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  2. 2016
  3. July
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  5. ICU Pharmacy Services
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Exit Survey
 
 
We are writing to request your participation in a survey on critical care clinical pharmacy services. Completion of this survey will take 5-10 minutes. This survey is part of a research project being carried out by Nova Southeastern University’s College of Pharmacy. The survey aims to assess the scope and type of clinical pharmacy services provided in Intensive Care Units in Puerto Rico. The data collected from this survey will be used to describe pharmacy services currently provided and identify areas of need.
Participation in this study is voluntary and confidential. Your answers will not be linked to your name, email address, or any other way in which to trace your identity. If you do not wish to take part in this study, please disregard this message.
If you have questions about your rights as a research subject, please feel free to call Nova Southeastern University’s Human Research Oversight Board (954) 262-5369.
If you have questions regarding this research study you may contact one of the investigators below. Your participation is greatly appreciated.
I have read this email and I fully understand its contents and voluntarily consent to participate.  All of my questions concerning this research have been answered.  If I have any questions in the future about this study they will be answered by the investigator listed below or his/her staff. 
 
I understand that the completion of this questionnaire implies my consent to participate in this study.
 
Principal Investigador                                                 Co-Investigador
Yarelis Alvarado, Pharm.D., BCPS                               Georgina Silva, PhD
Professional Offices Park IV                                        Professional Offices Park IV
997 San Roberto Street                                               997 San Roberto Street
San Juan, PR 00926                                                     San Juan, PR 00926               
787-773-6576                                                           787-773-6556
[email protected]                                                    [email protected]
 
 
Practice Site Information: This information is needed to compare different institutions and to know the resources available to pharmacists.

Select the type of hospital that best describes your institution:
 
Private not for profit
 
Private for profit
 
Academic
 
Local government
 
Federal Government
 
 
Practice Site Information: This information is needed to compare different institutions and to know the resources available to pharmacists.

Select the number of beds available at your hospital:
 
Less than 100 beds
 
100-200 beds
 
201-300 beds
 
301-400 beds
 
More than 400 beds
 
 
Practice Site Information: This information is needed to compare different institutions and to know the resources available to pharmacists.

Select the total number of intensive care units at your hospital (i.e. adult, neonatal = 2)
 
1
 
2
 
3
 
4
 
5 or more
 
 
 
Indicate the total number of ICU beds in your hospital:
   
 
 
 
Select the type of ICU available at your hospital (select all that apply)
 
Medical
 
Surgical
 
Cardio
 
Trauma
 
Neurosurgical
 
Respiratory
 
Neonatal
 
Pediatric
 
Burn
 
Transplant
 
Other

 
 
 
Select the type of physician coverage in your ICUs:
 
Closed ICU: patients managed by intensivist
 
Open ICU: patients managed by internal medicine physicians
 
Mixed ICU: intensivist available only by consultation
 
 
 
Select the patient record system used at your hospital:
 
Electronic health record only
 
Paper record only
 
Mixed paper and electronic record
 
 
 
Select the pharmacy systems available at your hospital (select all that apply)
 
Computer prescription order entry (CPOE)
 
Laboratory system interface with pharmacy program (labs popup when verifying prescription orders)
 
Pharmacy system alerts: allergy/interactions/doses
 
Bar Code Medication Administration (eMAR)
 
Pharmacy intervention documentation system

 
 
 
Select the pharmacy setup that best describes your hospital:
 
Centralized
 
ICU Satellite Pharmacy