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Scenario: Johnny Parker (DOB 06/15/10) saw Jean Burke, NP, for a well-child visit. Johnny is off schedule with his hepatitis B vaccine series, and today he is to get his last hepatitis B booster. You (a medical assistant) prepare the medication and give the injection in his right deltoid muscle. Later in the day, you realize that hepatitis B has been out of stock for 1 week. You must have given a hepatitis A booster to Johnny. You realize that you failed to read the label three times during the preparation of the medication. You report the mistake to Jean Burke, NP, and your supervisor. Your supervisor calls Lisa Parker, Johnny’s mother. They will come back next week for the hepatitis B vaccine. You need to complete the incident report.

Equipment and supplies: Incident report form & black pen

Information about the drug administered: 

– Brand name: ?

– Dosage: ?

– Route of administration: ?

– Adverse reactions: ? 

– Description of incident (Who, What, Where, How, Why; include sequence of events, personnel involved, reason incident occurred): ?

– Actions taken by staff members: ?

– Details of patient injury or adverse reactions: ?

– Witness name: ?

– Phone number: ?

– Address: ?

– Corrective action taken/follow-up (things that have been or will be done to prevent recurrence): ?

– Office Manager comments: ?

– Office Manager signature: ?          – Date: ?

– Provider comments: ?

Provider signature: ____________?_________________Title:_______?________Date:___?______

 

 

SCIENCE
HEALTH SCIENCE
NURSING
NURSING 100

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