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NPSF - Patient Safety Curriculum
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How would you like your name to appear on your certificate?



Agreement
By completing this form, you attest that you have attended the activity in its entirety.
Objective 1: Name three key principles associated with the discipline of patient safety
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Objective 2: Describe two measurement techniques and methods used to evaluate the effectiveness of patient safety efforts
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Objective 3: List the processes required for effectively reporting, investigating, and analyzing patient safety incidents
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Please answer the following MOC questions:
Are you a physician taking this course to satisfy Maintenance of Certification (MOC) requirements? 
How did you discover this MOC activity? 
If you answered 'Other' to the above question, please explain how:
This MOC Activity is releveant to my current practice. 
If 'Yes' explain how. If 'No' explain why not:
Completion of this MOC activity will improve my care processes or clinical outcomes associated with this educational activity.
If 'Yes' explain how. If 'No' explain why not:
I will recommend this MOC Activity to one of my peers. 
If 'No' explain why not:
Only Florida licensees need to answer this question.  Notice to Florida Licensees:  In order for us to report your hours to CE Broker, you MUST provide us with your Florida alpha-numeric license number (e.g., PY1234, SS123, MH1234, MT1234).  Please be sure you enter this number accurately, or CE Broker will not record your hours.
PHARMACISTS AND PHARMACY TECHNICIANS ONLY -- Please provide the following:
NABP eProfile ID (ePID):
Date of Birth (MM/DD) - Example September 24 would be 0924:
Please rate the following:
How well did the educational sessions give a balanced view of therapeutic options, including the use of generic names?
Comments:
Quality of presentations
Comments:
Please assess your perception of increased knowledge of patient safety as a result of this curriculum. 
Please answer the following:
Was the educational content scientifically sound?
If you answered 'No' to the above question, please explain:
Did you perceive any product/service/company/commercial bias in any educational session you attended or materials you received?
If you answered "Yes" to the above question, please detail the situation below (e.g. session title, speaker name):
Were you solicited by sales personnel in an educational room (other areas do not matter) while you attended this educational activity?
If you answered 'Yes' to the above question, please explain in detail (e.g. who, when, where):
What questions have arisen in your practice for which you need answers/strategies that you can implement?
List the changes you will make to your practice after completing this curriculum. 
What did you like MOST about this curriculum?
What did you like LEAST about this curriculum?
Would you recommend this curriculum as a resource to others? 
How could this curriculum be improved to better impact competence, performance and/or patient/client outcomes?
Suggestions for future educational offerings: What are your needs or the needs of your peers?
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