Home Care Incident Report
1. Incident Overview
1.1 Incident Summary
This section provides a brief summary of the incident, outlining the type of incident, the parties involved, and a high-level overview of the initial response actions.
Incident Type | Fall/Injury |
Date of Incident | October 25, 2050 |
Location | Patient's Home (Living Room) |
Reporting Personnel | John Doe, RN |
Time of Incident Report | 10:15 AM |
Report Prepared By | [Your Name], RN, Home Care Manager |
1.2 Reporting Details
Report Date: October 26, 2050
Report ID: HCIR-2050-1025
Incident Reported to Supervisor: Yes
Supervisor Notified: Sarah Johnson, October 25, 2050, 10:20 AM
2. Patient Information
2.1 Patient Background
Patient Name | Ms. Alice Brown |
Date of Birth | March 12, 1942 |
Medical ID | P12345 |
Primary Physician | Dr. Emily Parker |
Primary Caregiver | Susan White, CNA |
2.2 Current Medical Condition
Diagnosis: Hypertension, Osteoporosis, Mild Cognitive Impairment
Allergies: None reported
Mobility Level: Uses a walker indoors, some assistance required for transfers
Medication: Lisinopril, Calcium Supplements
3. Incident Details
3.1 Date, Time, and Location
Date | October 25, 2050 |
Time | 9:50 AM |
Location | Living Room, Patient's Home |
3.2 Incident Description
At approximately 9:50 AM, Ms. Alice Brown fell while attempting to sit in her recliner chair. She was alone at the time of the incident, and her primary caregiver, Susan White, heard the fall and immediately responded.
Narrative Description:
Event Description: The patient attempted to sit down without properly aligning herself with the chair, resulting in a misbalance and fall to the side.
Injuries Noted: Bruising on the right forearm and minor abrasion on the knee; no head injury was evident.
Patient’s Reaction: Patient reported mild pain but was coherent and responsive.
3.3 Persons Involved
Role | Name | Contact Information |
|---|
Patient | Ms. Alice Brown | (555) 123-4567 |
Caregiver | Susan White, CNA | (555) 987-6543 |
Supervisor | Sarah Johnson, RN | sjohnson@homecareagency.com |
Physician | Dr. Emily Parker | eparker@healthclinic.com |
4. Immediate Actions Taken
4.1 Medical Interventions
Initial Assessment:
Vital signs were stable: BP 130/80, HR 78 bpm.
Bruising and abrasion cleaned with antiseptic solution.
Applied ice pack to bruised area.
Pain Management:
4.2 Notifications and Reporting
4.3 Additional Safety Measures
5. Incident Analysis
5.1 Root Cause Analysis
5.2 Contributing Factors
Factor | Description |
|---|
Environment | Clutter around seating area |
Patient Awareness | Mild cognitive impairment |
Mobility Assistance | Limited assistance provided at the time |
6. Impact and Outcome
6.1 Patient Health Impact
6.2 Staff Involvement and Outcomes
7. Recommendations and Follow-Up Actions
7.1 Recommended Actions
Enhanced Training: Conduct refresher training for the caregiving team on fall prevention.
Home Environment Assessment: Schedule a visit to assess the home layout and minimize fall risks.
Patient Education: Reinforce safe mobility practices with Ms. Alice Brown.
7.2 Implementation Timeline
Action | Timeline | Responsible Party |
|---|
Training for caregiver staff | Within 1 week | Training Coordinator |
Home environment reassessment | Within 3 days | Occupational Therapist |
Patient mobility review | Ongoing | Caregiver |
7.3 Responsible Parties
Caregiver: Susan White, CNA
Home Care Manager: [Your Name], RN
Physician: Dr. Emily Parker
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