Critical Incident Report Sample

The district nursing team were now to be responsible for the wound care of an ulcer on the sole of her right foot on her impending discharge. She had previously attended the practice nurse and a podiatry service based within her local clinic. Due to a change in circumstances, she was now clearly housebound for the near future due to mobility issues. Prior to an arranged visit, the patient had called the nurse to advise her that she was pyrexial and was experiencing a pain in her right foot that was different from her normal neuropathic pain, which was often problematic. She was also finding it difficult to mobilise and was disinclined for diet but was taking oral fluids.

For clinical week 9, I was assigned to the UMC Wound Care Clinic to view a different field of nursing. As soon as I arrived at the clinic the nurse told me that I could bounce around from patient room to patient room to view as many wounds and burns as possible. The first patient room that I went into was a young Hispanic man who had an infection on his right lateral thigh area that spread from the popliteal area to the greater trochanter. When I asked the patient what had happened he told me he was injured at work and the injury got infected, which he never went to the doctor to have it evaluated. So, basically the infection was eating away at his skin and muscles. The patient has to come to the wound clinic every day to get dressing changes.

Although the situation was quite challenging, it provided me with some useful experiences for the future practice. I understand that all institutions should have a policy for documenting the assessment of patients, including pressure ulcers (Morison 2001). I have come to be familiar with the homes assessment policy using the Sterling Pressure Sore Severity Scale and most importantly I have learned that by using a universal assessment tool it supports a systemic and consistent approach to pressure ulcer evaluation. This therefore supporting continuity of care.

Maria Niceforo, a 75-year-old woman receiving in-home nursing care, had died of infection due to numerous pressure wounds (Le May, 2016). She was admitted to the hospital presenting with a bleeding pressure wound across her back and legs that had penetrated through the bone (Le May, 2016). It was also observed that the wounds were soiled with urine and dried faeces (Le May, 2016). She was receiving in-home support from registered nurses, who according to her son, were not consistent nor reliable in their care of Mrs. Niceforo (Le May, 2016). Another contributing factor to her death was inadequate communication and documentation of her treatment (Menagh, 2016). For example, one of the nurses had reported not providing treatment to Mrs. Niceforo's bottom as she was not aware of it (Menagh, 2016). I was quite

I spoke with Ms. Valerie on July 31, 2017, at 6:58 p.m over the phone. Ms. Valerie stated that the client Bryce Linder verbalized that an advocate Leslie McKeown slapped him in the face. Then later she stated that the advocate Catina Hampton slapped him on the left side of his face during a group session, held at the HCAP office Located at 4120 Directors Row Suite D. Ms. Valerie stated that Bryce informed her that Catina verbalized to the client, “I have to slap you because you were being disrespectful during group.” Ms. Valerie also mentioned that Catina filed a CPS report on the family because Bryce stated that his former therapist molested him in the past and no one reported the incident. The advocate went out of town for a family emergency the week of July 24 –July 30. Ms. Valerie stated that Catina Hampton asked her if it was ok to take care of her two dogs during the time that she was out. Ms. Valerie stated that one of the dogs died from overheating and the other dog was stuck under the house.

The healthcare team honored the patients’ wishes as best as possible; the only time we bothered the patient was when we changed the dressings on the pressure ulcers located on the anterior portion of the left foot and right buttocks and when we provided the patient with PRN pain medications. Since this is a Medical Surgical floor, we were required to do one assessment, and that occurred during the time the health care team went in as a group to clump all of the care up and do it at one time. The only negative experience that had occurred was when the patient was expressing non-verbal signs of pain – and from that point, we worked quickly to give him his PRN pain medications to manage it.

Brian Burger a Dallas Police Officer was arrested and indictment, for ran over a cyclist, lien in the accident report and obstruct the investigation when the chase a cyclist Fred Bradford. According to Eric Nicholson of Dallas Observer, Bryan Burgess, 28 and his partner Officer Michael Puckett were in their routinely vigilance when they saw a men driving without lights in his bicycle and also without Helmer. The cyclist approach a car that was parking with it in unidentified occupied in there. Sun Fred the cyclist saw the police car, he fleet in his bicyclist. Officer Puckett follow the suspect by foot, in the mind time officer Burger driving his patrol car chasing the cyclist ending struck the

Preventable health care errors contribute to at least 44,000 deaths per year, increasing the cost of health care and limiting public trust. The Adverse Health Event Law passed in 2003 requires disclosure and examination of specific unfavorable events with corrective action plans with some aspects shared publically in order to educate consumers about health care facilities issues and improvements (MDH 2015).

