LeaFix Evaluation Form

Name*

Hospital Name*

Department

1) Would a multi-purpose tape, or a tie, normally be used to secure the airway?

Yes
No
Other

If other, please specify.

2) Was LeaFix a better alternative for airway securement?

Yes
No

If no, please give reasons.*

3) Did you use LeaFix for securing both ET tube and Supraglottic airways?

Yes
No
Other

If other securement product is used, please specify.

Usability

Please check the appropriate rating.

1) Applying LeaFix onto the patient’s face was straight forward.

Comments 1

2) The adhesive was gentle on patient’s skin.

Comments 2

3) LeaFix secured the airway satisfactorily for the duration of the procedure.

Comments 3

4) The disposal of the product after the procedure was easy and in line with current environmental policy.

Comment 4

5) Using LeaFix introduced a greater degree of consistent airway securement.

Comment 5

Guidance and Training

Please check the appropriate rating.

1) The training was delivered competently and provided adequate guidance on use.

Comment 6

User Opinion

Using the scale, please indicate your opinion about LeaFix before and after using the product.
Please use the following rating scale: 0=Low ; 5=High

Before use

After use

Before use - Confidence in the product.

Confidence in the product.

After use - Confidence in the product.

Before use - Reducing infection risk from reusable tape rolls.

Reducing infection risk from reusable tape rolls.

After use - Reducing infection risk from reusable tape rolls.

Before use - Reliability of the product.

Reliability of the product.

After use - Reliability of the product.

Before use - Likelihood of recommending to a colleague.

Likelihood of recommending to a colleague.

After use - Likelihood of recommending to a colleague.

Overall, in regards to your experience using LeaFix what worked well and what could be improved?

What could be improved?

Do you think LeaFix offers your department more benefits over current practice? Why?

Will you continue to use LeaFix? Why?

Please provide any further feedback.

Declaration – Conflict of interest and confidentiality

Consent

Please tick the box to agree.

I declare that I do not have a conflict of interest, affecting my objectivity in evaluating this product. I have no financial or other interest in any of the product suppliers being evaluated. I agree to keep all results and deliberations concerning this product confidential.

Innovators Not Imitators

Usability

Guidance and Training

User Opinion

Declaration – Conflict of interest and confidentiality

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