Unusual Incident Report Form: Fill & Download for Free

I rushed into a patient’s room and asked my preceptee (who was in his final shifts of his 12-week preceptorship) “you didn’t give that Lovenox yet, did you?” He raised his hand up from her abdomen, empty syringe in hand, and proudly announced that he just administered it. This was in the morning, within an hour of getting report on our 6 patients, and we were under pressure to hurry and give meds to this particular patient so she could go to surgery. ….Yep. Surgery.Needless to say, I had to report the med error to my facility, the surgical team, and the patient. The surgery had to be postponed for another day. It came along with all the shame and guilt you can imagine.There is a 6th Right: Right Reason. Every med must be considered for appropriateness by the nurse. Just because it was ordered by a physician, approved and provided by pharmacy, and scans in without flagging any warnings from our EMR systems, our critical thinking while serving as the last line in the med admin process VERY often catches near-mistakes. It is exceptionally rare (if ever) that a nurse makes it through a shift without challenging legitimately the appropriateness of one or more meds on the list of dozens of meds they are assigned and expected to administer. There are many potential weak spots leading to this. For example, the ordering physicians to think ahead and discontinue inappropriate meds for the patients’ upcoming treatments. Sometimes this is just due to having multiple physicians on the case, and the left hand doesn’t know what the right hand is doing. In this case, for example, the attending physician ordered the standard Lovenox daily for DVT prevention, but the surgical team scheduled the patient for surgery, the patient was scheduled for surgery but pharmacy doesn’t check for such things and the EMR system is also not associated with this detail, so there it is: the lovenox is Ordered, Approved, Provided, and on the Scheduled Med list on EMR. Some other examples of such disjointedness that is 99.9% only caught by the astute nurses’ critical thinking skills (using the 6th Right): meds that will be dialyzed out, PO meds for newly NPO patients, standardly ordered meds despite symptoms making those meds contraindicated (i.e. stool softeners for a patient with diarrhea), and let’s not forget that sometimes we are trying to provide patients with the meds they would have taken at home but they were unable to provide accurate info to begin with so they end up being given our best guess at what is the intended med and dose of their fill-in-the-blank med.Another common reason is that in healthcare, the only constant is change. A real pet-peeve of mine on Cerner and/or paper charting specifically is not being flagged that an order has changed. For example, I see on the EMR my patient is scheduled to get antibiotic A in a few minutes. I obtain the med, which is dispensed to me. I scan it and administer it, only to catch later that just prior to admin of antibiotic A, a physician ordered that A should be discontinued and antibiotic B should be given instead. The time lag before pharmacy reviewed it and Cerner and paper charting are infamously incapable of effectively alerting us to this new order in real time. Another thing about Cerner and paper orders are that these formats make orders VERY easy to miss. After my current job, I will not work for another facility with either of these unsafe systems. A “med error” I got written up for was that I missed an order to give a Gatorade to an NPO patient an hour before her surgery (now I’ve learned that this surgeon carb loads PO prior to his surgeries). I didn’t see the Gatorade order because it was visually lost to me in the several dozen same-font, cluttered and disorganized listing of orders, not to mention it contradicts the surgeon’s NPO order AND wasn’t looking for such an order because it was so unusual. That was the first Gatorade order I’d ever had in my nearly 14 years of nursing. So, now I’m bitter about the write-up, grossly frustrated and disappointed in the ordering system, and highly anxious about the huge potential for more serious mistakes (and anxiety and other negative feelings makes a human even more prone to making a mistake). It is, indeed, maddening.Punitive work cultures, communication issues between humans, and information system failures to alert the nurse of real-time results can also lead to med errors. I reported myself mid-shift when I realized I missed a normal-valued lab result that I had no idea was even drawn (thinking from the prior nurses’ report that it was a lab not due until near the end of my shift). I should have responded to this lab result with a very sight adjustment in a drip. I informed the patient, the physician, my charge nurse, and my facility via an incident report of the self-caught error. I’m confident had I not caught it myself that no one else would have, either, and according to my colleagues “should have just kept my mouth shut about it.” Ethically, I felt obligated to hold myself accountable, but I got written up for this med error. This further increases my anxiety about the potential for making errors and my resentment at having to work with an info system that has much to be desired in the prevention of med errors. We are asked, and indeed expected, to write incident reports on all deviations from the norm of care so the system can identify patterns they might be able to prevent in the future, but with a punitive culture (and having so much documentation required already that we are lucky to be able to clock out “on time”) …it’s just unrealistic to think all errors and near-misses are even documented.Being late with a med is a med error. This is very common, though, for any number of reasons. During med pass, patients will need help to the bathroom, food/drink needs, calls for unscheduled meds they need urgently, family members and patients have questions to be answered, the meds you are supposed to give are not prepared yet or simply can’t be located, unusual vital signs and lab results need to be called to the doctor, and the list goes on and on…. And there you are, nearly every shift something will be given late to someone. Bam! …Med error.An easy “trap” to try your darnedest to avoid is drawing up the correct dose a partial med (pill that must be split with a device, partial IV med vial…) while also administering a multitude of other meds AND while being almost constantly interrupted. Good luck with never making an error with odd doses in the midst of the turbulence of med passes on a busy hospital floor. Keep in mind, too that we are performing all this multitasking and critical thinking in a noisy, socially exposed environment, listen out for safety concerns, and have to pleasantly smile while adhering to every policy in all we do.The last example I’d like to mention is common: the nurse takes all the steps to set up the primary and secondary lines to administer an IV med as a secondary, but the clamp is closed. Of note, I can’t think of a nurse that hasn’t experienced this med error at some point.Not one physician, pharmacist, EMR system designer, or nurse wants to have any part of a med error. In fact, the extreme anxiety of the potential to make errors and the shame and guilt when errors are made contribute greatly to the woes of our professional community. I don’t see true resolution to widespread, common med errors until and unless we create and implement systems/technologies which allow crystal clear communication between all professional disciplines involved in actual real-time.In order to survive with your sanity intact, learn from the mistakes of others, be as proactive as possible about reviewing orders over, and over, and over again, learn about your physicians’ particularities, ask tons of questions of the more seasoned nurses around you, learn about coping skills such as mindfulness to be able to face the fact that there will be times you will unintentionally make mistakes, form the best habits possible to minimize your risks of making mistakes (watch that your IV med is actually dripping so you know that clamp is open), and listen to your patients! They will help you more than any EMR or electronic ordering system with checking the 6 Rights. If they are questioning the reason for a med, then you should pay special attention to questioning it, too.

