Form #6 Form #6 Learning Outcomes Survey

Attachment G

Learning Outcomes Survey

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Enhancing Safety for Patients with

Limited English Proficiency

Learning Outcomes Survey

For each of the following questions, please circle the letter next to the one best answer.

1. A 22-year-old male patient, Alejandro, arrives at the Emergency Department (ED) by ambulance in a coma, accompanied by several family members. The family members speak Spanish and Alejandro’s mother, Juanita, speaks some English. The ED triage nurse, Jim, says he will call an interpreter, but Juanita says, “No, I speak English”. Jim should:

1. Drop the issue so as not to further offend the patient’s mother

2. Drop the issue, but make a note in the record that an interpreter may be needed later

3. Ask the patient’s mother to sign a waiver

4. Acknowledge that her English is quite good, but say it’s the hospital’s policy to call an interpreter to avoid misunderstandings.

2. What does the acronym “CUS” stand for in the TeamSTEPPS patient safety system?

   1. Create Understanding and Safety

   2. Concerned, Unify, Standardize

   3. Correct, Undo, Study

   4. Concerned, Uncomfortable, Safety

3. Maria, age 20, is scheduling a knee surgery appointment for her mother Rigoberta, a 54-year-old Guatemalan patient who does not speak English. The receptionist, Carolyn, knows that one of the nurses, Betty, speaks Spanish. When she schedules Rigoberta’s appointment, Carolyn should:

   1. Make sure Betty is scheduled to do Rigoberta’s intake assessment

   2. Schedule a Spanish-speaking interpreter for Rigoberta’s appointment

   3. Ask Maria what language her mother speaks best

   4. Ask Maria to come to the appointment with her mother so she can interpret

4. Through the interpreter, Nurse Arroyo tells the patient, Mr. Chin: "take this medication once every 12 hours, with food", the patient looks confused; the interpreter should:

a. Say to the nurse, "Let me check back with you. This medicine is to be taken after eating twice a day, once in the morning and once at night, is that correct?" and interpreter the nurse’s response.

b. Say to the patient, "Mr. Chin, let check back with you. Do you understand how to take your medicine?" and interpret his response to Nurse Arroyo.

c. Say to the patient, “Mr. Chin, let me check back with you. That means you should take the medicine after eating twice a day, once in the morning and once in the evening after eating.”

d. Say to the nurse, "Let me check back with you. Do you think Mr. Chin understood how to take his medicine?”

5. Nurse Angelis is preparing to discharge Mr. Lo, a 65-year-old Hmong patient who was hospitalized for asthma. She explains to Mr. Lo how to use a single-dose dry powder inhaler at home. The interpreter, Mr. Khang, interprets Nurse Angelis’s instructions. The patient nods. Nurse Angelis states that Mr. Lo is ready to be discharged. Mr. Khang worries that Mr. Lo may not have fully understood Nurse Angelis’s instructions. Mr. Khang’s responsibility is to…

   1. Interpret the nurse’s and patient’s words to one another without adding or subtracting anything

   2. Interrupt the conversation to state his concern

   3. Report the incident to his supervisor

   4. Follow Mr. Lo out of the room and offer to provide a more detailed explanation

Public reporting burden for this collection of information is estimated to average 10 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Answer key:

1 D; 2 C; 3 C; 4 A; 5 B