12/16/23, 11:09 AM Apollo Lighthouse

AIRS (Apollo Incident Report System)

Hospital
Kolkata
Name *:

Incident 12-Dec-2023 03:1 Incident 11-Dec-2023 10:0

Reporting Occurrence
Date & Time Date & Time
*: *:

WHO IS REPORTING?

Incident reported by * Place of Occurrence *:

Narendra Nath Dutt

OT6

Employee ID / UHID

1048546

WHO WAS INVOLVED?

Employee ID / UHID
Patient Attender Visitor  Employee

1111

Name* Sex:

aaa Male

Age: Department Name

3 ORTHOPEDICS

Physician / HOD:

Dr Partha Bhattacha

CATEGORY OF EVENT / OCCURRENCE (select of any one option atleast is mandatory)

IPSG Infection Control

Medication Related Food Safety

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Laboratory & Sample Related Hospital acquired Complications

Radiology Anesthesia / Surgery Related

Facility Safety Sentinel Event

Security Related IT related

 Equipment Related Billing related

Malfunction during
use Any Other

Staff / Doctor Related

Clinical Related

Blood & IV related

Medical Record Documentation Related

Critical Incident

Yes

Event Documented Seen by Attending

Yes No Yes No
on Chart: Physician:
 NA  NA

Attending Physician Family / Relatives

Yes No Yes No
informed: informed:
 NA  NA

Emergency Physician
Yes No
Informed:
 NA

Outcome *:
 No harm/no treatment Major potential life threatening
Insignificant Harm/ Minimal disability or other residual effect
Treatment Death Imminent/ Predictable
Significant physical intervention/ Resultant death
residual effect possible

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Major Or Extensive Intervention/

Residual Effect

What went wrong? *

One ortho case was posted in OT-6 today

morning at 7AM in which C-Arm shots were
required but when the shot was taken it was
observed that the image is not clear

Immediate Action Taken *

informed biomedical

What should have happened ? *

C-ARM image quality should have been

clear

Any other relevant and associated

information

Severity Assessment Code(SAC)

Severity Probability Actual Consequence Insignificant Minor Moderate Major Extreme

Frequent Almost Certain 3 3 2 1 1

probable Likely 3 3 2 1 1

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12/16/23, 11:09 AM Apollo Lighthouse

Severity Probability Actual Consequence Insignificant Minor Moderate Major Extreme

Occasional Possible 4 3 2 2 1

Uncommon Unlikely 4 4 3 2 1

Remote Rare 4 4 3 3 2

Comments / Completed By:

Akash Karmakar

HOD COMMENT

SNo HOD Name's HOD Comments Files Date & Time

1 Ms Pallavi Kar
Poor image quality was DocScanner 16 Dec 2023 10-16 16-Dec-2023
reported by OT am.pdf 10:22 am
Technician in OT-6 on (../hod/upload/DocScanner 16
12.12.23. at 9am. The C- Dec 2023 10-16 am.pdf)
Arm (Make-GE; Model; WhatsApp Image 2023-12-16 at
Brivo OEC865; Asset no. 10.18.14 AM.jpeg
AGH003923) was (../hod/upload/WhatsApp Image
checked by Biomedical 2023-12-16 at 10.18.14 AM.jpeg)
engineer and the poor WhatsApp Image 2023-12-16 at
image quality issue was 10.18.14 AM (1).jpeg
informed to GE(Call log. (../hod/upload/WhatsApp Image
no. 1-12804598124). GE 2023-12-16 at 10.18.14 AM
engineer checked the (1).jpeg)
m/c and found blood
and fluid spillage on
collimeter and
monoblock. All testing
and calibration was
done and the
monoblock was
recommended to be
replaced for improving
the image qualtity. GE
engineers have been
requested to come for
further discussion on
the matter.

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