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Event details by discoverer/reporter

Event Report Number

The date the event report was sent

REPORTING SPECIALTY

Event Date and time

Event discovery date and time

Event area Select the region Dedicated patient care areaPublic complex areasNon-patient work areaExternal perimeter of the complex

Event location New event location added Pediatric Clinic No. 502Emergency corridor near the entrance to the receptionAccounting OfficeThe patient care room number 305Operating Room No. 2Emergency Department

New location added

Departments Involved Select the relevant department doctorsNursingThe laboratoryRaysTherapeutic nutritionnatural therapyHigher ManagementHRAccountingcustomers serviceEmploymentinformation technologypharmacyMarketingqualityLegal Affairs

Are there any affected people? Select yes or no YESNO

People affected No people affected one patient affectedtwo patient affectedone staff affectedtwo staff affectedone visitor affected

Statement 1

Statement 2

Incident Type Please check the relevant fields

Type of incident Basic classification Basic classification AdministrativeCommunicationFacility ManagementSecurity VarianceSafetyMedical & Clinical CareTreatment/Test/Procedure

Incident Type Secondary Classification Secondary classification Policy and ProcedureUnauthorized UseService CancellationSupplies qualitySupply AvailabilityAdmission Discharge TransferOtherPatient Identification VarianceLabeling VarianceDocumentationCoordination HandoverMedical RecordsOtherEquipment/InstrumentsUtility SystemBehavioral VarianceFacility PropertyPersonal Belonging/LossCenter acquired injury/TraumaFire SafetyHazardous MaterialInfection ControlFallOccupational SafetyFacility Property Damage OtherPatient and Family EducationPatient and Family RightsAssessment of PatientCare of PatientsIV RelatedMedication errorOthers

Incident Type Classification Analytical A new analysis type has been added. PrescribingPreparation& dispensing errorAdministration errorMonitoring errorFailure to implement nursing proceduresPresence of equipment in an unauthorized areaPoor coordination and communication between employeeNeglect in providing medical and therapeutic careSurgical site error due to misreading records.Delay in routine procedures

Add new analysis type

Event Description by Reporter/Discoverer

Occurrence Description: (If more space is needed, please attach your description) أثناء إجراء عملية جراحية دقيقة لمريض في غرفة العمليات، قام الطبيب بتحديد مكان خاطئ للفتح الجراحي بناءً على خطأ في قراءة السجلات الطبية. نتيجة لذلك، تم إلحاق ضرر جسيم بأحد الأعضاء الحيوية للمريض، ما أدى إلى نزيف داخلي شديد. الطبيب لم يتبع البروتوكولات المتبعة في التحقق من الهوية والموقع الجراحي قبل بدء العملية.

Immediate action taken by the discoverer

Immediate action None NeededRemoved obstacleProvided First AidProvided assistance to manage the incident

No help requested Immediate SupervisorHousekeepingMaintenanceSecurityInfection ControlPatient Safety OfficerEnvironmental Safety OfficerOther

Select other help

Immediate action taken by discoverer/othersتم اتخاذ الإجراءات الطارئة فورًا، بما في ذلك إيقاف العملية والبدء في تقديم العلاج اللازم لإنقاذ المريض من النزيف، وتم استدعاء الأطباء المختصين للمساعدة في تدبير الحالة. تم توجيه المريض إلى وحدة العناية المركزة لمتابعة حالته.

Admin

Date and time the report was sent to the Quality and Risk Management Officers.

Date and time the report was received by the Quality and Risk Management Officers.

This report is electronic and all transactions are recorded in the database.

Forward the report to the relevant person/department. The person concerned was not directed. 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Date and time the report was forwarded to the relevant person/department.

The severity of the outcome

The seriousness of the outcome was not determined. InsignificantMinorModerateMajor TemporaryMajor PermanentCatastrophicNot known at time of reportingDeath

Recommended Corrective Action:

Recommended corrective action

فتح تحقيق رسمي لتحديد المسؤوليات، مع تعليق الطبيب المعني عن العمل لحين انتهاء التحقيق، ومراجعة الإجراءات لضمان منع تكرار الحادث.

Send a request to the Quality Department to amend the report if the report is not received by the Quality Department.

Do you want to make any changes to the event notification report Select Yes to edit. YES

Reason for modifying the report