Nursing Home Incident Report

Field	Detail
Date of Report	[Month, Day, Year]
Incident Date	[Month, Day, Year]
Time of Incident	Approximately 2:30 PM
Reported By	[Your Name], Staff Nurse
Position	RN (Registered Nurse)
Contact Information	[Your Company Email], Ext: 204
Incident Location	West Wing Hallway, near Room 112
Resident Involved	[Resident Name]
Resident Room Number	112
Age	78
Gender	Male
Incident Type	Medication Error Fall/Accident Injury Property Loss/Damage Verbal/Physical Abuse Other:

Description of Incident:

At approximately 2:30 PM on April 3, 2024, [Resident Name] was involved in an incident where he accidentally tripped and fell in the West Wing Hallway, near his room (Room 112). The fall resulted in a visible laceration on his right forearm and minor bruising around his right knee. [Resident Name] was attempting to navigate around a recently mopped area of the floor, which was not marked with a "wet floor" sign at the time.

Immediate Action Taken:

• Staff on site, including myself and two nurse aides, immediately assisted [Resident Name] to a seated position and assessed his condition.

• First aid was administered to the laceration on his right forearm, and an ice pack was applied to his knee to reduce swelling.

• [Resident Name] was then escorted to his room for further evaluation and to rest.

• A follow-up medical examination was conducted by [Doctor's Name], the attending physician, who confirmed the laceration required minor sutures and recommended an X-ray of the right knee to rule out any fractures.

• The family of [Resident Name] was notified of the incident by phone at 3:00 PM and provided with details of his condition and the actions taken.

Witness(es) Name and Contact Information:

[Employee Name], Nurse Aide	[Your Company Email], Ext: 207
[Employee Name], Nurse Aide	[Your Company Email], Ext: 208

Photographs Taken:

• Yes

• No

Photograph Description:

Photos of the incident location, showing the absence of a "wet floor" sign, and a photo documenting the initial injury.

Injury Assessment:

• Location of injury: Right forearm and right knee.

• Type of injury: Laceration and bruising.

• Severity: Minor laceration requiring sutures; bruising without apparent fracture.

Medical Intervention:

• Sutures were administered to the right forearm.

• An ice pack is applied to reduce swelling around the knee.

• X-ray of right knee scheduled.

Recommendations to Prevent Future Incidents

1. Immediate Placement of Safety Signage: Ensure that "wet floor" signs and other safety signage are immediately placed in areas undergoing cleaning or maintenance to prevent slips and falls.

2. Staff Training Enhancement: Organize comprehensive training sessions for all staff members on safety protocols, including the importance of timely signage placement and hazard identification.

3. Safety Audit of Common Areas: Conduct regular safety audits of all common areas and hallways to identify potential hazards that could lead to incidents, ensuring corrective measures are promptly implemented.

4. Emergency Response and First Aid Training: Schedule regular refresher courses for all staff on emergency response procedures and first aid to ensure preparedness for any type of incident.

5. Resident Safety Education: Implement an educational program for residents focusing on personal safety within the nursing home, including how to navigate common areas safely.

6. Review and Update Safety Policies: Periodically review and update existing safety and emergency response policies to reflect best practices and incorporate lessons learned from past incidents.

7. Incident Reporting System Enhancement: Improve the incident reporting system to ensure ease of use, enabling staff to quickly report hazards or incidents, facilitating faster response and documentation.

Follow-Up Actions

1. Monitor Resident's Recovery: Regularly check on [Resident Name]’s recovery progress, ensuring his well-being and comfort while recovering from the injuries sustained.

2. Implement Safety Recommendations: Begin the process of implementing the safety recommendations outlined above, starting with the most critical actions that have immediate impacts on resident safety.

3. Staff Training Sessions: Schedule and conduct the first set of enhanced training sessions for staff, focusing on safety awareness and emergency response, within one month from the date of the report.

4. Conduct Safety Audit: Plan and execute a comprehensive safety audit of the nursing home’s facilities and common areas to identify any potential hazards that need to be addressed to prevent similar incidents.

5. Engage Residents in Safety Education: Launch a safety awareness program for residents, including workshops and informational sessions on navigating the nursing home safely.

6. Review of Incident Reporting and Response Process: Evaluate the current incident reporting and response process for efficiency and effectiveness, making necessary adjustments to ensure rapid and appropriate responses to future incidents.

7. Scheduled Review of Implemented Measures: Set a date for reviewing the effectiveness of the implemented safety measures and training programs, with adjustments to be made based on feedback and observed outcomes.

Report Filed By:

[Your Name]

[Month, Day, Year]

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