Incident Report for Patient Safety

Vediana Aulia, 1706039231, Faculty of Nursing Universitas Indonesia 2017

Student, vedianaulia@gmail.com
Incident report helps to identify events, mitigate their effects, and develop
processes to prevent re-occurrence. It also provides valuable data used to evaluate
other patient safety interventions such as aggregate patient safety reviews, root cause
analysis, sentinel event reporting, clinical focus reviews, and peer reviews. The key
for effective reporting system is for the staff to routinely report incident and near
misses (WHO, . Near miss also need to be reported because it can lead to adverse
event if it happened again.
Some university already provide their student with incident reporting
facilities. Some already provide list of direct call or an apps if incident ever happened
and some even already give guide to report an incident about data that should be
given to the staff about the incident such as
 Injured person's name, address, etc
 Place of accident (be specific); Work location
 Specific type of injury (e.g. cut, sprain, chemical splash)
 Specific body part injured
 Was medical attention required (doctor or hospital)?
 Describe how accident occurred
 What do you think can be done to prevent this from reoccurring?
 Include any equipment involved in the incident
 What were the primary & contributing causes of the incident?
From the case the nurse already found the way out to prevent the risk incident
happened to the patient. Patient with hepatic encephalopathy are often experience
agitation, flapping hand tremor, irritability, that caused patient to feel uncomfortable
with the medical equipment. Restrain and medication are needed for the patient ‘s
agitation (Prabhakar, 2003), but restrain can cause harm to the patient, that’s why
physical restrain should be removed or minimize as soon as possible (Richards, 2000)
the nurse need to reassess her intervention and find another way to calm the patient.
 Incident may not occur in this case, that’s because nurse already prevent it,
but nurse still have to report the event to prevent incident in further days. Nurse
action to restrain the patient might be occur based on the past cases before that have
been reported. That’s why incident report held an important role for the patient safety.
It can be concluded that incident might happen, as a nurse we need to assess
the risk and the prevention of incident from happening again. If incident ever
happened and can’t be prevent we need to know our role and immediately report the
incident. Incident report might be various, we need to know how to report the
incident based on the system used in the hospital.

References
Christopher F, et all. (2000). Emergency medicine clinics of North America.
Elsevier. Retrieved from :
https://www.sciencedirect.com/science/article/pii/S073386270570122X
Prabhakar S, Bhatia R. (2003). Management of agitation and convulsions in
hepatic encephalopathy. Europe PMC Retrieved from
https://europepmc.org/abstract/med/15025257
SBU. (nd). Laboratory emergency : Accidents and injury reports. Stony
Brook University : author. Retrieved from
https://ehs.stonybrook.edu/programs/laboratory-safety/laboratory-
emergencies/accidents-injury-reports.php
WHO. (2011). Patient safety curriculum guide : multi professional edition.
World Health Organization : Author.