Assignment Prompt & Instructions
– ## EventReportTemplatePartB.docx
– ## EventReportTemplatePartA1.docx
– ## EventReportAssignmentInstructions.Thakur.04.10.25.docx
**## EventReportTemplatePartB.docx**
Event Report Assignment Part B
[Student Name]
[Course Number]: [Course Name]
[Professor's Name]
West Coast University Los Angeles Campus
[Due Date]
**Part B – QUESTIONS TO ANSWER (MUST BE HANDWRITTEN)**
1. What is the incident report used for?
2. How do incident reports improve patient care?
3. What information is included in an incident report?
4. Who completes the incident report? Once completed what do you do with the incident report?
5. True / False Documentation in the patient record should include the fact that an incident report was filed.
6. What is a sentinel event?
7. What is the difference between a near miss and an actual incident?
References
**## EventReportTemplatePartA1.docx**
Event Report Assignment Part A
[Student Name]
[Course Number]: [Course Name]
[Professor's Name]
West Coast University Los Angeles Campus
[Due Date]
**TO BE COMPLETED ONLY IF LOST TIME/INJURY OR FIRST AID WAS REQUIRED:**
**Type of Injury Sustained:**
**Cause of lost time/injury or first aid**
**Was medical treatment necessary?**
□ Yes □ No
_If yes_, name of hospital &/or treating physician:
\_\_\________________________________________________________
**Incident Reporting Form**
_Use this form to report any workplace accident/injury, incident, close call, or illness._
_Return completed form to the Operations Supervisor or _________________________
**Type of Report:**
**□** **□ □ □ □ □**
**Lost Time/ First Aid Incident Near Miss Observation Unprofessional**
**Injury or Inappropriate Behavior**
***Details of person involved (to be completed by person injured/involved, if possible)**
**Person Completing Report: ______________________________________________Date:__________________**
**Person(s) Involved: ___________________________________________________________________________**
**Equipment ID (**
**_if applicable_): _________________________**
**Event Details**
**Date of Event: _______________ Location of Event (be specific): ______________________________**
**Time of Event: ______________ Witnesses: _______________________________________________**
**Description of Event (Describe tasks being performed and sequence of events)**
**\_\_\__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________**
*****
**_If more space is required use the back of this form_**
**_If known_, cause of event/injury:**
·
**Unsafe act (activity or movement)?**
·
**Unsafe condition (environment, device, or weather)?**
**Explain:**
**\_\_\________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________**
**Signature of**
**~~Employee~~ Student: _________________________________Date: _______________________**
**Signature of Risk Manager:**(leave blank)
**_________________________Date: _______________________**
**## EventReportAssignmentInstructions.Thakur.04.10.25.docx**
**EVENT REPORT ASSIGNMENT**
**INSTRUCTIONS**
In this assignment, you will be given two different scenarios. You will choose one scenario and complete a two-part assignment using the provided templates (Part A & Part B).
**The assignment consists of two parts:**
**Part A:** Complete an event/incident report based on your chosen scenario.
**Part B:** Answer the handwritten questions in the same template document.
**IMPORTANT REQUIREMENTS**
·
**Choose only ONE scenario** from the two provided below.
·
**Identify only ONE problem** in your chosen scenario (each scenario contains multiple issues).
· When completing the event report template (
**Part A**):
· Use objective information only.
· Be brief and factual.
· Use short declarative sentences.
· Focus on ONE problem per incident report.
· Use the template provided.
· For the handwritten questions template (
**Part B**):
· All answers MUST be handwritten.
· Each answer requires a minimum of 5 sentences.
· Include in-text citations.
· Use the template provided.
· Provide 3 references from the last 5 years (references may be typed).
· Your submission must include:
· A title page.
· Page numbers.
· Both Part A and Part B completed in the provided templates.
**IMPORTANT NOTE**
Please download the templates (Part A and Part B) document, which contains:
1. The event report form (Part A)
2. The questions to be answered (Part B)
Both parts must be completed and submitted together.
**SCENARIOS (CHOOSE ONE)**
**EVENT SCENARIO – 1**
John Williams, a 44 year-old patient who arrives in the ED with complaints of a terrible headache. He has a blindfold on to shield all light in an attempt to reduce his pain currently reported to be 9/10. After a quick assessment, the physician orders the patient to receive pain medication in the form of a pill.
The order reads Norco 7.5 mg — 325 mg two tablets every 4 hours prn moderate pain (6-8/10).
