Free Hospital Critical Incident Report Template
Hospital Critical Incident Report
Reported by: [Your Name]
Report Date: May 30, 2051
I. Incident Overview
Incident Date and Time: May 29, 2051, 10:00 AM
Location: [Your Company Name], Emergency Department
Patient Information: [Patient's Name], Age: 45, Gender: Male
II. Description of Incident
On May 29, 2051, at approximately 10:00 AM, a medication error occurred while administering treatment to patient [Patient's Name].
The incorrect dosage of Ibuprofen (10mg instead of 5mg) was administered by Nurse [Your Name] instead of the prescribed dosage. This error was identified immediately after administration.
III. Immediate Actions Taken
Upon realization of the error, the following immediate actions were taken:
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Notified the attending physician, Dr. [Doctor's Name].
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Initiated emergency protocols to mitigate patient harm.
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Documented the incident in patient records and reported to Hospital Management.
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Communicated with the patient and family members regarding the incident and the corrective measures being taken.
IV. Analysis of the Incident
Initial analysis indicates that the medication error was a result of miscommunication between the pharmacy and the nursing staff. Contributing factors may include high workload and inadequate double-check procedures.
V. Consequences
The patient experienced an adverse reaction to the medication error, requiring additional medical intervention. The incident has been classified as a critical incident due to the harm caused to the patient.
VI. Corrective Actions and Recommendations
To prevent such incidents from occurring in the future, the following corrective actions and recommendations have been proposed:
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Implementing mandatory double-checks for medication administration.
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Conducting refresher training sessions for staff on medication safety protocols.
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Enhancing the readability and clarity of medication labels and patient charts.
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Reviewing and updating hospital medication administration policies.
VII. Follow-Up Actions
An internal debriefing session is scheduled for June 1, 2051, to discuss the incident in detail and reinforce the importance of medication safety. Continuous monitoring will be conducted to ensure adherence to the new protocols and to assess their effectiveness in reducing medication errors.
VIII. Contact Information
Nurse's Name: [Your Name]
Email: [Your Email]
Phone Number: [Your Company Number]
Hospital Name: [Your Company Name]
Address: [Your Company Address]
