you about?

17) What one thing would you change to improve the system?

18) What else would you like to tell us about your experience with the MEADERS?

19) Has your participation in this study affected you personally?

Yes

□

No

□

How has your use of this system affected you?

PLEASE TELL US A LITTLE ABOUT YOURSELF

What is your gender?

Male

□

Female

□

In what year were you born?

Are you of Hispanic/Latino origin?

□ Yes

□ No

What is your race?

Please check all that apply.
□	American Indian or Alaskan Native
□	Asian
□	Black or African American
□	Pacific Islander/Native Hawaiian
□	White