Nurse Judy removes the medicine and takes it to the bedside where she has difficulty scanning the medication but the patient is moaning and grabbing his head so she overrides the scanner. Later, the supervisor asks Nurse Judy why the count is wrong for Norco 10mg -325mg. It is determined that Mr. Williams received a larger dose than was ordered.
When Nurse Judy left for the day she met her carpool driver in the elevator who asked her how her day went.
The elevator was crowded and Judy was daydreaming but blurted out, "my supervisor got all bent out of shape because I gave Mr. Williams the wrong dose for his pain pill. I'm sure he didn't mind since he went to sleep and no more moaning with a headache. Can you imagine coming to the ED for a headache?"
**EVENT SCENARIO – 2**
Lynette Donovan, a 15-year-old female African American was a passenger in a motor vehicle collision and is now admitted to the hospital with a fractured right femur. The emergency department health care provider applied a cast to the affected leg with insufficient padding.
· Lynnette told the nurses that her right leg felt numb, was swollen and looked discolored.
· The nurses recognized that these symptoms indicate impaired circulation in the extremity with the cast.
· The nurse was unable to reach Lynette's health care provider despite several calls.
· The nurse has not notified the nursing supervisor of the patient's situation.
· David Ortiz is a 23-year-old nursing student newly assigned to the nursing division and to Miss Donovan. His initial assessment notes that the patient's right leg is swollen, slightly blue, and slightly malodorous. Lynette seems very anxious and upset.
· David remembers that Lynette Donovan is legally a minor. She is hurt and afraid and in an unfamiliar setting.
· She may not be comfortable speaking with the health care providers who are present, and her expressions of pain may be modified by the circumstances she is in.
· Lynette Donovan developed gangrene in the right leg. She requires a right below-the-knee amputation.
· David Ortiz is returning from escorting Miss Donovan to the operating room for her procedure. He gets on the elevator, where several visitors and two nursing supervisors are talking about the health care provider who "made Donovan lose her leg."
**## EventReportAssignmentInstructions.Thakur.04.10.25.docx**
**EVENT REPORT ASSIGNMENT**
**INSTRUCTIONS**
In this assignment, you will be given two different scenarios. You will choose one scenario and complete a two-part assignment using the provided templates (Part A & Part B).
**The assignment consists of two parts:**
**Part A:** Complete an event/incident report based on your chosen scenario.
**Part B:** Answer the handwritten questions in the same template document.
**IMPORTANT REQUIREMENTS**
·
**Choose only ONE scenario** from the two provided below.
·
**Identify only ONE problem** in your chosen scenario (each scenario contains multiple issues).
· When completing the event report template (
**Part A**):
· Use objective information only.
· Be brief and factual.
· Use short declarative sentences.
· Focus on ONE problem per incident report.
· Use the template provided.
· For the handwritten questions template (
**Part B**):
· All answers MUST be handwritten.
· Each answer requires a minimum of 5 sentences.
· Include in-text citations.
· Use the template provided.
· Provide 3 references from the last 5 years (references may be typed).
· Your submission must include:
· A title page.
· Page numbers.
· Both Part A and Part B completed in the provided templates.
**IMPORTANT NOTE**
Please download the templates (Part A and Part B) document, which contains:
1. The event report form (Part A)
2. The questions to be answered (Part B)
Both parts must be completed and submitted together.
**SCENARIOS (CHOOSE ONE)**
**EVENT SCENARIO – 1**
John Williams, a 44 year-old patient who arrives in the ED with complaints of a terrible headache. He has a blindfold on to shield all light in an attempt to reduce his pain currently reported to be 9/10. After a quick assessment, the physician orders the patient to receive pain medication in the form of a pill.
The order reads Norco 7.5 mg — 325 mg two tablets every 4 hours prn moderate pain (6-8/10).
Nurse Judy removes the medicine and takes it to the bedside where she has difficulty scanning the medication but the patient is moaning and grabbing his head so she overrides the scanner. Later, the supervisor asks Nurse Judy why the count is wrong for Norco 10mg -325mg. It is determined that Mr. Williams received a larger dose than was ordered.
When Nurse Judy left for the day she met her carpool driver in the elevator who asked her how her day went.
The elevator was crowded and Judy was daydreaming but blurted out, "my supervisor got all bent out of shape because I gave Mr. Williams the wrong dose for his pain pill. I'm sure he didn't mind since he went to sleep and no more moaning with a headache. Can you imagine coming to the ED for a headache?"
**EVENT SCENARIO – 2**
Lynette Donovan, a 15-year-old female African American was a passenger in a motor vehicle collision and is now admitted to the hospital with a fractured right femur. The emergency department health care provider applied a cast to the affected leg with insufficient padding.
