Identifying and Managing Older Adults at Risk for Opioid-Induced Respiratory Depression

Program Evaluation

We appreciate your participation in our continuing education activity. Your responses to this anonymous survey will allow us to improve our program offerings and services. Thank you for your time.

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* 1. What is your primary professional discipline?

Medicine

Rehab Therapy (PT/OT/SLP)

Nursing

Social Work

Pharmacy

Other

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* 2. Please list all professional license/certificate/degree(s) you hold:

EVALUATION OF TRAINING:
Please use the scale below to rate the efficacy of the learning objectives, the presenters, and the instructional format:
1 = Totally ineffective, wouldn't recommend
2 = Somewhat ineffective, at least one serious deficiency
3 = Somewhat effective, acceptable but not outstanding
4 = Effective, meets high standards, would recommend
5 = Highly effective, among the best

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* 3. Rate the relationship between activity content to stated learning objective:

	1	2	3	4	5
Describe validated tools and practice-based methods to assess the risk for opioid- induced respiratory depression.	Describe validated tools and practice-based methods to assess the risk for opioid- induced respiratory depression. 1	Describe validated tools and practice-based methods to assess the risk for opioid- induced respiratory depression. 2	Describe validated tools and practice-based methods to assess the risk for opioid- induced respiratory depression. 3	Describe validated tools and practice-based methods to assess the risk for opioid- induced respiratory depression. 4	Describe validated tools and practice-based methods to assess the risk for opioid- induced respiratory depression. 5
Describe strategies to overcome some of the barriers to naloxone co-prescribing in the primary care setting.	Describe strategies to overcome some of the barriers to naloxone co-prescribing in the primary care setting. 1	Describe strategies to overcome some of the barriers to naloxone co-prescribing in the primary care setting. 2	Describe strategies to overcome some of the barriers to naloxone co-prescribing in the primary care setting. 3	Describe strategies to overcome some of the barriers to naloxone co-prescribing in the primary care setting. 4	Describe strategies to overcome some of the barriers to naloxone co-prescribing in the primary care setting. 5
Summarize and demonstrate essential patient/caregiver overdose education elements including proper use of naloxone.	Summarize and demonstrate essential patient/caregiver overdose education elements including proper use of naloxone. 1	Summarize and demonstrate essential patient/caregiver overdose education elements including proper use of naloxone. 2	Summarize and demonstrate essential patient/caregiver overdose education elements including proper use of naloxone. 3	Summarize and demonstrate essential patient/caregiver overdose education elements including proper use of naloxone. 4	Summarize and demonstrate essential patient/caregiver overdose education elements including proper use of naloxone. 5

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* 4. Rate the effectiveness of the presenter(s)

	1	2	3	4	5
a. Presentation Style	a. Presentation Style 1	a. Presentation Style 2	a. Presentation Style 3	a. Presentation Style 4	a. Presentation Style 5
b. Knowledge of Subject	b. Knowledge of Subject 1	b. Knowledge of Subject 2	b. Knowledge of Subject 3	b. Knowledge of Subject 4	b. Knowledge of Subject 5
c. Quality of Material	c. Quality of Material 1	c. Quality of Material 2	c. Quality of Material 3	c. Quality of Material 4	c. Quality of Material 5
d. Practical applicability or relevance of topic	d. Practical applicability or relevance of topic 1	d. Practical applicability or relevance of topic 2	d. Practical applicability or relevance of topic 3	d. Practical applicability or relevance of topic 4	d. Practical applicability or relevance of topic 5

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* 5. Please rate the effectiveness of teaching strategies:

	1	2	3	4	5
Effectiveness of teaching strategies:	Effectiveness of teaching strategies: 1	Effectiveness of teaching strategies: 2	Effectiveness of teaching strategies: 3	Effectiveness of teaching strategies: 4	Effectiveness of teaching strategies: 5

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* 6. What was the most significant thing(s) you learned?

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* 7. In your work with older adults, do you intent to implement at least one practice improvement learned as a result of this activity?

Yes

N/A

If yes, please describe:

RETROSPECTIVE ASSESSMENT:
Use the following scale to rate your perceived level of confidence in the topics listed below BEFORE the training an AFTER the training. Scale: 1= not at all confident, 2= somewhat confident, 3= mostly confident 4= fully confident

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* 8. How confident were/are you in your ability to:

	Before	After
a. Describe validated tools and practice-based methods to assess the risk for opioid- induced respiratory depression.	a. Describe validated tools and practice-based methods to assess the risk for opioid- induced respiratory depression. Before menu	a. Describe validated tools and practice-based methods to assess the risk for opioid- induced respiratory depression. After menu
b. Describe strategies to overcome some of the barriers to naloxone co-prescribing in the primary care setting.	b. Describe strategies to overcome some of the barriers to naloxone co-prescribing in the primary care setting. Before menu	b. Describe strategies to overcome some of the barriers to naloxone co-prescribing in the primary care setting. After menu
c. Summarize and demonstrate essential patient/caregiver overdose education elements including proper use of naloxone.	c. Summarize and demonstrate essential patient/caregiver overdose education elements including proper use of naloxone. Before menu	c. Summarize and demonstrate essential patient/caregiver overdose education elements including proper use of naloxone. After menu

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* 9. Please feel free to share any additional comments and suggestions. Your feedback is extremely valuable to us.

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* 10. Please indicate what type of continuing education credit you are looking to obtain:

Nursing

Social Work

Pharmacy

Certificate of attendance

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* 11. If you would like a Certificate of Completion/ Continuing Ed please complete the information below:

Name and Title

Organization

State

Email Address