An incident report is not part of the patient’s chart, but it may be used later in litigation. A report has two functions:
- It informs the administration of the incident so management can prevent similar incidents in the future.
- It alerts administration and the facility’s insurance company to a potential claim and the need for investigation.
Regulations issued under OSHA require all employers with more than ten employees at any time during the previous calendar year to maintain records of recordable occupational injuries and illnesses.
When to Report
Incidents that must be reported and documented include:
- Exposure Incidents: skin, eye, mucous membrane or parental contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.
- Accident, Injury: patient, visitor, employee slips or falls, or other incident, which results or may result in injury.
- Event, Behaviors, or Actions: incidents that are unusual, contrary to agency policy or procedure or which may result in injury.
- Vaccine Adverse Event Reporting System: reaction to vaccine administered at agency (use VAERS form, instructions and sample in Immunization section).
- Medication reaction: reaction to any drug administered at or provided by health department. Complete Adverse Drug Reaction Form. For more information,call 1-800-332-1088.
- Property damage or missing articles.
- Administration of wrong medication or vaccine.
- Improper administration of medication or vaccine.
Patient safety event reporting systems are ubiquitous in hospitals and are a mainstay of efforts to detect patient safety events and quality problems. Incident reporting is frequently used as a general term for all voluntary patient safety event reporting systems, which rely on those involved in events to provide detailed information. Initial reports often come from the frontline personnel directly involved in an event or the actions leading up to it (e.g., the nurse, pharmacist, or physician caring for a patient when a medication error occurred), rather than management or patient safety professionals. Voluntary event reporting is therefore a passive form of surveillance for near misses or unsafe conditions, in contrast to more active methods of surveillance such as direct observation of providers or chart review using trigger tools. The Patient Safety Primer Detection of Safety Hazards provides a detailed discussion of other methods of identifying errors and latent safety problems.
Characteristics of Incident Reporting Systems
An effective event reporting system should have four key attributes:
|Box. Key Components of an Effective Event Reporting System|
- All sampled hospitals had incident reporting systems to capture events, and administrators we interviewed rely heavily on these systems to identify problems
- Hospital staff did not report 86 percent of events to incident reporting systems, partly because of staff misperceptions about what constitutes patient harm
- Nurses most often reported events, typically identified through the regular course of care; 28 of the 40 reported events led to investigations and led to policy changes
- Hospital accreditors reported that in evaluating hospital safety practices, they focus on how event information is used rather than how it is collected
EMPLOYEE: Return this COMPLETED FORM to your SUPERVISOR as soon as possible.
Name of Person Involved: ______________________________________________________________
Address: ____________________________________ City: ___________________________________
Phone Number: _____________________ Age: ________ DOB: _____________ Sex: M ____ F _____
SS#: _________________________ Date of Incident: _____________ Time: ______ am/pm
Exact Location of Incident: ______________________________________________________________
Check Type of Accident: Check:
Clerical/Data Entry _____ Patient
Communications _____ Employee
Testing Process _____ Visitor
Result reporting _____ Volunteer
Safety _____ Other
Medical Device Failure
Adverse Drug Reaction
Exposure to Hazardous Substance
Medication Error (Wrong: Route, Dosage, Medication, Schedule)
EMPLOYEE: Involved _____ yes _____ no
Were they doing their regular job duties: _____ yes _____ no Observed by employee yes
Hire Date: ____________ Marital Status: ____________ Situation observed only by employee yes
Employee Classification: ______________________________
Protective Equipment being used: _____ yes _____ no
If not used, Why: ___________________________________________________________________________________
Description of Incident/Complaint (Who, What, Where, How, Why, Include sequence of events, personnel involved, body part injured, reason incident occurred) (If medication error include brand name, manufacturer, dosage) (Use additional form if necessary)
Actions Taken by Staff Members: _________________________________________________________
Witness Name: ________________________________ Phone Number: _________________________
Witness Name: __________________________________ Phone Number: _______________________
MEDICAL FOLLOW-UP: Was Medical Attention Sought: _____ yes _____ no
Treatment Refused: _____ yes _____ no First Treatment Date: _____________________________
Treating Physician: ________________________________ Phone Number: ____________________
First Day Off Work: _________________________ Return to Work Date: _______________________
Duties Restricted: _____ yes _____ no Explain: ___________________________________________
Incident Reported By: __________________________________ Date: ________________________
Supervisor Notified: _____ yes _____ no Date: _________________ Time: _______________
Name of Supervisor: __________________________________________________________________
Signature and Title of Person Preparing Report: ______________________________ Date: _________
Supervisor Comments: ________________________________________________________________
Supervisor Signature: ___________________________________________________ Date: ________
Corrective Action Taken/Follow-Up: (Things that have been or will be taken to prevent recurrence)
Director Comments: ___________________________________________________________________
Director Signature: ______________________________________________________ Date: ________
Nursing Administrator Signature: ___________________________________________ Date: ________
Administrator Signature: __________________________________________________ Date: ________
Signature of Person making Complaint: ______________________________________ Date: ________
Worker Compensation first Report Sent: _____ yes _____ no Date: _______ OSHA 300 Log # : ______
_____ I understand the potential risks related to the exposure to the incident that occurred and agree to receive an examination and/or treatment for the exposure, as recommended by my physician. This includes serological testing for Hepatitis B and the HIV virus as indicated.
_____ I understand the potential risks related to the exposure incidents that occurred and DO NOT agree to have an examination or treatment for the exposure.
Employee Signature: _________________________________________________ Date: ___________
Supervisor Signature: ________________________________________________ Date: ___________
I understand the information above will be used by my employer to help determine liability for injury. I acknowledge that the above statements are true and accurate representation of the requested information.
Employee Signature: ___________________________________________________ Date: _________
Job Title: ___________________________________________
Testing for HBV: Baseline and 6 months*
Testing for HIV: Baseline, 6 weeks, 3 months, 6 months, and 1 year**