· Lynnette told the nurses that her right leg felt numb, was swollen and looked discolored.
· The nurses recognized that these symptoms indicate impaired circulation in the extremity with the cast.
· The nurse was unable to reach Lynette's health care provider despite several calls.
· The nurse has not notified the nursing supervisor of the patient's situation.
· David Ortiz is a 23-year-old nursing student newly assigned to the nursing division and to Miss Donovan. His initial assessment notes that the patient's right leg is swollen, slightly blue, and slightly malodorous. Lynette seems very anxious and upset.
· David remembers that Lynette Donovan is legally a minor. She is hurt and afraid and in an unfamiliar setting.
· She may not be comfortable speaking with the health care providers who are present, and her expressions of pain may be modified by the circumstances she is in.
· Lynette Donovan developed gangrene in the right leg. She requires a right below-the-knee amputation.
· David Ortiz is returning from escorting Miss Donovan to the operating room for her procedure. He gets on the elevator, where several visitors and two nursing supervisors are talking about the health care provider who "made Donovan lose her leg."
**## EventReportTemplatePartB.docx**
Event Report Assignment Part B
[Student Name]
[Course Number]: [Course Name]
[Professor's Name]
West Coast University Los Angeles Campus
[Due Date]
**Part B – QUESTIONS TO ANSWER (MUST BE HANDWRITTEN)**
1. What is the incident report used for?
2. How do incident reports improve patient care?
3. What information is included in an incident report?
4. Who completes the incident report? Once completed what do you do with the incident report?
5. True / False Documentation in the patient record should include the fact that an incident report was filed.
6. What is a sentinel event?
7. What is the difference between a near miss and an actual incident?
References
**## EventReportTemplatePartA1.docx**
Event Report Assignment Part A
[Student Name]
[Course Number]: [Course Name]
[Professor's Name]
West Coast University Los Angeles Campus
[Due Date]
**TO BE COMPLETED ONLY IF LOST TIME/INJURY OR FIRST AID WAS REQUIRED:**
**Type of Injury Sustained:**
**Cause of lost time/injury or first aid**
**Was medical treatment necessary?**
□ Yes □ No
_If yes_, name of hospital &/or treating physician:
\_\_\________________________________________________________
**Incident Reporting Form**
_Use this form to report any workplace accident/injury, incident, close call, or illness._
_Return completed form to the Operations Supervisor or _________________________
**Type of Report:**
**□** **□ □ □ □ □**
**Lost Time/ First Aid Incident Near Miss Observation Unprofessional**
**Injury or Inappropriate Behavior**
***Details of person involved (to be completed by person injured/involved, if possible)**
**Person Completing Report: ______________________________________________Date:__________________**
**Person(s) Involved: ___________________________________________________________________________**
**Equipment ID (**
**_if applicable_): _________________________**
**Event Details**
**Date of Event: _______________ Location of Event (be specific): ______________________________**
**Time of Event: ______________ Witnesses: _______________________________________________**
**Description of Event (Describe tasks being performed and sequence of events)**
**\_\_\__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________**
*****
**_If more space is required use the back of this form_**
**_If known_, cause of event/injury:**
·
**Unsafe act (activity or movement)?**
·
**Unsafe condition (environment, device, or weather)?**
**Explain:**
**\_\_\________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________**
**Signature of**
**~~Employee~~ Student: _________________________________Date: _______________________**
**Signature of Risk Manager:**(leave blank)
**_________________________Date: _______________________**
**## EventReportAssignmentInstructions.Thakur.04.10.25.docx**
**EVENT REPORT ASSIGNMENT**
**INSTRUCTIONS**
In this assignment, you will be given two different scenarios. You will choose one scenario and complete a two-part assignment using the provided templates (Part A & Part B).
**The assignment consists of two parts:**
**Part A:** Complete an event/incident report based on your chosen scenario.
**Part B:** Answer the handwritten questions in the same template document.
**IMPORTANT REQUIREMENTS**
·
**Choose only ONE scenario** from the two provided below.
·
**Identify only ONE problem** in your chosen scenario (each scenario contains multiple issues).
· When completing the event report template (
**Part A**):
· Use objective information only.
· Be brief and factual.
· Use short declarative sentences.
· Focus on ONE problem per incident report.
· Use the template provided.
· For the handwritten questions template (
**Part B**):
· All answers MUST be handwritten.
· Each answer requires a minimum of 5 sentences.
