Hospital Surgical Incident Report
Hospital Surgical Incident Report
[YOUR COMPANY NAME] | [YOUR COMPANY ADDRESS]
I. Patient Information
|
Patient Name |
Patient ID |
Age |
Medical History |
|---|---|---|---|
|
Jeff Summers |
123456 |
30 |
No known allergies, history of hypertension |
II. Surgery Details
|
Type of Surgery |
Date of Surgery |
Time of Surgery |
Surgical Team Members |
|---|---|---|---|
|
Knee Arthroscopy |
05/30/2050 |
10:00 AM |
Dr. [YOUR NAME] (Surgeon), Dr. Smith (Anesthesiologist), Nurse Johnson (Surgical Nurse) |
III. Incident Description
On 05/30/2050, during a scheduled knee arthroscopy, the surgical team mistakenly operated on the left knee instead of the right knee. The patient, Jeff Summers, was prepped for surgery and brought into the operating room at 9:45 AM. Despite standard preoperative verification procedures, the error occurred due to miscommunication and a failure to double-check the surgical site markings.
IV. Immediate Actions Taken
Upon realization of the error, the following steps were immediately taken:
-
The surgery was halted.
-
The surgical site was re-evaluated and confirmed to be incorrect.
-
The patient was informed about the error while still under anesthesia.
-
Corrective surgery on the right knee was performed immediately after securing consent from the patient's legal guardian.
V. Follow-Up Actions
|
Follow-Up Action |
Responsible Party |
Timeline |
|---|---|---|
|
Post-surgical monitoring |
Dr. [YOUR NAME] (Surgeon) |
Daily for 7 days |
|
Incident review meeting |
Risk Management Team |
06/02/2050 |
|
Staff training session |
Quality Assurance Department |
06/10/2050 |
|
Implementation of new verification protocols |
Hospital Administration |
06/15/2050 |
VI. Witness Statements
Statement from Nurse Johnson
"I was responsible for prepping the patient and was part of the surgical team. I observed the incorrect knee being operated on but did not realize the mistake until it was too late. I did not cross-check the patient's records against the marked site."
Statement from Dr. Smith (Anesthesiologist)
"I administered anesthesia and was present during the surgery. The preoperative verification checklist was not thoroughly followed, which contributed to the error."
VII. Recommendations
|
Recommendation |
Implementation Date |
Responsible Department |
|---|---|---|
|
Strict adherence to preoperative verification |
Immediately |
Surgical Team |
|
Double-checking surgical site markings |
Immediately |
Surgical Team |
|
Enhanced staff training on patient safety protocols |
06/10/2050 |
Quality Assurance Department |
|
Regular audits of surgical procedures |
07/01/2050 |
Risk Management Team |
VIII. Summary
This Hospital Surgical Incident Report outlines a critical error where a surgery was performed on the wrong knee. Immediate corrective actions were taken, and new protocols have been recommended to prevent such incidents in the future. The hospital's commitment to patient safety and continuous improvement remains paramount.
