Incident Report
Document
-complete name of the person or people involved and the names of all witnesses -complete factual account of the incident -any equipment or resources being used -any variables believed to be important -in detail the patient's response and the treatment
Avoid
-including a reference to the incident report -using words such as error or inappropriate -using inflammatory words or judgmental statements
Incident Report
accurate and comprehensive report used by healthcare agencies to document any unexpected or unplanned occurrence that affects or could potentially affect a patient, family, or staff
Examples
medication errors, falls, patient injury such as burns, medical-legal incident such as patient or family refuses treatment as ordered and refuses to sign consent, incorrect sponge count in surgery, failure to report change in patient's condition
