Sedation 301: Beyond Midazolam: Pre-Course Assessment
Please fill out the following questionnaire to help tailor the upcoming course to better suit your needs and ensure course pre-requisites are being met. You can save the form and come back to complete it later, however, meeting the pre-requisites is mandatory to be able to attend the course.
Dental Artistry, Newmarket, Auckland
0830 Hrs registration for 0900 Hrs start. Finish time 1700 Hrs
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Current NZSSD Member
*
Please Select
Yes
No
Plan to join
*New Zealand Society for Sedation in Dentistry
Have you completed the SST online training course (Safe sedation training - license available through membership to the NZSSD). if you have done your SST online module over 2 years ago, have you completed a SST refresh module (available through NZSSD membership)?
*
Yes
No
Other
Have you previously attended the NZSSD formal training course for Midazolam only sedation?
*
Yes
No
Other equivalent course. Please list.
I have a minimum of 2 staff members that are certified to monitor sedated patients (Completed the monitoring course or equivalent certified formal training).
*
Yes
No
No, but I will have this completed prior to the course
Other
How many years have you been practicing IV sedation?
*
2 years or less
2-5 years
5-10 years
Over 10 years
Previous experience in sedation (Please leave column blank if not applicable or no experience in a particular regime).
*
Rows
1-50 cases
50-100 cases
100-200 cases
Over 200 cases
Midazolam Only
1
2
3
4
Midazolam + Fentanyl
5
6
7
8
Nitrous oxide
9
10
11
12
GA experience
13
14
15
16
What is the average number of cases yo would expect to see in a week?
*
Rows
0-2 cases
2-5 cases
5-10 cases
11 or more cases
Weekly caseload
17
18
19
20
Regarding your current sedation technique and outcomes...
*
Rows
Stronly disagree
Disagree
Neutral
Agree
Strongly agree
I am satisfied with the results
21
22
23
24
25
I would like more stability for my cases
26
27
28
29
30
I am satisfied with my technique, but would like to learn more
31
32
33
34
35
I would like more predictability for my sedations
36
37
38
39
40
Regarding management of an adverse event during IV sedation, I am confident...
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Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
In managing adverse cardio respiratory outcomes
41
42
43
44
45
In airway management
46
47
48
49
50
My support staff is suitably trained
51
52
53
54
55
I have written checklists and guides for emergencies
56
57
58
59
60
I perform 6 monthly audits of my procedures
61
62
63
64
65
Please provide 2 case reports/notes from recent sedation cases. These should be in PDF or JPEG formats. Please also redact patient names and contact details so that these are anonymous (unless formally consented to be shared by the patients).
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Why did you choose this course?
*
I need the sedation specific CPD
Interested in this topic
I would like to advance my sedation skills
Other
Were there any specific issues you were facing with Midazolam sedation that you would like discussed on the course? Any other queries?
Please verify that you are human
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