INCIDENT REPORTS

Function/Purpose
An incident report is not part of the patient’s chart, but it may be used later in litigation. A report has two
functions:
1. It informs the administration of the incident so management can prevent similar incidents
in the future.
2. It alerts administration and the facility’s insurance company to a potential claim and the
need for investigation.

Regulations issued under O SHA require all employers with more than ten employees at any time
during the previous calendar year to maintain records of recordable occupational injuries and illnesses.

When to Report
Incidents that must be reported and documented include:
1. Exposure Incidents: skin, eye, mucous membrane or parental contact with blood or other
potentially infectious materials that may result from the performance of an emploeyee’s
duties.
2. Accident, Injury: patient, visitor, employee slips or falls, or other incident, which results or
may result in injury.
3. Event, Behaviors, or Actions: incidents that are unusual contrary to agency policy or
procedure or which may result injury.
4. Vaccine Adverse Event Reporting System: reaction to vaccine administered at agency (use
VAERS form, instructions and sample in Immunization section.)
5. Medication reaction: reaction to any drug administered at or provided by health department.
Complete Adverse Drug Reaction Form. For more information, noise 1-800-332-1088.
6. Property damage or missing articles.
7. Administration of wrong medication or vaccine.
8. Improper administration of medication or vaccine.

O SHA Record keeping Requirements

O SHA 300 Log-recordable and nonrecordable injuries are distinguished by the treatment provided;
i.e., if the injury required medical treatment, it is recordable; if only first aid was required, it is not
required, it is not recordable. However, medical treatment is only one of several criteria for determining
recordability. Regardless of treatment, if the injury involved loss of consciousness, restriction of work
or motion, transfer to another job or termination of employment, the injury is recordable. An explanation,
with examples, is included in the backside of the O SHA 300 Form.
Analytical Report
®

Evonik India Private LImited (20060), India

Description: DDGS, Dr. Shabbir Ahmed Khan, C/o Globus Spirit Ltd.
Lab code: SG14-0000527-001
Date of delivery: 16 December 2014
Date of release: 26 December 2014
Crude protein (%)*: 46.38
Crude protein (% as is): 47.76
Dry matter (%): 90.61

Results of amino acid analysis / Total contents after hydrolysis of protein

Amino acid Content (%)* AA (%) in CP Content (% as is)

Methionine 1.047 2.257 1.078

Cystine 0.893 1.926 0.920
Methionine + Cystine 1.940 4.183 1.998
Lysine 1.193 2.571 1.228
Threonine 1.548 3.338 1.594
Arginine 3.211 6.922 3.306
Isoleucine 1.826 3.936 1.880
Leucine 3.496 7.538 3.600
Valine 2.561 5.521 2.637
Histidine 0.954 2.056 0.982
Phenylalanine 2.267 4.887 2.334
Glycine 1.905 4.108 1.962
Serine 2.095 4.516 2.157
Proline 1.966 4.238 2.024
Alanine 2.499 5.387 2.573
Aspartic acid 3.800 8.193 3.913
Glutamic acid 7.231 15.588 7.445
Total (without NH 3) 38.491 82.984 39.633
Ammonia 1.039 2.240 1.070
Total 39.531 85.224 40.703

* Figures standardized to a dry matter content of 88%

AA = Amino acid, CP = Crude protein

Evonik Industries AG | Animal Nutrition

animal-nutrition@evonik.com | www.aminoacidsandmore.com
 WORKSHOP RECOMMENDATIONS

One strategy for moving from the current patch work High Priority Actions:
Environment with its “islands of innovation” to an IT- i. Build Community
Transformed educational environment os to create a ii. Create organizational enablers
sustainable ecology for ongoing improvements in IT- iii. Coordinate change
enabled educational resources and practices.

The steering committee and workshop participants recognize that the desired changes will be difficult
to achieve, and achieving them will require coordinated action that brings together all of the constituents
to STEM education and IT product development. The committee concluded that generating a detailed
road map would not be appropriate at this time. Instead, a series of transitional activities should be
undertaken to lay the groundwork for change and to define future actions and initiatives. The
recommendations can be divided into three high-priority actions: (1) build community; (2) create
organizational enablers; (3) coordinate change.

BUILD COMMUNITY

An active, informed community is essential to an IT-transformed educational environment. An active

community would support dissemination and diffusion by encouraging discourse and networking
around the development, use, understanding, and sharing or IT-enabled learing resources.

Precursor Committee on IT-Enabled STEM Education. Cultivating community must begin by

establishing open, ongoing communication between targeted groups around issues of common
interest. Establishing and interim committee that would bring together experts and forward-looking
leaders representing the key stakeholders in IT-based STEM education will bring national attention to
the objectives, and spark the interest of a broad spectrum of researchers. The interim committee should
coordinate initial activities and plans, and identify a permanent organizational champion to carry out the
long-term plans. The interim committee should be sponsored by one or more organizations that have
significant influence on STEM education (e.g., NAE, National Academy of Sciences, NSF, and National
Aeronautics and Space Administration).
 RESEARCH REPORT

1.1 BACKGROUND
The research and associated case studies are aimed to help promote greater corporate responsibility
for health and safety within the small and medium-sized enterprise (SME) sector. The HSE has
identified a need to produce robust evidence on the business benefits that effective management of
occupational health and safety brings and so the aim of this research is to contribute to fulfilling this
need. The research aimed to cut accross the range of industrial sectors, and approaches ranging from
management of specific risks to the benefits of greater employee involvement.

