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