Maternal Emergency Drill: Code Blue Survey

	Excellent	Above Average	Average	Below Average	Poor
List five causes for maternal loss of consciousness.	List five causes for maternal loss of consciousness. Excellent	List five causes for maternal loss of consciousness. Above Average	List five causes for maternal loss of consciousness. Average	List five causes for maternal loss of consciousness. Below Average	List five causes for maternal loss of consciousness. Poor
Explain how to safely get a patient out of the tub in an emergent situation.	Explain how to safely get a patient out of the tub in an emergent situation. Excellent	Explain how to safely get a patient out of the tub in an emergent situation. Above Average	Explain how to safely get a patient out of the tub in an emergent situation. Average	Explain how to safely get a patient out of the tub in an emergent situation. Below Average	Explain how to safely get a patient out of the tub in an emergent situation. Poor
Give examples of interventions for Airway, Breathing and Circulation.	Give examples of interventions for Airway, Breathing and Circulation. Excellent	Give examples of interventions for Airway, Breathing and Circulation. Above Average	Give examples of interventions for Airway, Breathing and Circulation. Average	Give examples of interventions for Airway, Breathing and Circulation. Below Average	Give examples of interventions for Airway, Breathing and Circulation. Poor
Describe how one can provide clarification and simplification with potential maternal codes.	Describe how one can provide clarification and simplification with potential maternal codes. Excellent	Describe how one can provide clarification and simplification with potential maternal codes. Above Average	Describe how one can provide clarification and simplification with potential maternal codes. Average	Describe how one can provide clarification and simplification with potential maternal codes. Below Average	Describe how one can provide clarification and simplification with potential maternal codes. Poor

Excellent

Above Average

Average

Below Average

Poor

List five causes for maternal loss of consciousness.

List five causes for maternal loss of consciousness. Excellent

List five causes for maternal loss of consciousness. Above Average

List five causes for maternal loss of consciousness. Average

List five causes for maternal loss of consciousness. Below Average

List five causes for maternal loss of consciousness. Poor

Explain how to safely get a patient out of the tub in an emergent situation.

Explain how to safely get a patient out of the tub in an emergent situation. Excellent

Explain how to safely get a patient out of the tub in an emergent situation. Above Average

Explain how to safely get a patient out of the tub in an emergent situation. Average

Explain how to safely get a patient out of the tub in an emergent situation. Below Average

Explain how to safely get a patient out of the tub in an emergent situation. Poor

Give examples of interventions for Airway, Breathing and Circulation.

Give examples of interventions for Airway, Breathing and Circulation. Excellent

Give examples of interventions for Airway, Breathing and Circulation. Above Average

Give examples of interventions for Airway, Breathing and Circulation. Average

Give examples of interventions for Airway, Breathing and Circulation. Below Average

Give examples of interventions for Airway, Breathing and Circulation. Poor

Describe how one can provide clarification and simplification with potential maternal codes.

Describe how one can provide clarification and simplification with potential maternal codes. Excellent

Describe how one can provide clarification and simplification with potential maternal codes. Above Average

Describe how one can provide clarification and simplification with potential maternal codes. Average

Describe how one can provide clarification and simplification with potential maternal codes. Below Average

Describe how one can provide clarification and simplification with potential maternal codes. Poor

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* 2. Rate the teaching effectiveness of the presenter: Shari Stone-Ulrich, MSN, CNM

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* 3. Rate the effectiveness of the teaching methods used.

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* 4. Rate the organization of the program material.

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Excellent

Above Average

Average

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Poor

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* 5. Rate the session overall.

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Excellent

Above Average

Average

Below Average

Poor

Maternal Emergency Drill: Code Blue

EVALUATION FORM

Question Title

* 1. Rate the degree to which you were able to achieve the learning objectives.

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* 2. Rate the teaching effectiveness of the presenter: Shari Stone-Ulrich, MSN, CNM

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* 3. Rate the effectiveness of the teaching methods used.

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* 4. Rate the organization of the program material.

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* 5. Rate the session overall.

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* 6. What part of the program provided the most useful information?

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* 7. What additional information would have been helpful?

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* 8. Additional comments.