Appendix A. Sample Data Collection Protocol for the Community Pharmacy Point of Contact: Paper Survey

Community Pharmacy Survey User's Guide

Data Collection Tasks and Schedule for the Community Pharmacy Survey on Patient Safety Culture

Listed below are the schedule and tasks for administering the paper survey. Fill in the dates for your survey. Post this protocol in your office to remind you of the schedule.

Target Date Activity

One week before survey distribution

Date: __________

Print and post publicity materials. Post survey flyers throughout the pharmacy (e.g., on bulletin boards, in work areas). Promote survey throughout the data collection period.

Beginning of Week 1

(Start of Survey Data Collection)

Date: __________

Distribute survey packets to all staff members on the survey distribution list. Consider distributing the packets at staff meetings and encourage survey participation. Caution staff, however, not to discuss their answers if they complete their surveys during the meeting.

Beginning of Week 2

Date: __________

Distribute a second survey packet. If you are not using individual identifiers to track respondents, distribute second survey packets to all staff. If you are using identifiers to track respondents, distribute second survey packets only to nonrespondents.

Near End of Week 2

Closeout Date: __________

Calculate preliminary response rate. If the rate is high enough, close out data collection at the end of Week 2.

To increase your response rate, extend data collection by a few days or a week. If your response rate is lower than 50 percent, consider distributing reminder cards to all staff (or only to nonrespondents if you are using identifiers). It may be sufficient to remind staff in person to complete the survey.

New Closeout Date: _________ Close out extended data collection.

Return to Contents
Proceed to Next Section

Page last reviewed April 2014
Internet Citation: Appendix A. Sample Data Collection Protocol for the Community Pharmacy Point of Contact: Paper Survey: Community Pharmacy Survey User's Guide. April 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/pharmacy/toolkit/pharmsopsuserguidea.html