Hospital Surgical Incident Report

[YOUR COMPANY NAME] | [YOUR COMPANY ADDRESS]

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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:

1. The surgery was halted.

2. The surgical site was re-evaluated and confirmed to be incorrect.

3. The patient was informed about the error while still under anesthesia.

4. 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.

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