incident report

Introduction

A form that documents an actual or potential adverse outcome directly associated with patient care.

They are used to identify trends. Analysis of trends is used in quality improvement & risk prevention. An incident report is NOT used for action against an employee.

An incident report must be completed whenever a patient experiences a negative outcome directly associated with care or services provided at your facility, real or potential.

Examples:

• falls
• assaults, including sexual assault
• suicide, suicide attempt
• patient abuse
• missing patient
• medication error

Do not file an incident report if incident involves employee, visitor or volunteer.

Form 2126 is used for visitors. Automatic Safety Incident Surveillance Tracking System (ASISTS) should be used for employees & volunteers.

Required information

• patient information
• description of incident
• physician's examination, findings, & actions
• service level findings & actions

Report must be in Quality Management office within 24 hours.

Notify Quality Management & Administration immediately if serious injury or death

Incident reports may be reviewed by:

• product line managers
• managers & supervisors
• Quality Management
• Administration
• regional counsel

More general terms

• report