Writing Incident Reports Flashcards
6 cards from real CELBAN practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Writing Incident Reports flashcards as text
When writing an incident report, which of the following statements is the most appropriate and professional?
Answer: Patient found on floor at 07:30. Stated, "I was trying to reach my water glass and I slipped."
This statement is the most appropriate because it is objective and factual. It states the time, what was observed, and includes a direct quote from the patient without adding any personal opinions, assumptions, or blame.
A nurse is preparing an incident report after a patient received the wrong dose of medication. Which of the following details is LEAST necessary to include in the report?
Answer: The nurse's opinion on why the error occurred.
Incident reports should be factual and objective. Including personal opinions, speculation, or blame is inappropriate and unprofessional. The other options are all critical facts of the incident that must be documented.
You are a nurse who witnessed a visitor slip and fall on a wet floor in the hospital hallway. The visitor states they are not injured, but you insist on completing an incident report. What is the primary purpose of writing this report?
Answer: To document the event for risk management and quality improvement.
The main purpose of an incident report is to serve as a tool for the healthcare organization to track and analyze events for risk management, identify patterns, and implement changes to improve safety and quality of care. It is not primarily for billing, discipline, or legal action for the injured party.
Which of the following BEST describes the type of language that should be used when writing the narrative portion of an incident report?
Answer: Objective, factual, and chronological.
Incident reports require clear, objective, and factual language. The events should be described in the order they occurred (chronologically) without including personal feelings, judgments, or assumptions.
A nurse finds a patient on the floor beside their bed. After assessing the patient and ensuring their immediate safety, the nurse calls the physician. What is the next most appropriate action regarding documentation?
Answer: Document the factual details of the fall and the physician notification in the patient's chart.
The nurse should document the objective facts of the incident (what was seen, the patient's condition, actions taken) in the patient's medical record. The incident report is a separate, internal administrative tool and reference to it should not be made in the patient's chart.
When documenting an incident, which piece of information is considered 'subjective' data?
Answer: The patient stating, "I feel dizzy."
Subjective data is information reported by the patient that cannot be directly measured or observed by the healthcare provider. The patient's feeling of dizziness is their personal experience. The other options are objective data, which are measurable and observable facts.