Many of the important facts on this matter have already been discussed by my fellow Quoraites / Quowriters in their answers to this question, I would like to summarize as under : -PNR remains live on Passenger Reservation System (PRS) maintained by CRIS, right from the time it is generated (up to 120 in advance of journey date) and till 5 days after journey date, normally.After that PNR data (Ticket Booking details) continue to remain with CRIS (Centre for Railway Information Systems) for at least 3 years, usually.The actual travel details are stored for at least 3 months in the form of working reservation charts which are handed over at the train destination station by the train TTE / Conductor after completion of duty / on arrival of train at its destination.These are Minimum time periods for storage of records / data which is applicable in normal circumstances.However, if anything unusual / incidents either reported to the Railway Authorities or matter / case is being persued in accordance with law (like Police, Investigating Authorities, Courts etc.,) records are stored till the case / matter is sorted out or even afterwards.It is very important point to note here that third party information cannot be shared unless persued in accordance with law of the land.Hope this helps. Do hit “UpVote” if found useful.Thanks to everyone at / on Quora for giving me an opportunity to write more than 500 answers.Thanks for reading.Heartfelt Gratitude for the encouragement through UpVotes.

Yes, in a way. In security, we have to write incident reports on anything we observe that is unusual. When training s new officer, if an incident pops up, we both have to write an incident report. The trainee, most times having no experience, will need help filling out their report. I help them use terms that will sound more professional, and help them form short but informative sentences. This is not cheating, it is training. I make sure that the trainee uses slightly different language so it doesn't look copied. My sargent on my first post used this technique and I've never forgotten it.