

 |
| |
|
|
|
SAMPLE SELF-SURVEY INTERVIEW
QUESTIONS |
|
Administrator/ Medical Director |
|
IG Tag ID # |
Topic |
Question |
|
245 |
Adverse Events |
If a patient experiences adverse
reactions potentially related to the water system, what actions will
be taken and by whom? |
|
468 |
Discharge and Transfer |
How are patients informed of the
situations under which a patient can be transferred, discharged, or
when dialysis could be discontinued? |
|
640 |
Transfer Requests |
How does the facility determine whether
it will accept a patient requesting transfer into the facility? |
|
|
|
Dialysis Patient |
|
IG Tag ID # |
Topic |
Question |
|
404 |
Temperature/Comfort |
If you let the staff know that you are
feeling cold, what do they do for you? |
|
407 |
Emergency Preparedness |
If there is an area-wide disaster-
- How would you know if the unit was open or not?
- If you couldn't get in, what would you do?
- How could you find out if what dialysis units near you were open and
available? |
|
465 |
Patient Rights |
If you have a complaint, who do you go to
with it? |
|
|
Patient Care Staff |
|
IG Tag ID # |
Topic |
Question |
|
245 |
Adverse Events |
What symptoms would indicate that a
patient might be having a potential pyrogenic reaction?
What actions would you take? |
|
464 |
Patient Rights |
If a patient complains about another
staff member or any other issue or concern, what do you do? |
|
465 |
Patient Rights |
If a patient wants to file a grievance
with the Network or state survey agency, how do they do that? |
|
Click here for more information about
workbook pricing
|
|