Get Ut Patient Safety Sentinel Event Reporting Form 2007-2025
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How to fill out the UT Patient Safety Sentinel Event Reporting Form online
This guide will assist you in accurately completing the UT Patient Safety Sentinel Event Reporting Form online. Following these instructions will help ensure that all necessary information is captured effectively.
Follow the steps to complete the form efficiently.
- Click ‘Get Form’ button to obtain the form and open it in your selected tool.
- Begin by filling out the facility information. Input the name of the facility, your name as the person reporting, your email address, and your telephone number. Provide your title if applicable.
- Complete the patient information section. Enter the patient's date of birth, age, and gender. Specify the principal admitting diagnoses, including relevant ICD codes if known. Proceed to list the principal discharge diagnoses with appropriate ICD and CPT codes.
- In the event information section, enter the date and time of the event. Include the date of determination along with any relevant patient outcomes. Check the appropriate box regarding the patient's cognitive status prior to the event and document the location where the event occurred.
- Indicate the type of occurrence by checking the relevant options. This could include a range of events, such as surgery errors or device-related incidents. Ensure you provide additional details in the space available if necessary.
- In the analysis and corrective action section, check all applicable types of harm or outcomes resulting from the event. Document any contributing factors and actions taken in response to the event.
- Finally, review all the information you have inputted for accuracy. Once verified, save any changes made, and you may choose to download, print, or share the completed form as required.
Ensure timely reporting and improve patient safety by completing the UT Patient Safety Sentinel Event Reporting Form online.
Responsibility for reporting a patient incident lies primarily with the healthcare professionals who witness or are involved in the incident. However, everyone in the healthcare setting has a role in fostering a safe environment by reporting issues. The UT Patient Safety Sentinel Event Reporting Form equips healthcare workers and patients alike with the tools necessary to ensure incidents are reported and addressed promptly.
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