Event reporting that closes the loop in your hospital
Report fast, classify the same day, and show the board that every fix held.
Who reports, who signs
Nurses, physicians, pharmacists and ancillary staff report. Unit managers investigate, risk and quality classify and sign, and the CNO and governing body review the trends.
You answer to
SAMPLE RECORD · SYNTHETIC DATA
Where reporting breaks down.
Reporting is a chore, so it is rare
A long form after a twelve-hour shift gets skipped. Serious events reach risk management; the near misses that predict them do not.
Investigations end in a document, not a change
A root cause analysis is filed. Six months later, nobody can say what was fixed, who checked it, or whether it came back.
The sentinel event decision cannot wait
Deciding if a fall with injury or procedure event is a sentinel event starts a 45-business-day analysis. Risk management must see it the same day.
Units and the board see different pictures
Quality committees get a slide deck built by hand. Clinics, behavioral units and affiliated sites use different forms.
The incidents this pack is built for.
- Patient fall with or without injury
- Medication event
- Wrong-site or retained-item procedure event
- Pressure injury
- Restraint or seclusion event
- Elopement or wandering
- Patient self-harm or suicide attempt
- Blood or blood product event
- Device or equipment failure
- Delay in care or handoff failure
- Workplace violence against staff
- Obstetric event
What you answer to.
- 42 CFR 482.21, hospital QAPI
- A data-driven program that tracks medical errors and adverse events, analyzes causes, prevents repeats and checks that gains last. Multi-hospital systems may elect one program under 482.21(g).
- 42 CFR 482.13(e) and (g), restraint and seclusion
- Violent or self-destructive behavior: orders, monitoring, face-to-face evaluation within 1 hour. A restraint or seclusion death goes to CMS by close of business the next business day after you know.
- Obstetric QAPI, effective January 1, 2027
- Hospitals with obstetric services must use QAPI to assess and improve outcomes and disparities, with at least one measurable improvement project a year.
- The Joint Commission
- Sentinel Event Policy: a full analysis and corrective action plan within 45 business days, with at least one stronger or intermediate-strength action. Self-reporting is encouraged, not required.
- CIHQ and DNV
- CMS-approved hospital accreditors. Their standards must meet or exceed Medicare's, so your QAPI program is tested against them.
- 21 CFR 803.30, FDA device reports
- A hospital is a device user facility. Report a device-related death to FDA and the manufacturer, and a serious injury to the manufacturer, within 10 work days of becoming aware.
- State adverse event reporting
- States set their own rules for serious events. Check yours; routing and escalation can be set per hospital.
A fall with a hip fracture, from report to verified action plan
An example, not a customer story: a possible sentinel event, from first text to verified plan.
01Report
Nurse finds patient, texts Lauren
The patient is on the floor; the nurse assesses, calls the provider and texts Lauren.
Lauren asks about fall risk, bed alarm, rounding, sedatives and injury, and the nurse signs.
Fracture triggers leader notifications
Imaging shows a hip fracture. The nurse manager raises the harm level, and a fracture rule alerts the risk manager, CNO and patient safety officer.
Family disclosure is logged.
02Investigate
Risk manager records sentinel decision
The 45-business-day analysis window is noted.
The risk manager records whether the event meets sentinel event criteria, and why. Joint Commission reporting stays a leaders' call.
RCA team opens the investigation
Lauren drafts a timeline and likely causes.
The root cause analysis team edits, adds the family's account where fitting, and completes the five whys.
03Correct
Action plan names owners and measures
At least one action is stronger or intermediate-strength, such as a standard bed-exit alarm setting.
Each action has an owner, date, evidence, effectiveness measure and plan to sustain it.
Analysis and plan approved, exported
With the audit trail attached, the analysis and plan are approved and exported ahead of the 45-business-day mark.
Effectiveness check verified, actions close
Falls with injury on the unit over the period are attached as the effectiveness check.
The CNO verifies the check and the actions close.
04Prove
Quality committee reviews falls by unit
Falls with injury by unit and shift reach the quality committee and the governing body.
The QAPI packet lists the actions as verified.
Illustrative scenario. Details are invented to show how the workflow runs.
See this on your site.
Thirty minutes, built around your incidents, your regulator and the proof you have to produce.
Set up for your kind of site.
Forms, routing, exports and roles are configured per site. We load them for you on paid plans.
Forms
- Patient safety event report with harm scale
- Fall with injury form
- Medication event form, with high-alert drugs
- Procedure and retained item form
- Restraint and seclusion form
- Obstetric event form
- Device event sheet for the FDA decision
- Sentinel event review record
Routing
- Fall with injury, procedure event or unexpected death: risk and unit managers
- Possible sentinel event: risk manager, CNO and patient safety officer
- Restraint or seclusion death: risk manager, with the CMS deadline noted
- Device death or serious injury: risk manager decides on the 10-work-day report
- High-alert drug event: pharmacy and medication safety committee
Exports
- QAPI summary packet for 42 CFR 482.21, one PDF
- Incident PDF with sentinel event analysis, action plan and signatures
- CSV counts by unit, shift and event type
- CSV of restraint and seclusion events, for the 482.13(g)(2) log
- Survey packet for Joint Commission, CIHQ or DNV (rolling out)
Roles
- Reporter: any clinical or support staff member
- Editor: unit educators and charge nurses
- Supervisor: unit managers
- Admin: risk manager and quality director
- Super admin: system quality leader
- Viewer: CNO, medical leaders, governing body and consultants
Outcomes you can plan for.
Reports that arrive because they are easy
A short chat on the unit replaces the long form, so near misses and no-harm events reach risk management.
Sentinel event decisions made the same day
A rule flags events that match sentinel event criteria. A person classifies them and records why.
Actions that carry a verification
Every action has an owner, a date and an effectiveness check, and stays open until a person verifies it.
One view across units and sites
Departments, clinics and affiliated sites share event types, so the quality director sees the system and each unit in one view.
The rules behind this pack.
Hospitals: frequently asked
Something we missed? Ask us, and a person answers.
What does 42 CFR 482.21 require hospitals to do with adverse events?
Track quality indicators, medical errors and adverse patient events, then analyze causes, act to prevent repeats and measure whether gains last. Run and document performance improvement projects. See hospital QAPI.
How does a hospital handle a possible sentinel event?
Accredited hospitals are expected to finish a full analysis and action plan within 45 business days. The Joint Commission defines a sentinel event as a patient safety event that reaches a patient and causes death, severe harm or permanent harm. A fall with any fracture is one example. See sentinel events.
We already have an event reporting system. Where does IncidentKit fit?
It fits community and specialty hospitals, outpatient sites outside the main system, and teams whose current tool logs events but does not verify fixes. It runs alongside your EHR, and import and migration brings history across. Deeper EHR links are rolling out.
What changes for obstetric services in 2027?
From January 1, 2027, hospitals with obstetric services must use QAPI to assess and improve outcomes and disparities, with a measurable project each year. IncidentKit tracks obstetric events as their own category. Outcome and disparity analysis by patient group uses clinical data that stays in your EHR.
See it on your site.
Tell us about your sites and we will build the demo on your kind of facility. Or start free and report something real today.