Free Hospital Action Incident Report Template
Hospital Action Incident Report
Date: May 15, 2055
Reported By: [YOUR NAME]
Report ID: INCIDENT-2055-123
I. Incident Details
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Date and Time of Incident: May 14, 2055, 08:30 AM
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Location: Emergency Department, Room 203
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Description of Incident: While attempting to walk to the restroom unassisted, patient [PATIENT'S NAME] slipped and fell. The patient sustained a fractured hip as a result of the fall.
II. Involved Parties
Patient Information:
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Name: [PATIENT'S NAME]
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Age: 67
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Medical Record Number: MRN2055-456
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Diagnosis/Condition: Admitted with pneumonia, awaiting further evaluation.
Staff Involved:
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Staff Member 1: [NURSE'S NAME]
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Staff Member 2: [PHYSICIAN'S NAME]
III. Incident Assessment
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Nature of Incident: Patient Fall
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Severity Level: Moderate
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Root Cause Analysis: Upon investigation, it was determined that the patient attempted to walk to the restroom unassisted due to a delayed response to the call light. Additionally, there was a lack of sufficient monitoring during patient ambulation.
IV. Actions Taken
Immediate Actions:
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The patient was promptly assessed and transferred to radiology for X-rays to evaluate for any additional injuries.
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The attending physician, [PHYSICIAN'S NAME], was immediately notified of the incident.
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Family members were informed of the patient's fall and current condition.
Follow-Up Actions:
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Implemented an hourly rounding protocol for patients at risk of falls to ensure timely assistance.
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Scheduled a staff education session on fall prevention strategies and the importance of responding promptly to patient needs for next week.
V. Risk Management
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Risk Assessment: Analysis revealed an increased risk of patient falls in high-traffic areas of the Emergency Department, particularly during peak hours.
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Mitigation Strategies: To address this, plans are underway to install additional handrails and non-slip flooring in high-risk areas to provide better support and reduce the risk of falls.
VI. Recommendations
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Conduct regular audits of fall prevention protocols to ensure adherence and effectiveness.
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Explore the possibility of implementing patient monitoring devices to alert staff of patient movements and potential fall risks.
VII. Conclusion
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Lessons Learned: This incident underscores the importance of proactive monitoring and the implementation of preventive measures to minimize patient falls, especially in high-traffic areas. Timely response to patient needs and continuous staff education are crucial in ensuring patient safety.
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Closure Status: The incident report was closed following the implementation of corrective actions and preventive measures.
For further inquiries or additional information, please contact:
[YOUR NAME]
Chief Medical Officer
[YOUR COMPANY NAME]
Email: [YOUR COMPANY EMAIL]
Phone: [YOUR COMPANY NUMBER]
Address: [YOUR COMPANY ADDRESS]
Website: [YOUR COMPANY WEBSITE]
