Nursing Home Incident Report

---

I. Incident Details

• Date and Time of Incident: May 15, 2055, at 10:30 AM

• Location: [YOUR COMPANY NAME], [YOUR COMPANY ADDRESS]

• Reported By: [YOUR NAME], Registered Nurse

• Reported To: [SUPERVISOR'S NAME], Nursing Supervisor

• Patient(s) Involved: [PATIENT'S NAME]

• Witness(es): Toni Conner, Certified Nursing Assistant

II. Description of Incident

On May 15, 2055, at approximately 10:30 AM, it was reported that [PATIENT'S NAME], a 78-year-old male, experienced a fall incident in the Dining Hall of [YOUR COMPANY NAME]. According to witness accounts provided by Toni Conner, a Certified Nursing Assistant, the patient was attempting to transfer from his wheelchair to the dining chair when he lost his balance and fell to the ground. Immediate assistance was provided by [YOUR NAME], a Registered Nurse on duty, and other staff members.

III. Assessment and Medical Response

Upon examination, [PATIENT'S NAME] complained of acute pain in his left hip and displayed signs of distress. Vital signs were monitored, and the nursing team promptly administered first aid measures. A thorough assessment revealed a contusion on his left hip and a minor abrasion on his right elbow. The nursing staff ensured the patient's comfort and stability while assessing his condition further.

IV. Actions Taken

• [PATIENT'S NAME] was stabilized and made comfortable, with extra attention given to his left hip injury.

• The incident was documented comprehensively in the patient's medical records, detailing the circumstances, injuries sustained, and initial response.

• Family members of the patient were immediately notified of the incident and provided with updates on his condition and treatment plan.

• A multidisciplinary team meeting, involving nursing staff, physicians, and caregivers, was promptly convened to review the incident thoroughly. The meeting aimed to identify contributing factors, discuss preventive measures, and ensure a coordinated approach to resident care.

V. Follow-Up and Preventive Measures

• In response to the incident, [PATIENT'S NAME]'s care plan was revised to include increased monitoring and assistance with transfers to prevent further falls.

• Environmental assessments were conducted in the Dining Hall and other communal areas of the facility to identify and address potential hazards, such as uneven flooring or inadequate seating arrangements.

• Staff members received additional training sessions focused on proper transfer techniques, fall prevention strategies, and the importance of timely response to resident emergencies.

• The incident and subsequent measures taken will be reviewed comprehensively during the next quality assurance meeting, scheduled for June 5, 2055. This review will serve to evaluate the effectiveness of implemented interventions and identify any further opportunities for improvement in resident safety protocols.

VI. Conclusion

Despite the prompt response and appropriate interventions, incidents of this nature underscore the importance of ongoing vigilance and proactive measures to ensure resident safety within our facility. [YOUR COMPANY NAME] remains committed to providing high-quality care and continuously improving our practices to safeguard the well-being of our residents.

Report Templates @ Template.net