Anesthesiology M&M:<Division><For DOS>

<Date Presented>

Resident / Fellow PresenterTitle

Faculty Mentor

SUMMARY OF OR EVENTS REPORTEDData Range:    

TOTAL CASES ST - OR NT - OR TOTAL COMPLICATIONS

Dental Damage / Lip Lac.

N / V

Recall

Regional Complication

Ischemia / AMI

Cardiac Arrest / Green Button

Hypotension

Hypoxia

Re – intubation within 48 hrs

Other (Define)

Deaths

PRIVILEGED DOCUMENT: Pursuant F.S. 395.0191, 395.0193, 395.0197, 766.101, and/or F.S. 766.1016 this document is privileged and confidential. It is not subject to discovery. DO NOT copy, print, forward, or release.

Morbidity Report<Date Range>

Date Pt. Name MR # Complication Attending Resident

PRIVILEGED DOCUMENT: Pursuant F.S. 395.0191, 395.0193, 395.0197, 766.101, and/or F.S. 766.1016 this document is privileged and confidential. It is not subject to discovery. DO NOT copy, print, forward, or release.

PRIVILEGED DOCUMENT: Pursuant F.S. 395.0191, 395.0193, 395.0197, 766.101, and/or F.S. 766.1016 this document is privileged and confidential. It is not subject to discovery. DO NOT copy, print, forward, or release.

Date Patient Name MR # Cause of Death Attending Resident

Mortality Report<Date Range>

Case for Discussion

Case for Discussion

Case for Discussion

Case for Discussion

Case for Discussion

Characterize the incidentNo adverse outcomeNear miss (no adverse outcome)Major adverse outcomeCatastrophic adverse outcome (grim prognosis) Sentinel event (death)

Classification/CompetenciesThe issue occurred as a problem related to (check all that apply):Medical knowledgePatient care provided/not providedCommunication/Interpersonal skillsProfessionalismPractice-based learning and improvementSystems-based practice

What I would do differently in same/similar case

1. Insert point #1 here and describe…….

2. Insert point #2 here and describe…….

Key Issue(s) & Take-Home Points

Division of Pediatric Anesthesiology

References: