SIMS/QPS-26/2023.

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MORBIDITY REVIEW SHEET

CASE PRESENTATION
Case presenter: Minutes by:

THE PATIENT
Patient Name: UHID No:

D.O.B: Age:

BACKGROUND
Date of admission: Date of Surgery:
Diagnosis:
MDT decision: (if applicable)
(Multidisciplinary Team)
Date of incident :
Brief summary of events that
occurred:
Specify whether the event was
recorded by department HOD as
an incident /OVR and whether it
was graded as minor or major.
Was an OVR/ incident report
form/investigation made?

ANALYSIS
Categorisation of contributing factors as agreed by M&M group:
Human factors Patient factors
System factors Insufficient data
Other:
Any additional comments:

LEARNING: Describe what you feel you have learnt from this event.

STANDARD OF CARE GRADING BY M&M TEAM: Choose an item

Good Practice Less than satisfactory
Room for improvement Insufficient Data
Preventable harm (Yes/No):
Further investigation required (Yes/No) :
Any additional Comments:
 SIMS/QPS-26/2023.00

MORBIDITY REVIEW SHEET

WHAT ARE THE OPPORTUNITIES OR RECOMMENDATIONS FOR QUALITY IMPROVEMENT AND
PATIENT SAFETY?
1.
2.
3.
4.
5.

IDENTIFY WHAT WENT WELL

1.

2.

3.

4.

5.

REVIEW OUTCOME: WAS THE EPISODE POTENTIALLY AVOIDABLE?

☐ Yes – if Yes, which contributory factor or factors were absent that, if present, might have made the morbidity
potentially avoidable?
☐ Organisation and management
☐ Personnel
☐ Access to care or influences from the patient’s context

☐ No– if No, what aspects of care could have been improved (if any)?

WAYS IN WHICH YOURPRACTICE HAS CHANGED AS A RESULT:

State whether you have made any changes to the way you approach your clinical practice as a result of
this event.

Name of the Physician: ___________________________________Signature: _________________

Name of Head of Department:_____________________________Signature:__________________
Date: _______________________