Incident Report

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  Incident Report (PDF, 245 KB)

Instructions: Imagine you are a registered nurse at Main Street Hospital. One of your patients is Nancy Williams, a 66-year-old female who has recently undergone a double knee replacement. Nancy has been recovering since her operation three days ago. She is currently assigned to room 411. At 9:30 a.m., while you were checking Nancy’s vital signs, you noticed a pressure sore on the back of her upper left leg. A CNA who is working with you, Jim Hamlin, also saw the pressure sore. Nancy did not have this sore when she was admitted to the hospital. You notice that it is a Stage I sore that, while not severe right now, requires attention and treatment. After discovering the pressure sore, you notified your supervisor, Dr. Molofsky, and he came to see the patient at noon.

Note: When filling out this form, use today's date.