PREHOSPITAL DRUG AND IV BOX INCIDENT REPORT
INSTRUCTIONS
| WHAT TO REPORT: | Any perceived problem
that could adversely affect pre-hospital care; any
incident having occurred that represents a deviation from
established policy or procedure; any infection control hazard; any unusual occurrence,
regardless of whether harm or damage resulted. |
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| WHO REPORTS: | - Any individual ALS
technician or ALS Agency representative. - Representatives of hospital Emergency rooms. - Representatives of hospital pharmacies. - TEMS staff members |
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| WHEN TO REPORT: | An incident report should
be generated as soon as a potential problem has been
discovered or an incident has occurred. Reports should be
forwarded to the TEMS office as soon as possible. |
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| HOW TO REPORT: | The originator should
complete all sections in the upper third of the form,
describing the problem/incident concisely, and recording
of the box number(s) as well as the EMS agency exchanging the box and
the last hospital restocking the box. All reports originated by ALS agency personnel will be submitted to the Chief Operations officer or EMS officer, as appropriate, for problem resolution at the agency level. If Agency Can Solve: ALS Agency Supervisor completes the lower third of the form, and sends the yellow copy to TEMS for file. If Agency Cannot Solve: Both original and yellow copies should be forwarded to TEMS for solution/corrective action. All reports originated by hospital emergency rooms or pharmacies will be forwarded to TEMS for problem resolution/corrective action. |
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| COPY DISTRIBUTION: |
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TIDEWATER
EMERGENCY MEDICAL SERVICES COUNCIL, INC.
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