Incident Report Policy and Form


All unusual events shall be documented using an incident 
report form; if more appropriate to the specific incident, a 
narrative report may be used.  As required by law or other 
applicable requirements, the transfer of a patient to another 
level of care (acute hospital or emergency center) or the 
death of a patient will prompt notification to the 
appropriate State agency and to the accrediting agency.  It 
is the obligation of every employee to carry out incident 
reporting responsibilities as appropriate to his specific job.
1.  An incident report shall be completed, as soon as 
    possible, when any adverse, unexpected event occurs 
    including medication error or drug reaction; cardiac or 
    respiratory arrest; patient death; or patient, employee 
    or visitor accident.
2.  Reports must include a description of what happened,
    what consequences resulted, who was involved, actions 
    taken by all persons involved, and recommendations to 
    preclude recurrence.  Such reports are to be forwarded 
    to the Medical Director.
3.  All incident reports will be reviewed by the appropriate 
    management staff, with emphasis on generating 
    recommendations of system or procedural changes to 
    prevent a recurrence of the incident.
4.  The incident report is a confidential document and must 
Incident Report Policy and Form
    be handled as such. It is not part of the patient's 
    medical record and must not be stored in the patient 
See the 'INCIDENT REPORT' form.

Approved By Governing Board
Control #12.0