Quality Improvement
Anesthesia ID:
107509
What is the nature of this report?
Patient is awake and can contribute to assessment
Yes
No
Any occurrence of vomiting
Yes
No
Nausea or vomiting requiring treatment
Yes
No
Patient Physical Exam:
Pain Score (10-point VAS scale):
Mental status at baseline
Yes
No
on PACU admission
Vital signs at baseline
Yes
No
Highest pain score
Airway patency at baseline
Yes
No
Pain score at time of assessment
Patient experienced an unexpected event during perioperative care
Use the list boxes below to select any adverse events that took place and use the
'Add Event Type'
button to record them. Clicking one of the quick buttons below will also add that type of event to this record. You may add as many as necessary.
Category
Subcategory
Type
-- None --
Administration
Airway management
Blood
Cardiovascular
Death
Equipment/Device
Eye injury
Infection
Lab abnormalities
Location
Measure
Medication
Neurological-CNS
Neurological-peripheral
Other patient injury
Pain
Patient condition
PONV
Procedural
Process
Respiratory
Surgical service
Surgical specialty
Upgrade of care
Other
-- None --
-- None --
[Use of this application does not satisfy PQRS reporting requirements]
[Not part of patient's chart]
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