Bereavement Survey

We are very sorry for your recent loss and would like to offer our condolences at this difficult time. We appreciate that having been recently bereaved, this must be a very difficult time for you and your family but would be very grateful for any feedback which you can provide us about the care you and your relative or friend received leading up to and at the time of their death. This is very important to us as the feedback will help us to improve the care for future patients, their relatives and friends. We would be grateful if you could complete the questions below - you can do this anonymously if you prefer. If you would prefer to talk to someone, you can telephone Lizzy Zabrocki, Nurse Specialist for End of Life Care on 0191 29016 or 0191 2138304. Alternatively you could contact the Patient Advice and Liaison Service (PALS) on 0800 032 02 02

Please tick the box next to the relevant answer to each of the following questions:

Q.1

Hospital site your relative or friend died:

Royal Victoria Infirmary (RVI)
Freeman

Q.2

Which ward were they a patient on?

Q.3

What date did your relative or friend die? Do not worry if you can't recall the exact date

Month (MM)
/

Day (DD)
/

Year (YYYY)

Q.4

Did you feel involved in your relative or friend's care as much as you wanted to be?

Yes
No
Not sure/Can't remember

Comments:

Q.5

Did you feel that you had the opportunity to ask staff any questions you had?

Yes
No
Not sure / Can't remember

Comments:

Q.6

If you did have questions, do you feel that your questions were answered fully?

Yes
No
Not sure / Can't remember

Comments:

Q.7

Did your relative or friend have a conversations about where they would prefer to die during their last admission to hospital?

Yes
No
Not sure / Can't remember

Comments:

Q.8

If yes, where was this?

Hospital
Home
Hospice
Other:

Q.9

Did your relative or friend die where they wished to?

Yes
No
Don't know

Comments:

Q.10

Are you satisfied that your relative or friend received medications for any symptoms in a timely way in their last hours/days of life?

Very satisfied
Satisfied
Not satisfied
Not sure /Can't remember

Comments:

Q.11

Are you satisfied that your relative or friend was supported to drink or receive fluids if they wished in their last hours/days of life?

Very satisfied
Satisfied
Not satisfied
Not sure/Can't remember

Comments:

Q.12

Did your relative or friend have their religious/spiritual needs met?

Yes
No
Not sure/Can't remember
Not applicable

Comments:

Q.13

Overall, how would you rate the staff on the following points of care:

	Excellent	Good	Average	Poor	Very poor
Communication
Emotional support
Respect and dignity
Management of symptoms

Communication

Excellent Good Average Poor Very poor

Emotional support

Excellent Good Average Poor Very poor

Respect and dignity

Excellent Good Average Poor Very poor

Management of symptoms

Excellent Good Average Poor Very poor

Q.14

Were you given appropriate information on what to do following the death of your relative or friend?

Yes
No
Not sure/Can't remember

Comments:

Q.15

Can you think of anything that we could have done to improve your relative or friend's care?

Q.16

If you would like to be contacted about this survey or have any further feedback to provide, please provide your name and contact details below.

Thank you very much for taking the time to complete this survey. We value all feedback and will use this to improve our services where possible.