· Include in-text citations.
· Use the template provided.
· Provide 3 references from the last 5 years (references may be typed).
· Your submission must include:
· A title page.
· Page numbers.
· Both Part A and Part B completed in the provided templates.
**IMPORTANT NOTE**
Please download the templates (Part A and Part B) document, which contains:
1. The event report form (Part A)
2. The questions to be answered (Part B)
Both parts must be completed and submitted together.
**SCENARIOS (CHOOSE ONE)**
**EVENT SCENARIO – 1**
John Williams, a 44 year-old patient who arrives in the ED with complaints of a terrible headache. He has a blindfold on to shield all light in an attempt to reduce his pain currently reported to be 9/10. After a quick assessment, the physician orders the patient to receive pain medication in the form of a pill.
The order reads Norco 7.5 mg — 325 mg two tablets every 4 hours prn moderate pain (6-8/10).
Nurse Judy removes the medicine and takes it to the bedside where she has difficulty scanning the medication but the patient is moaning and grabbing his head so she overrides the scanner. Later, the supervisor asks Nurse Judy why the count is wrong for Norco 10mg -325mg. It is determined that Mr. Williams received a larger dose than was ordered.
When Nurse Judy left for the day she met her carpool driver in the elevator who asked her how her day went.
The elevator was crowded and Judy was daydreaming but blurted out, "my supervisor got all bent out of shape because I gave Mr. Williams the wrong dose for his pain pill. I'm sure he didn't mind since he went to sleep and no more moaning with a headache. Can you imagine coming to the ED for a headache?"
**EVENT SCENARIO – 2**
Lynette Donovan, a 15-year-old female African American was a passenger in a motor vehicle collision and is now admitted to the hospital with a fractured right femur. The emergency department health care provider applied a cast to the affected leg with insufficient padding.
· Lynnette told the nurses that her right leg felt numb, was swollen and looked discolored.
· The nurses recognized that these symptoms indicate impaired circulation in the extremity with the cast.
· The nurse was unable to reach Lynette's health care provider despite several calls.
· The nurse has not notified the nursing supervisor of the patient's situation.
· David Ortiz is a 23-year-old nursing student newly assigned to the nursing division and to Miss Donovan. His initial assessment notes that the patient's right leg is swollen, slightly blue, and slightly malodorous. Lynette seems very anxious and upset.
· David remembers that Lynette Donovan is legally a minor. She is hurt and afraid and in an unfamiliar setting.
· She may not be comfortable speaking with the health care providers who are present, and her expressions of pain may be modified by the circumstances she is in.
· Lynette Donovan developed gangrene in the right leg. She requires a right below-the-knee amputation.
· David Ortiz is returning from escorting Miss Donovan to the operating room for her procedure. He gets on the elevator, where several visitors and two nursing supervisors are talking about the health care provider who "made Donovan lose her leg."
**## EventReportTemplatePartB.docx**
Event Report Assignment Part B
[Student Name]
[Course Number]: [Course Name]
[Professor's Name]
West Coast University Los Angeles Campus
[Due Date]
**Part B – QUESTIONS TO ANSWER (MUST BE HANDWRITTEN)**
1. What is the incident report used for?
2. How do incident reports improve patient care?
3. What information is included in an incident report?
4. Who completes the incident report? Once completed what do you do with the incident report?
5. True / False Documentation in the patient record should include the fact that an incident report was filed.
6. What is a sentinel event?
7. What is the difference between a near miss and an actual incident?
References
**## EventReportTemplatePartA1.docx**
Event Report Assignment Part A
[Student Name]
[Course Number]: [Course Name]
[Professor's Name]
West Coast University Los Angeles Campus
[Due Date]
**TO BE COMPLETED ONLY IF LOST TIME/INJURY OR FIRST AID WAS REQUIRED:**
**Type of Injury Sustained:**
**Cause of lost time/injury or first aid**
**Was medical treatment necessary?**
□ Yes □ No
_If yes_, name of hospital &/or treating physician:
\_\_\________________________________________________________
**Incident Reporting Form**
_Use this form to report any workplace accident/injury, incident, close call, or illness._
_Return completed form to the Operations Supervisor or _________________________
**Type of Report:**
**□** **□ □ □ □ □**
**Lost Time/ First Aid Incident Near Miss Observation Unprofessional**
**Injury or Inappropriate Behavior**
***Details of person involved (to be completed by person injured/involved, if possible)**
**Person Completing Report: ______________________________________________Date:__________________**
**Person(s) Involved: ___________________________________________________________________________**
**Equipment ID (**
**_if applicable_): _________________________**
**Event Details**
**Date of Event: _______________ Location of Event (be specific): ______________________________**
**Time of Event: ______________ Witnesses: _______________________________________________**
**Description of Event (Describe tasks being performed and sequence of events)**
**\_\_\__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________**
*****
**_If more space is required use the back of this form_**
**_If known_, cause of event/injury:**
·
**Unsafe act (activity or movement)?**
·
**Unsafe condition (environment, device, or weather)?**
**Explain:**
**\_\_\________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________**
**Signature of**
**~~Employee~~ Student: _________________________________Date: _______________________**
**Signature of Risk Manager:**(leave blank)
**_________________________Date: _______________________**
**## EventReportAssignmentInstructions.Thakur.04.10.25.docx**
**EVENT REPORT ASSIGNMENT**
**INSTRUCTIONS**
In this assignment, you will be given two different scenarios. You will choose one scenario and complete a two-part assignment using the provided templates (Part A & Part B).