In 1998, the National Incident-Base Reporting System (NIBRS) was created. The NIBRS is a reporting system that collects data on every crime in further detail than the Uniform Crime Reporting Program (UCR Program). The NIBRS shows information about place of occurrence, weapon used, type and value of property damaged, and relationships between the perpetrator and victim. The UCR Program shows information of the summaries of crimes. Many thing that these programs are separate but the NIBRS is underlying of the UCR Program. These two systems differ from the National Crime Victimization Survey because with this surveys are mailed to households which allow more exposure to unreported

Pressure ulcer prevention (PUP) in surgical patients has become a major interest in acute care hospitals with the increased focus on patient safety and quality of care. A pressure ulcer is any area of skin or underlying tissue that has been damaged by unrelieved pressure or pressure in combination with friction and shear. Pressure ulcers are caused due to diminished blood supply which in turn leads to decreased oxygen and nutrient delivery to the affected tissues (Tschannen, Bates, Talsma, &Guo, 2012). Pressure ulcers can cause extreme discomfort and often lead to serious, life threatening infections, which substantially increase the

Mr. J.’s daughter noticed a red mark on her father who then reported this to the nursing assistant and her concerns were immediately dismissed. If the nursing assistant was properly trained in the use of restraints and had knowledge of patient outcomes, this patient would not have developed a pressure ulcer. The nursing assistant should have immediately informed the nurse and measurements should have been taken to prevent further breakdown of the patient’s skin which was not done. It is evident in reading this case that Mr. J developed a Stage I pressure ulcer from being retrained in one position with no assessment or release for an undetermined amount of time.

Pressure ulcers remain a major health problem for many years. However, pressure ulcers have received minimal attention when we talk about patient safety issues. It is no doubt a patient safety issue as it can lead to serious damage such as life-threatening infections (Robyn). On a med/surge unit, individuals may experience long or short hospital stays depending on the situation. For the short stays, the focus of care is often on maximizing regaining activities of daily living and assessment and education regarding pressure ulcers is often minimal or non-existent (RNAO). What we fail to realize is that every patient who is at risk needs to be assessed and educated regarding pressure ulcers and the harm it can cause. During the hospital stay, patients may have limited movement and the pressure ulcers can extend into the muscle, tendon, and bone (RNAO). In many cases, patients do not notice the formation of an ulcer and as it may be in areas that are not as visible such as the coccyx. On a unit where there is short staffing, it is more vital to remember to assess for pressure ulcers and prevent the formation of an ulcer. Often, patients are admitted with the presence of a stage one or two pressure ulcer, whether it was from home or long-term care. In that case, patient education need to take place and teachings should be reinforced regarding the prevention of new pressure ulcers forming. Clients should also receive education regarding how to prevent

Yes, accidents in a workplace are real and can occur anytime when immense care is not taken. According to Laflamme, (1990) work accidents may also be referred to as workplace accident, or occupational accidents. On the other hand, Saari, (2009), argues that 120 million accidents occur on an annual basis in various workplaces around the world. About 210,000 of these accidents are fatal while about 500 men and women working in different companies are killed in the process of performing their duties at work. Accidents occurring in workplaces are frequently not brought to the limelight because they might damage the reputation of involved companies and this could

Hello, my name is Caroline McLean and I work for Konica Minolta where I am the escalation team lead. I have been with the company for 16 years. The experience that I had with the subject matter in one way or another we think critically whether or not we know it or not. Being a part of the escalation team allows me to think about the decision that I make before actually making a decision. My expectation for the course is to give me the tools that will guide me in thinking even more critical

Incident reporting mechanism is an essential component in nursing occupation that facilitates the identification and monitoring of adverse events or incidents that occur during health care service. It is a defined procedures and protocols that should be place and disseminate throughout the organization. The reporting system is used to report occurrence such as falls, safety issues for patients, medication errors, treatment and procedural problems, and malfunctioning equipment. The benefit of incident reporting mechanism is to protect patient from injury or harm. In order to maximize patient safety, adverse events, mistakes and errors, and near misses incidents should be report in a timely and accurate manner. Furthermore, it is also used to make the nurse aware of inadequacies of her own part which make her reflect upon the situation and how this could be learned from, so as to prevent making same mistake again.