Medication Administration SOP Template
A free medication administration SOP template for healthcare teams. Use it directly - no signup or email.
What is a medical incident report?
A medical incident report is a formal record of any event that caused or could have caused harm to a patient, staff member, or visitor. It is used by risk management teams to identify patterns and prevent recurrence.
The template
Medical Incident Report Template
MEDICAL INCIDENT REPORT
Report number:
[Auto-assigned or enter manually]
Date:
[Date]
Reported by:
[Name and role]
Department:
[Department or ward]
Confidential:
Yes - not for patient clinical notes
SECTION 1 - INCIDENT DETAILS
Date:
[Date]
Time:
[Time]
Location:
[Ward/unit / specific location]
Incident type:
- Medication error
- Patient fall
- Pressure injury
- Clinical deterioration
- Procedure complication
- Equipment failure
- Healthcare-associated infection
- Blood transfusion error
- Diagnostic error
- Communication failure
- Aggression or violence
- Near miss
- Other:
Severity:
- No harm - reached patient, no detectable harm
- Low harm - minimal harm, no treatment required
- Moderate harm - short-term harm, treatment required
- Severe harm - permanent or long-term harm
- Death - event contributed to patient death
SECTION 2 - PATIENT DETAILS
Patient identifier:
[Hospital number - not full name]
Age:
[Age or date of birth]
Gender:
[Gender]
Admission date:
[Date]
Primary diagnosis:
[Working diagnosis at time of incident]
SECTION 3 - STAFF INVOLVED
Staff 1:
Name:Role:Years in role:
Present at incident:
YesNo
Staff 2:
Name:Role:Years in role:
Present at incident:
YesNo
Agency or locum involved:
Yes - role:No
SECTION 4 - INCIDENT DESCRIPTION
What happened? (facts only - no opinions)
What was the patient doing at the time?
What was the staff member doing at the time?
SECTION 5 - IMMEDIATE ACTIONS
Immediate action taken:
Treatment required:
Yes - describe:No
Patient condition affected:
Yes - describe:No
Patient or family notified:
- Yes - by whom and when:
- No - reason:
SECTION 6 - CONTRIBUTING FACTORS
Tick all that apply:
Patient:
- Condition complexity
- Non-compliance
- Comm barrier
Staff and team:
- Staffing levels
- Fatigue
- Skill gap
- Supervision gap
- Comm between staff
Environment and equipment:
- Equipment failure
- Environmental hazard
- Facilities
Process and policy:
- Absent or unclear SOP
- Policy not followed
- Handover failure
- Documentation error
Organisation:
- Inadequate training
- Time pressure
- Resources
Other:
UnknownOther:
SECTION 7 - WITNESSES
Witnesses:
YesNo
Witness 1:
Name:Role:Contact:
Witness 2:
Name:Role:Contact:
SECTION 8 - SENTINEL EVENT AND RCA CHECK
Sentinel event:
Yes - notify immediatelyNoUncertain
RCA required:
YesNoTo be determined
SECTION 9 - NOTIFICATIONS
Nurse in charge:
Yes - NameTimeNo
Medical officer:
Yes - NameTimeNo
Department manager:
Yes - NameTimeNo
Risk manager:
Yes - NameTimeNo
External:
Yes - to whom:No
SECTION 10 - RECOMMENDATIONS
Immediate changes:
Longer-term changes:
Responsible:
Target date:
SECTION 11 - SIGN-OFF
Completed by:
Name:Role:Date:
Reviewed by:
Name:Role:Date:
Submitted to risk management:
Date:Reference:
IMPORTANT: Do not place in patient clinical notes.
Do not disclose without risk manager approval.
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What this template covers
Incident details
date, time, location, type, and severity
Patient details
identifier, age, diagnosis at time of incident
Staff involved
names, roles, experience, agency staff
Incident description
factual chronological account only
Immediate actions
treatment, patient condition, family notification
Contributing factors
patient, staff, environment, process, organisation
Witnesses
names and contact details
Sentinel event and RCA check
escalation and investigation triggers
Notifications
who was notified and when
Recommendations
immediate and longer-term changes
Sign-off
completed, reviewed, submitted to risk management
Confidentiality notice
how this document must be handled
How to use this template
Complete immediately after the incident
Fill in the report as soon as the patient is safe - most organisations require submission within four hours.
Complete Section 1 first
Incident type and severity determine who gets notified and whether an RCA is required.
Write Section 4 with facts only
State what was observed in chronological order - no assumptions or causes.
Tick all contributing factors in Section 6
Include every factor that played a role - not just the most obvious one.
Check Section 8 carefully
If unsure whether this is a sentinel event, escalate to your risk manager rather than deciding alone.
Submit within your required timeframe
Enter the reference number in Section 11 and do not keep the report outside the risk management system.
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