**The assignment consists of two parts:**
**Part A:** Complete an event/incident report based on your chosen scenario.
**Part B:** Answer the handwritten questions in the same template document.
**IMPORTANT REQUIREMENTS**
·
**Choose only ONE scenario** from the two provided below.
·
**Identify only ONE problem** in your chosen scenario (each scenario contains multiple issues).
· When completing the event report template (
**Part A**):
· Use objective information only.
· Be brief and factual.
· Use short declarative sentences.
· Focus on ONE problem per incident report.
· Use the template provided.
· For the handwritten questions template (
**Part B**):
· All answers MUST be handwritten.
· Each answer requires a minimum of 5 sentences.
· Include in-text citations.
· Use the template provided.
· Provide 3 references from the last 5 years (references may be typed).
· Your submission must include:
· A title page.
· Page numbers.
· Both Part A and Part B completed in the provided templates.
**IMPORTANT NOTE**
Please download the templates (Part A and Part B) document, which contains:
1. The event report form (Part A)
2. The questions to be answered (Part B)
Both parts must be completed and submitted together.
**SCENARIOS (CHOOSE ONE)**
**EVENT SCENARIO – 1**
John Williams, a 44 year-old patient who arrives in the ED with complaints of a terrible headache. He has a blindfold on to shield all light in an attempt to reduce his pain currently reported to be 9/10. After a quick assessment, the physician orders the patient to receive pain medication in the form of a pill.
The order reads Norco 7.5 mg — 325 mg two tablets every 4 hours prn moderate pain (6-8/10).
Nurse Judy removes the medicine and takes it to the bedside where she has difficulty scanning the medication but the patient is moaning and grabbing his head so she overrides the scanner. Later, the supervisor asks Nurse Judy why the count is wrong for Norco 10mg -325mg. It is determined that Mr. Williams received a larger dose than was ordered.
When Nurse Judy left for the day she met her carpool driver in the elevator who asked her how her day went.
The elevator was crowded and Judy was daydreaming but blurted out, "my supervisor got all bent out of shape because I gave Mr. Williams the wrong dose for his pain pill. I'm sure he didn't mind since he went to sleep and no more moaning with a headache. Can you imagine coming to the ED for a headache?"
**EVENT SCENARIO – 2**
Lynette Donovan, a 15-year-old female African American was a passenger in a motor vehicle collision and is now admitted to the hospital with a fractured right femur. The emergency department health care provider applied a cast to the affected leg with insufficient padding.
· Lynnette told the nurses that her right leg felt numb, was swollen and looked discolored.
· The nurses recognized that these symptoms indicate impaired circulation in the extremity with the cast.
· The nurse was unable to reach Lynette's health care provider despite several calls.
· The nurse has not notified the nursing supervisor of the patient's situation.
· David Ortiz is a 23-year-old nursing student newly assigned to the nursing division and to Miss Donovan. His initial assessment notes that the patient's right leg is swollen, slightly blue, and slightly malodorous. Lynette seems very anxious and upset.
· David remembers that Lynette Donovan is legally a minor. She is hurt and afraid and in an unfamiliar setting.
· She may not be comfortable speaking with the health care providers who are present, and her expressions of pain may be modified by the circumstances she is in.
· Lynette Donovan developed gangrene in the right leg. She requires a right below-the-knee amputation.
· David Ortiz is returning from escorting Miss Donovan to the operating room for her procedure. He gets on the elevator, where several visitors and two nursing supervisors are talking about the health care provider who "made Donovan lose her leg."
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