ELLIS MEDICAL LIBRARY
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JIT Coach Survey
*
Indicates required field
Coach Name
*
B. Bird
E. Hart
D. Liebers
P. Sweet
Was this observed during rounds
*
Yes
No
What was the role of the health care professional you observed?
*
RN = Nurse
NA = Nursing Assistant
MD = Doctor
RT = Respiratory Therapy
PT = Physical Therapy
Diet = Dietary Technician
Lab = Lab Technician
HSK = House Keeping
CM/SW = Case Mgmt/Social Worker
Pharm = Pharmacist
Rad = Radiology Tech
Other
If other please specify their role:
*
Was it an entry or an exit?
*
Entry
Exit
Did the person wash?
*
Yes
No
Possible contributing factors to not washing
*
Dispenser Location
Dispenser Empty
Dispenser Broken
Equipment Shared
Hands Full of Supplies
Hands Full of Meds
Improper Use of Gloves
Follow Person Entry or Exit
Frequent Entry or Exit
Admissions or Discharges Process
Lack of Immediate Feedback
Distracted or Forgot
Perception that HH is not Required
Perception of Skin Irritation
Other
If other please specify:
*
Comments:
*
Submit
Home
EBP
EBPModel
Practice Question
Searching for Evidence
Translating
Apply
Disseminate
Services
Article Requests
Literature Searches
Table of Contents Emails
Technology Lending
Training
Resources
ASL
BestPractices
Catalog
Databases
E-Books
End of Life Resources
Journals
JournalClub
Current Nursing Journals
Phone Apps
Technology Tutorials
CE Resources for Nurses
About
News
Librarian's Hours
Contact