Patient Medical Incident Report

Patient Medical Incident Report

Incident Report Date: May 28, 2050


I. Incident Details

Incident Date and Time: May 27, 2050, 3:45 PM
Location of Incident: Room 205, Intensive Care Unit (ICU)
Type of Incident: Medication Error
Patient Name: [Patient's Name]
Patient Identification Number: 123456789


II. Incident Description

Description of Incident:

During the patient's routine medication administration, it was discovered that [Patient's Name] received 20 units of insulin instead of the prescribed 10 units. The error occurred due to a miscommunication during the shift change. The patient experienced symptoms of hypoglycemia, including sweating, dizziness, and confusion.

Actions Taken Immediately:

  • Administered 15 grams of oral glucose.

  • Monitored blood glucose levels every 15 minutes.

  • Notified the on-call physician, Dr. [Doctor's Name].

  • Documented the incident in the patient’s medical record.


III. Witness Information

Witness 1: [Name]
Contact Information: [Phone Number]

Witness 2: [Name]

Contact Information: [Phone Number]


IV. Medical Treatment Provided

Initial Assessment:

Patient was found to be hypoglycemic with a blood glucose level of 45 mg/dL. Patient was conscious but exhibiting signs of confusion and weakness.

Medical Personnel Involved:

  • Dr. [Doctor's Name], On-call Physician

  • [Your Name], Registered Nurse

Treatment Administered:

  • Administered oral glucose (15 grams).

  • Blood glucose levels monitored every 15 minutes until levels stabilized above 70 mg/dL.

  • Continuous monitoring for 2 hours post-incident.


V. Follow-Up Actions

Recommendations for Future Prevention:

  • Reinforce double-checking protocols for medication administration.

  • Implement a mandatory sign-off process for high-risk medications.

  • Conduct additional training sessions on effective communication during shift changes.

Follow-Up Care Instructions:

  • Continue to monitor blood glucose levels every 4 hours for the next 24 hours.

  • Schedule a follow-up appointment with the primary care physician.

  • Educate the patient and family members about signs of hypoglycemia and appropriate actions to take.


VI. Reporter Information

Reporter Name: [Your Name]
Reporter Title: Registered Nurse
Contact Information: [Your Email]


VII. Organization Information

Organization Name: [Your Company Name]
Organization Address: [Your Company Address]
Organization Contact Number: [Your Company Number]
Website: [Your Company Website]



Date: May 28, 2050

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