OSHA Program Manual for Medical Facilities
SAFETY NEEDLE/SYRINGE EVALUATION (1 of 2 Pages)
Name: ___________________________
Occupation/Title:____________________
Dept/Unit: _________________________
Today’s Date: _____________
Product Name/ # of times used: ___________________ Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.
Product/Performance Issues
Yes
No
N/A Don’t know
How important is this issue? (Circle one 1=very important)
1. Is the product/packaging easy to store?
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5
2. Is the package easy to open?
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5
3. Did the syringe function properly for its intended purpose?
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5
4. Is this product available in the size needed?
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5
5. Are the needles interchangeable?
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5
6. Is the device simple and self-evident to operate?
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5
7. Did you need extensive training to use this product effectively?
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5
8. Can the safety feature be activated with one hand?
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5
9. Is the device compatible with other devices it may have to connect to (or interact with)?
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5
10. Did the safety feature work reliably?
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5
11. Do both hands remain behind the needle during disarming?
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5
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18. Was dosage visibility adequate with this device?
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5
19. Do you have to expel remaining syringe contents prior to safety feature use?
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5
20. Do you think this device increases the risk of sprays?
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5
21. Was the exposed sharp blunted or covered once it was used?
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5
22. Did this product require compulsory use of the safety feature?
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5
12. Does the safety feature interfere with normal use of this product? 13. Does this product require more time to use than a non-safety product? 14. Does this product have an unmistakable indicator that the safety feature is activated? 15. Does this product cause more patient pain than usual? 16. Is this product equally satisfactory for different or diverse patient populations? 17. Are you confident that the dosage you drew was accurately delivered to the patient?
Form 10
OSHA Program Manual for Medical Facilities
(Safety Needle/Syringe Evaluation, page 2 of 2) What percentage of clinical procedures does this device address? _____ List the functions the device was not suitable for: ______________________________ _____________________________________________________________________ About how many times did you use this product before you were comfortable using it? ________ Did you have any needlesticks using this device?
yes no
If yes, describe: ________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Do you think this device will protect you from needlesticks? yes no If no, why: ____________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Based on your evaluation, which device would you rather use (check one):
The one we currently use This device Another device (specify alternative if known: ______________________________)
Are there any additional design features or other performance considerations you would like to see in a safety needle/syringe that have not been mentioned? Any additional comments you have? _____________________________________________________________________ _____________________________________________________________________
Form 10
OSHA Program Manual for Medical Facilities
PHLEBOTOMY DEVICE EVALUATION (1 of 2 Pages)
Name: _______________________________ Occupation/Title: _________________ Dept/Unit: _____________________________ Today’s Date: _____________ Product Name/ # of times used: _______________________ Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product.
Product/Performance Issues
Yes
No
N/A Don’t know
How important is this issue? (Circle one 1=very important)
1. The product/packaging is easy to store.
1
2
3
4
5
2. The package is easy to open.
1
2
3
4
5
3. The product can be used for both adults and children.
1
2
3
4
5
4. The device was satisfactory for patients with fragile veins.
1
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3
4
5
5. The device was satisfactory for heavy patients.
1
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5
6. Needles are available in appropriate sizes (length/gauge).
1
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5
7. The safety feature worked reliably.
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5
8. The safety feature did not interfere with the blood draw.
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9. The safety feature could not be bypassed.
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10. The safety device allowed me to see what I needed to see during the blood draw.
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11. This device did not create any extra risk of sprays, blood leakage, and/or drips.
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12. The device could be disposed of into the sharps container that is available for my use.
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13. The product was easy to use.
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14. Overall, the product was satisfactory for standard phlebotomy purposes.
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5
About how many times did you use this device? ___________________ About how many times did you use this device before you were comfortable using it? _________ What percentage of the time did you activate the safety mechanism? _____________
Form 11
OSHA Program Manual for Medical Facilities
(Phlebotomy Device Evaluation, page 2 of 2) Did you have any needlesticks using this device? yes no If yes, describe: _________________________________________________________ ______________________________________________________________________ Do you think this device will protect you from needlesticks? yes no If no, why: _____________________________________________________________ ______________________________________________________________________ Based on your evaluation, which device would you rather use (check one): The one we currently use This device Another device (specify alternative if known): ______________________________. Are there any additional design features or other performance considerations you would like to see in a phlebotomy product that have not been mentioned? Any additional comments you have? ______________________________________________________________________ ______________________________________________________________________
Adapted from Premiere Safety Institute. Gina Pugliese, Director. 700 Commerce Drive, Ste 100, Oakbrook, IL 60523. 630-891-4863
Form 11
OSHA Program Manual for Medical Facilities
GENERIC SAFETY DEVICE EVALUATION Date: ___________ Evaluator: _____________________________________________ Safety Product Evaluated: ___________________________ # of times used: ________
Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this particular product (1 = agree, 5 = disagree). 1.
I can activate the safety feature with one hand.
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5
N/A
2.
I can see the tip of the sharp when I need to (even when the safety feature is activated).
1
2
3
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5
N/A
3.
It is impossible NOT to use the safety feature.
1
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5
N/A
4.
This product can be used as quickly as I expected.
1
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3
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5
N/A
5.
The product is easy to handle while wearing gloves.
1
2
3
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5
N/A
6.
The device offers a good view of any aspirated fluid.
1
2
3
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5
N/A
7.
This product will work with all required syringe and needle sizes.
1
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5
N/A
8.
There is a distinct change (audible or visible) when safety feature is activated.
1
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5
N/A
9.
The safety feature operates reliably.
1
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5
N/A
10. The exposed sharp is permanently blunted or covered after use.
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5
N/A
11. The device is just as easy to process after use than our current product.
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5
N/A
12. This product is easy to learn and understand.
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5
N/A
13. The design of the product suggests proper use.
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5
N/A
14. It is almost impossible to skip a crucial step in proper use of the device.
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5
N/A
15. This device provides a better alternative to our current product.
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5
N/A
Comments/Concerns: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
Adapted from “Training for Development of Innovative Control Technology Project,” Trauma Foundation, San Francisco General Hospital, San Francisco, CA.
Form 12
