Molecule Transport Review #2 REVIEW JEOPARDY S2C06 Jeopardy Review.
Review
2
UNC Department of Surgery/Confidential Peer Review Do Not Copy UNC Liability Insurance Trust Fund Do Not Copy Revised 7/2005 Confidential Patient Information for Internal Use to Support Quality Improvement Revised 7/2005 DATE OF COMPLICATION __________________________ SERVICE ______________________________________________ NAME: ________________________________________ UNIT # _____________ AGE _______ SEX _______ PARTICIPATING RESIDENT: ________________________ ATTENDING SURGEON ____________________________________________ SURGICAL DIAGNOSIS:________________________________________________________________________________________________ COMORBIDITIES: ______________________________________________________________________________________________________ OPERATION DATE _____________________ OPERATION (S) __________________________________________________________ AUTOPSY: YES _______ NO _______ COMPLICATIONS ______________________________________________________________________________________________________ TYPE OF MORBIDITY / MORTALITY: ____ A Wound separation / dehiscence ____ N Myocardial infarction ____ B Wound infection/necrosis ____ O Small bowel obstruction ____ C Post-op abscess ____ P Anastomotic leak, stricture, etc. ____ D Anesthetic complication ____ Q GI Bleed ____ E Operative injury to normal organ ____ R Stroke / Seizure ____ F Intraop or postop bleeding ____ S Peripheral nerve injury ____ G Line complication ____ T Urinary tract infection ____ H Medication error ____ U Renal failure ____ I Transfusion error ____ V Shock/sepsis ____ J Thromboembolic ____ W Multiple organ failure ____ K Atelectasis/pneumonia ____ X Death ____ L ARDS ____ Y Other ____ M Cardiac arrhythmia TO BE COMPLETED AT M&M CONFERENCES FACTORS IN MORBIDITY/MORTALITY I. ____Unavoidable morbidity or mortality, due to: 1. Course of disease; occurred despite appropriate treatment, intervention. 2. Patient/family refused or non-compliant with recommended treatment. 3. Other:________________________________________________ II. ____Potentially avoidable morbidity or mortality, due to: 1. Misdiagnosis: Attending:____________________________________________ 2. Delay in diagnosis: Attending: ____________________________________________ 3. Technical performance: Attending: ____________________________________________ 4. Delay in treatment: occurred because appropriate preventative measures not taken. Attending: ____________________________________ 5. Equipment problem – user error. Attending:_____________________________________ 6. Other: ________________________________________ III. ____Analysis of cause of morbidity or mortality requires review by ________________ service. ACTION RECOMMENDED _______ YES (OR) _______ NO ACTION TAKEN:_________________________________________________________________ SIGNATURE_________________________________ _______________ DATE________________________ (TURN PAGE OVER) *Summaries on reverse side of this page MUST be completed.* EFFECTS ON OUTCOME _______ None _______ Unknown _______ Temporary sequelae _______ Permanent sequelae _______ Death Related to a System Issue ____ YES (OR) _____ NO Revised 7/2005
-
Upload
arash-samiei -
Category
Documents
-
view
214 -
download
1
description
Review
Transcript of Review
UNC Department of Surgery/Confidential Peer Review Do Not Copy UNC Liability Insurance Trust Fund Do Not Copy Revised 7/2005 Confidential Patient Information for Internal Use to Support Quality ImprovementRevised 7/2005 DATE OF COMPLICATION __________________________SERVICE ______________________________________________ NAME: ________________________________________UNIT # _____________ AGE _______SEX _______ PARTICIPATING RESIDENT: ________________________ ATTENDING SURGEON ____________________________________________ SURGICAL DIAGNOSIS:________________________________________________________________________________________________ COMORBIDITIES: ______________________________________________________________________________________________________ OPERATION DATE _____________________ OPERATION (S) __________________________________________________________ AUTOPSY: YES_______ NO _______ COMPLICATIONS ______________________________________________________________________________________________________ TYPE OF MORBIDITY / MORTALITY: ____ AWound separation / dehiscence____ NMyocardial infarction ____ BWound infection/necrosis____ OSmall bowel obstruction ____ CPost-op abscess____ PAnastomotic leak, stricture, etc. ____ DAnesthetic complication____ QGI Bleed ____ EOperative injury to normal organ____ RStroke / Seizure ____ FIntraop or postop bleeding____ SPeripheral nerve injury ____ GLine complication____ TUrinary tract infection ____ HMedication error____ URenal failure ____ I Transfusion error____ VShock/sepsis ____ JThromboembolic____ WMultiple organ failure ____ KAtelectasis/pneumonia____ XDeath ____ LARDS____ YOther ____ MCardiac arrhythmia TO BE COMPLETED AT M&M CONFERENCES FACTORS IN MORBIDITY/MORTALITY I.____Unavoidable morbidity or mortality, due to: 1.Course of disease; occurred despite appropriate treatment, intervention. 2.Patient/family refused or non-compliant with recommended treatment. 3.Other:________________________________________________ II.____Potentially avoidable morbidity or mortality, due to: 1.Misdiagnosis: Attending:____________________________________________ 2.Delay in diagnosis:Attending: ____________________________________________ 3.Technical performance:Attending: ____________________________________________ 4.Delay in treatment: occurred because appropriate preventative measures not taken. Attending: ____________________________________ 5.Equipment problem user error.Attending:_____________________________________ 6.Other: ________________________________________ III.____Analysis of cause of morbidity or mortality requires review by ________________ service. ACTION RECOMMENDED _______ YES (OR) _______ NO ACTION TAKEN:_________________________________________________________________ SIGNATURE_________________________________ _______________ DATE________________________ (TURN PAGE OVER) *Summaries on reverse side of this page MUST be completed.* EFFECTS ON OUTCOME _______ None _______ Unknown _______ Temporary sequelae _______ Permanent sequelae _______ Death Related to a System Issue ____ YES (OR)_____ NO Revised 7/2005 UNC Department of Surgery/Confidential Peer Review Do Not Copy UNC Liability Insurance Trust Fund Do Not Copy Revised 7/2005 Confidential Patient Information for Internal Use to Support Quality ImprovementRevised 7/2005 CASE SUMMARY: DISCUSSION SUMMARY: ACTION TAKEN / OTHER COMMENTS: (MUST COMPLETE SIGNATURE/DATE) Attending ModeratorDATE: Signature Revised 7/2005
