1. MANDATORY INCIDENT REPORTING (HOSPITAL) UNIT KUALITI HRPB

2. MANDATORY R EPORTABLE I NCIDENTS (HOSPITALS) A: All Locations B: Operation Theatre/ Anaesthesia C: Critical Care Areas D: Labour Room E: Hemodialysis Unit *Incidents that are reported under the Private Healthcare Facilities and Services Act 1998 and Regulations 2006 (also to be reported by MOH hospitals).

3. A: A LL LOCATIONS Code 1 to 13 3

4. A: A LL LOCATIONS Code 1. Adverse outcome of clinical procedures (includes known complications). Definition: Outcomes that are not intended or desired to occur as a result of performing a particular procedure. e.g. Pneumothorax following central venous access, GIT perforation following endoscopy, perforation of bowel following peritoneal dialysis catheter insertion etc. 4

5. A: A LL LOCATIONS * Code 2. Death of patient by unexplained cause or under suspicious circumstances that are required to be reported to police. Definition: Applies to death in health care facility only. 5

6. * Code 3. Unforeseeable or unanticipated injuries to patients during their stay in hospital: 3a. brain or spinal cord injuries 3b. falls resulting in fractures, concussions or lacerations extending beyond the epidermis into deep tissue or which threaten vital structures. 3c. life-threatening (or potentially fatal) transfusion errors or reactions. 3d. 2nd or 3rd degree burns involving 20% more of the body surface area of an adult or 15% or more of the body surface area of a child. 6 medical care quality section A: All locations

7. * Code 4. Fire in hospital resulting in death or injury. * Code 5. Malfunction/ intentional or accidental misuse of patient care equipment that occurs during treatment or diagnosis of patient and that was averted, or, if not averted, would have significantly adversely affected patients or employees of the hospital. e.g. wrong ventilator setting, diathermy burn & etc. 7 medical care quality section A: All locations

8. * Code 6. Assault or battery of patients by employees and/or contractors (e.g. security personnel) including physical, mental or emotional abuse, mistreatment or harmful neglect of any patient. * Code 7. Dislodgement of catheter resulting in serious harm/danger to patient’s life. Definition: Includes CVP/ chest drains/ intra-arterial catheters. 8 medical care quality section A: All locations

9. * Code 8. Infant discharged to the wrong person / missing infant. * Code 9. Patient suicide, or attempted suicide while being cared for in a health care facility. * Code10. Patient death or serious disability due to electric shock while being cared for in a healthcare facility. 9 medical care quality section A: All locations

10. A: A LL LOCATIONS * Code 11. Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a health care facility. * Code 12. Abduction of a patient (of any age). * Any pt below 18 yrs old whether abducted or absconded need to notify as an incident. Pt above 18, only notify if they were abducted by someone including family members. 10 medical care quality section

11. A: A LL LOCATIONS * Code 13. Medication error resulting in serious adverse event/ death. Definition: A serious adverse events is one where there is much pain and suffering or temporary/ permanent disability. 11 medical care quality section

12. B: O PERATION THEATRE / ANAESTHESIA Code 14 to 21 medical care quality section 12

13. B: O PERATION THEATRE / ANAESTHESIA Code 14. Delayed discharge from the recovery room following an operation due to complications arising from surgery or anesthesia. Definition: “Delay” is considered as more than (>) 2 hours in the recovery room. 13 medical care quality section

14. * Code 15. Wrong surgery. Definition: Patient received unintended operation. e.g. Surgery performed on the wrong body part, surgery performed on the wrong patient, wrong surgical procedure performed on a patient, wrong site, wrong level operated on etc. 14 medical care quality section B: Operation theatre/ anaesthesia

15. Code 16. Unplanned return to OT within 24 hours of surgery for elective case. Definition: e.g. Re-laporatomy to secure haemostasis following cholecystectomy. Note: Patient must be sent back to e.g. the ward first for a “return” to OT happen. 15 medical care quality section B: Operation theatre/ anaesthesia

16. Code 17. No consent or improper operation consent. **Excluded are: changes in operative plan due to intra-operative findings. 16 medical care quality section B: Operation theatre/ anaesthesia

17. * Code 18. Life-threatening complications of anesthesia. e.g. 1 : Failed intubation in patients undergoing general anesthesia (Inability to secure endotracheal intubation after two attempts by skilled operator). e.g. 2 : Aspiration of gastric contents (A clinical diagnosis supported by signs e.g. diffuse crepitations and rhonchi, after exclusion of other causes). e.g. 3 : Reintubation in the operation room or recovery room such as inadequate reversal, overdose of opioids. 17 medical care quality section B: Operation theatre/ anaesthesia

18. * Code 19.Unintended retention of a foreign object in a patient after surgery or other procedure. Code 20. Incorrect Instrument or Swab Count. Definition: Instrument or Swab Count which is not reconciled at the end of an operation. 18 medical care quality section B: Operation theatre/ anaesthesia

19. Code 21. Surgery Cancelled in OT. Definition: Elective and emergency surgery cancelled before patient arrived in OT is not included. Who to fill the IR 1.1? - 1 st page by the anaes / surgeon - 2 nd page depends on the reason of cancellation 19 medical care quality section B: Operation theatre/ anaesthesia

20. C: CRITICAL CARE AREAS Code 22 only 20

21. C: C RITICAL CARE AREAS Code 22. Readmission to ICU within 24 hours of discharge to ward. Definition: Patients who had been discharged from ICU to general ward, now requires readmission to ICU within 24 hours of the discharge to ward (participating in National ICU Audit). 21

22. D: LABOUR ROOM Code 23 to 27 22

23. D: L ABOUR ROOM * Code 23. Delay in delivery of patients with cord prolapse where the fetus is alive. Definition: Delivery of the baby should be less than 30 minutes after decision is made. 23

24. D: L ABOUR ROOM * Code 24. Injury to neonate at delivery. Definition: Includes any type of injury suffered by the infant during the process of delivery irrespective of the mode of delivery. 24

25. D: L ABOUR ROOM Code 25. Unplanned admission of mother to ICU/ CCU/ HDW post- delivery. Definition: Admission that is not an expected outcome of delivery. Excludes cases of placenta praevia and heart disease in pregnancy. 25

26. D: L ABOUR ROOM Code 26. Unplanned post-delivery procedure on mother. e.g. Caesarian hysterectomy, EUA/ laparotomy for cervical tear post-delivery, re-EUA after MRP. 26

27. D: L ABOUR ROOM Code 27. Failed instrumental delivery. Definition: An unsuccessful delivery is one in which the doctor had to resort to a Caesarian section following failure to deliver using the initial choice instrument. 27

28. E: HEMODIALYSIS UNIT Code 28 to 29 28

29. E: H EMODIALYSIS UNIT * Code 28. Intradialytic death while on regular chronic haemodialysis treatment. Code 29. Seroconversion to positive Hepatitis B or Hepatitis C while on dialysis treatment. 29