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  • OT Quality Control Form

    Uploaded by

    Dr. Kshitij Kumar
    14 views2 pages
    This quality control form documents anesthesia procedures and outcomes for a patient. It includes checks for proper endotracheal tube placement, injuries during intubation, issues with vascular access, anesthesia management and monitoring, any modifications to the anesthesia plan, post-operative ventilation needs, and equipment failures. The form is signed and dated upon completion to record the anesthesia for that patient.

    Original Description:

    Fill the form for Anesthesia Adverse Event

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    This quality control form documents anesthesia procedures and outcomes for a patient. It includes checks for proper endotracheal tube placement, injuries during intubation, issues with vascular access, anesthesia management and monitoring, any modifications to the anesthesia plan, post-operative ventilation needs, and equipment failures. The form is signed and dated upon completion to record the anesthesia for that patient.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    14 views2 pages

    OT Quality Control Form

    Uploaded by

    Dr. Kshitij Kumar
    This quality control form documents anesthesia procedures and outcomes for a patient. It includes checks for proper endotracheal tube placement, injuries during intubation, issues with vascular access, anesthesia management and monitoring, any modifications to the anesthesia plan, post-operative ventilation needs, and equipment failures. The form is signed and dated upon completion to record the anesthesia for that patient.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    OT: QUALITY CONTROL FORM (Anesthesia)

    Patient’s Name ……………………………………………………………………………….Age/Sex…………………………………..

    Reg. No. ……………………………………………. IPD No. ……………………………. Date………………….. OT No……….

    Anesthesia Quality Indicators

    1. Misplaced endotracheal tube :No yes 1. Esophageal 2. Bronchial


    2. During Laryngoscope, injury to :No yes
    1) Lips 2) Tongue 3) Gums 4) Teeth
    3. Inadvertent Carotid/Subdavlam arterial annulations No yes
    Puncture No yes
    4. Anesthetic Management
    PAC Done by Dr. ……………………………………………………………………………….
    Reassessment done by Dr. ……………………………………………………………………………….
    Any Discrepancy observed No Yes ………………………………………………...
    Case conducted by Dr. ………………………………………………………………………………..
    Dr. ………………………………………………………………………………..
    5. Modification of anesthesia plan, No yes
    Reason ……………………………………………………………………………………………..
    6. Circulatory Collapse following induction of anesthesia …………………………………………………………………..

    Critical Incident
    1. ……………………………………………………………………………………………………………………………………
    2. ……………………………………………………………………………………………………………………………………
    3. Unplanned Postoperative ventilation No yes
    4. Hoarseness No yes

    Equipment Failure
    1
    2

    Additional information (If Any) :-

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    Sign with Name

    Date & time

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