RDN protocol worksheet

Survey Protocol Worksheet

Date: Thursday, March 10^th 2017 Survey Name: Nutrition Clinic Satisfaction Survey

Survey Sponsoring Organization: CSU Survey Coordinator: Jenna Carlson, MS, RDN, LD

Purpose of Survey	To measure and increase patient/customer satisfaction with the registered dietitian nutritionists (RDN)
Survey Questionnaire	P:\Division of Public Health\CCN\Customer Survey Data\Nutrition survey data
How will you choose to whom you will offer the survey?	All of the RDN’s patients will be selected for interview each day. All patients will receive a survey 1x/month. If the patient is seen more than 1x/month, they will only complete the survey one time. All patients are asked to complete the survey at the end of a RDN visit. If the patient is under 13 years old, the parent/caretaker will assist the patient or complete the survey for the patient.
How often will the survey be done?	Every day except the specific primary clinic survey day.
How and by whom will the survey be administered?	After the visit, the RDN will ask the patient if they would like to complete a survey, after explaining how they were chosen and what the survey is for. The RDN will then leave the room until the patient/customer has completed the survey.
Data Flow from Start to Finish	Respondent collection box in the IM or FP patient rooms  RDN, Jenna Carlson will picks up surveys weekly  and enter the data into  survey monkey paper surveys are kept in a filing folder in RDN Office desk  Monthly informatics report is sent to RDN Supervisor, Celena Robinson and saved in the CCN folder under Customer Survey Data  Nutrition survey data this report is included on the annual report and shared as needed  Jan of each new year all paper surveys will be shredded.
How confidentiality will be assured?	There are no patient names, medical record or DOB on the surveys. The patient is encouraged to put their survey in a collection folders.
How will the number of people offered and responding to the survey be recorded?	RDN’s will submit surveys that were filled out and declined by patients. The RDN’s will write decline on the back of the survey or the reason for not offering survey.
What steps are taken to assure quality data?	Survey coordinator, RDN, Jenna Carlson will monitor the contact and response rates. The scale on the survey will be explained to each customer/patient.
Data Analysis	Data analysis is completed through Survey Monkey.
Who will receive the reports and how often?	Monthly informatics report is sent to RDN Supervisor, Celena Robinson and the other RDN’s

RDN Survey Protocol Worksheet 02/2017