ENA Pediatric Trauma Committee QA Report

ENA Trauma Committee QA Report

Dear Course Director:

Thank you for your continued support of ENPC/TNCC. Please complete this form as soon after a course as possible and forward it as well as a copy of all Course Evaluations, Summary Performance Report Form and names of participants recommended as instructor potential to ENPC - Sandi or TNCC- Katie.

We would appreciate it if you would also send a copy of your course schedule with the instructor’s names of who taught which lectures and skills stations.

Please send TNCC forms to: ENPC forms to:

Katie Heldt, RN Sandi Wynja, RN

2007 Trauma Chair – IA ENA 2007 Pediatric Chair – IA ENA

Iowa Methodist Medical Center St. Luke’s Regional Medical Center

1200 Pleasant Street 2720 Stone Park Blvd.

Des Moines, IA 50309-1406 Sioux City, IA 51104

Trauma Services – 4 South

Course Date: ______________ Course Location:__________________

Course Director: ____________ Course Number: ________________

Course Type: (Circle one) Provider Reverification Instructor

# of Participants _______ # of successful completion _________

# of participants needing to retake written exam ______

# of participants needing to retake a skills station _______

Instructor candidates verified at this course: ______________________

Trauma Committee Member/Designee verifying candidates: ____________

Any Comments: