Home Care Incident Report

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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

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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

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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

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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:

  • Offered over-the-counter pain relief; patient declined.

4.2 Notifications and Reporting

• Family Notified: Family members were informed at 10:30 AM.

• Incident Reported to:

  • Supervisor: Sarah Johnson

  • Primary Physician: Dr. Emily Parker, notified by email with full details and follow-up plan.

4.3 Additional Safety Measures

• Increased monitoring for 48 hours to observe potential delayed injuries.

• Caregiver repositioned furniture and reviewed safe seating practices with the patient.

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5. Incident Analysis

5.1 Root Cause Analysis

• Primary Cause: Unstable attempt to sit without caregiver assistance.

• Contributing Factors:

  • Possible mild cognitive impairment leading to misjudgment.

  • Clutter near the recliner chair, restricting movement.

5.2 Contributing Factors

Factor	Description
Environment	Clutter around seating area
Patient Awareness	Mild cognitive impairment
Mobility Assistance	Limited assistance provided at the time

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6. Impact and Outcome

6.1 Patient Health Impact

• Immediate Impact: Mild bruising and abrasion with no severe injury.

• 48-Hour Follow-Up: No additional complications were reported.

6.2 Staff Involvement and Outcomes

• Staff Support: Caregiver provided first aid and emotional reassurance.

• Follow-Up Required: Additional training for fall prevention and mobility assistance.

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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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