It is expected that the study will be used to:

• Provide robust evidence on the costs and benefits of health and safety initiatives to persuade
other SMEs of the business benefit of health and safety improvements;

• Highlight the costs and benefits of a variety of health and safety initiatives across a range of
industrial sectors;

• Provide material which might assist in the development of links that HSE is building with SMEs
and;

• Provide material which other actors such as investors, trade unions etc. Can use to engage with
decision-makers to persuade them of the business case for improved health and safety.

There are a number of important issues that have had a bearing on this study to develop and present
a series of case studies where the business case for health and safety initiatives has been persuasive
to an organization. Key drivers have been:

• The necessity to build a business case for health and safety improvements in order for a range
of actors to successfully convince others of the business benefits of health and safety.

• The potential of appropriate and well written case studies to tell a “good news” story and promote
the idea that health and safety is good for business.
 CASE STUDY: Child Malnutrition Eastern Cape South Africa

2.4 Case Study: Thembi’s Malnutrition

Thembi, an 18 month old girl, lives with her grandmother in a homestead in the Mount Frere district,
about an hour from the Sipetu Hospital by bus. Her grandmother receives a pension of R948 per month
(approx $135 in 2008), but this supports two other grandchildren and herself. She keeps chickens but
cannot grow a vegetable garden because rain has been erratic and she does not have running water.
Thembi’s mother has not managed to access the Child Support Grant* (see Social Security Grants in
section 3) as she is not functionally literate and has struggled to apply for the South African identity
document needed to access the grant. Thembi was breastfed for one week, but thereafter her mother
returned to work as a domestic worker in the city. Although her mother tries to visit once a month, this
is made difficult by the cost of transport and taking time off work.
For the past few months, Thembi’s grandmother has been feeding Thembi a thin porridge, but in the
last two weeks she has not been eating well. She has become miserable and irritable, and prefers to
be left alone, not moving at all unless her grandmother carries her.
On February 8th, grandmother became worried because Thembi’s stomach was distended, and gave
her an enema. That night Thembi passed three loose stools and was very restless. She drank the water
quickly that her grandmother gave her and then vomited. On the morning of the 9th February,
grandmother took Thembi to the hospital, a journey which cost R20 one way. This involved walking for
20 minutes to reach the bus stop. As she was in a hurry, she did not manage to prepare porridge for
Thembi.
Grandmother and Thembi waited for two hours for the bus. By the time they arrived at the hospital it
was 11h00 and the Outpatient Department was packed with people. Thembi looked weak. She had not
had anything to drink because her grandmother was afraid she would vomit on the bus. They waited in
the outpatient queue for one hour and then Thembi was seen by the Sister. By this time she was very
weak and she was taken to the ward immediately. There was no porter to escort grandmother to the
ward so she did not get there until 13h30.
When Thembi was admitted, she was very thin on her shoulders, ribs, upper arms and thighs. Where
her skin was loose, when the Sister pinched her skin and it took 4 seconds to flatten. Her feet were
also swollen (oedematous) and a dent remained when the Sister put pressure on her ankle. The skin
on her feet was dark and cracked. Her stomach was distended. Her little bit of thin hair had become
reddish, and her weight was found to be 60% of what it was supposed to be. Her pulse was weak and
fast (Ashworth & Burgess, 2003).
She was diagnosed with marasmic-kwashiokor (severe wasting and oedema), and dehydration.
Because of her weak pulse she was regarded as “in shock”. She was immediately put on an intravenous
drip of 15ml for an hour and warmly covered. A Sister stayed with her and monitored her pulse and
respiration rate to avoid overload with fluids. In the second hour another 15ml was administered and
then replaced with oral rehydration using ReSoMal (10ml per kg per hour) for five hours. Gradually
Thembi’s pulse became normal and a starter formula was used for three hourly feeds with added
potassium and magnesium (Ashworth & Burgess, 2003).
Thembi’s grandmother could not stay at the hospital because she had to go home to look after the other
grandchildren. Two weeks later, when she returned, the nurses suggested she take Thembi home. She
 CASE STUDY: Child Malnutrition Eastern Cape South Africa

SECTION 3 - Setting Description for Case Analysis

3.1 The Eastern Cape, South Africa

South Africa is divided into 11 provinces, one of the poorest being the Eastern Cape Province (EC): it
has the third largest population in South Africa with a high percentage of the population living in rural
areas. In 2010, it constituted 13,5% or 6 743 800 of South Africa’s population of 49 991 300 (Statistics
SA, 2010). Rural areas in South Africa are home to 70% of the country’s poorest households [Statistics
SA, 2010. Available: http://www.statssa.gov.za/publications/P0302/P03022010.pdf].
The Eastern Cape has a varied geography and climate, being mostly dry in the west, with scarce rainfall
during winter and very hot summers. Further east, rainfall is more plentiful and the humidity increases
so that it is subtropical along the coast. The interior is cold in winter and has heavy snowfalls in the
mountainous regions.

Map 1: Map of the Provinces of South Africa. Source: Wikipedia [Online] Available:
http://en.wikipedia.org/wiki/Provinces_of_South_Africa [Downloaded 8/4/10]
The Eastern Cape is divided into six district councils and one metropolitan municipality, called Nelson
Mandela Metropolitan Municipality. There are 39 local municipalities and six health districts. The
majority of the population in the district are black Xhosa-speakers with 63% living in rural villages and
homesteads (Statistics South Africa, 1999) [Available:
http://www.statssa.gov.za/census01/Census96/HTML/].
3.2 Prevalence of Malnutrition in South Africa
The prevalence of under-nutrition is highest in rural areas, particularly on commercial farms and in
informal (urban and peri-urban shack) settlements. The table below shows the percentage of children
by province in South Africa who displayed symptoms of severe malnutrition between 1994 and 2005.
In 2005 in the Eastern Cape, 18% of children showed stunting; 14% were underweight; 3% were