Teddy Bear Transport Outreach Education Request
Cook Children's Teddy Bear Transport team brings neonatal and pediatric education programs to your facility to help ensure the best quality care for your newborn and pediatric patients. Our goal is to help your team broaden their knowledge base by creating custom courses to meet their specific educational needs. In order for us to provide the appropriate education, please complete the request form below.
Facility:
*
Separate with commas
Unit/Department:
*
Unit/Department (additional):
Unit/Department (additional):
Name
*
First Name
Last Name
Role/Title:
*
Email:
*
Phone Number:
*
What certifications or coursework is required for your staff
i.e. NRP, PALS, STABLE, Fetal Monitoring
Does your hospital have an education department or an educator?
Yes
No
Estimated participants you expect to attend:
*
What disciplines do you anticipate participating:
i.e. RN’s, RT’s, Paramedics
Is your hospital in the process of obtaining accreditation or leveling (i.e. NICU, Trauma)
Yes
No
If you marked Yes regarding obtaining accreditation, please explain.
Has Teddy Bear Transport Outreach ever come to your facility to provide education?
Yes
No
Please list your top three topics of interest for education:
S.T.A.B.L.E.
S.T.A.B.L.E. – Cardiac Module
Neonatal Resuscitation Program
Neonatal Respiratory Conditions & Treatments
Neonatal Abstinence Syndrome
HIE and Cooling Protocol for Neonates
Delivery Room Emergencies
Pediatric & Neonatal X-Ray Interpretation
Line Access and Management (UVC’s, PIV’s, PICC’s)
Congenital Anomalies / Syndromes
Neonatal Sepsis
Pediatric Airway
Pediatric Trauma
DKA
Pediatric Respiratory Illnesses (Asthma/ Bronchiolitis)
Pediatric Sepsis Recognition & Protocols
Pediatric Mock Codes
Summertime Emergencies
Drowning
Ingestion Emergencies
Additional topics of interest not included on the list:
Submit
Should be Empty: