General Incident Report in Health care

1. Title

• Healthcare Incident Report

2. Basic Information

• Date of Report: [Insert date]
• Time of Incident: [Insert time]
• Date of Incident: [Insert date]
• Location of Incident: [Insert location, e.g., patient room, operating theater, or waiting area]
• Reported By: [Name and designation of reporter]
• Role/Position: [e.g., Nurse, Physician, Technician]

3. Patient Information

• Patient Name/ID: [Insert details]
• Age: [Insert age]
• Gender: [Insert gender]
• Unit/Ward/Department: [Insert unit/ward name]

4. Description of Incident

• Type of Incident: [e.g., medication error, fall, equipment failure, patient complaint]
• What Happened?: Provide a detailed account of the incident. Include relevant information such as actions leading up to the incident, people involved, and the outcome.
• Who Was Involved?: List all staff, patients, and witnesses (names and roles).
• Witnesses: Include names, roles, and contact information.

5. Immediate Actions Taken

• Describe steps taken to address the incident:
  • Patient Care: e.g., first aid provided, additional monitoring, or escalation to a higher level of care.
  • Reporting: Mention if a supervisor, doctor, or risk management team was informed.
  • Containment: e.g., stopping the use of faulty equipment or isolating the affected area.

6. Observations/Findings

• Highlight relevant factors that contributed to the incident, such as:
  • Environmental conditions (e.g., slippery floors, poor lighting).
  • Staff-related factors (e.g., staffing shortages, miscommunication).
  • Equipment-related factors (e.g., malfunction or improper usage).

7. Recommendations/Next Steps

• Suggest preventive measures, such as:
  • Enhanced staff training.
  • Equipment maintenance or replacement.
  • Policy or procedure updates.
  • Patient care follow-up and monitoring.

8. Attachments

• Include supporting evidence such as photographs, equipment logs, or medical records (ensuring patient confidentiality).

9. Signatures

• Reported By: [Name, Signature, Date]
• Supervisor/Manager Review: [Name, Signature, Date]

10. Follow-Up Section

• Resolution Actions: Describe steps taken post-incident to resolve or mitigate the issue.
• Date of Completion: [Insert date].
• Responsible Team/Person: [Name and role].