Far Eastern University

Dr. Nicanor Reyes Medical Foundation

Nursing Service Division

REPORTABLE EVENTS (STAFF NURSE/NURSING AIDE)

DATE REPORTED: August 20, 2018

NAME OF PATIENT: Leilanie Castillo AGE/GENDER: 37/f
ROOM/BED NO.: ISO 5b2 DEPARTMENT:
DATE AND TIME OF EVENT: 6-2pm Shift
STAFF INVOLVED: DONALIZA M. BULLAN AREA/UNIT: STATION 5B

EVENT:

In my 6:00pm to 2:00pm shift the patient relative from ISO 5b2, Ms. Leilanie Castillo ask me what time the medicine
should be given to their patient. I told her that it should be given at 12noon. They should buy it and give it at the
nurse station before the said time. I advised the relatives of Ms. Castillo if the medicine were purchase outside they
should give it to the pharmacy department for verification.

IMMDIATE ACTION(S) TAKEN:

Informed and reported to the head nurse regarding the incident.

REPORTED BY: NOTED BY:

____________________________ ______________________________
Signature over Printed Name Unit Manager

Please accomplish this report within 24 hours upon occurrence: Must be submitted immediately to the
Area Manager/ Patient Care Coordinator on duty.
 Far Eastern University
Dr. Nicanor Reyes Medical Foundation
Nursing Service Division

REPORTABLE EVENTS (STAFF NURSE/NURSING AIDE)

DATE REPORTED: August 20, 2018

NAME OF PATIENT: Leilanie Castillo AGE/GENDER: 37/f
ROOM/BED NO.: ISO 5b2 DEPARTMENT:
DATE AND TIME OF EVENT: 2pm Shift
STAFF INVOLVED: RHALP LESTER PUNO AREA/UNIT: STATION 5B

EVENT:
This is to report an incident regarding last August 20, 2018. I was the morning duty nurses was very busy on that
day. I am only duty on that time. Unfortunately, the supervisors advised me to pullout from PICU. Ms. Castillo was
the last patient was endorsed to me from ISO 5b2.

No special endorsement made.

I asked Ms. Donna Bullan if the patient was able to buy and bring to nurse on duty that day. She replied “NO”. Due
to very hectic situation that day. I wasn’t able to follow-up to patient the needed medicine if they able to buy.

At the end of my shift, I endorsed the patient as regular routine and told the incoming nurse on duty that the
medicine is still not available.

IMMDIATE ACTION(S) TAKEN:

REPORTED BY: NOTED BY:

____________________________ ______________________________
Signature over Printed Name Unit Manager
Please accomplish this report within 24 hours upon occurrence: Must be submitted immediately to the
Area Manager/ Patient Care Coordinator on duty.
 Far Eastern University
Dr. Nicanor Reyes Medical Foundation
Nursing Service Division

REPORTABLE EVENTS (STAFF NURSE/NURSING AIDE)

DATE REPORTED: August 20, 2018

NAME OF PATIENT: Leilanie Castillo AGE/GENDER: 37/f
ROOM/BED NO.: ISO 5b2 DEPARTMENT:
DATE AND TIME OF EVENT: August 20, 2018
STAFF INVOLVED: RHALP LESTER PUNO, DONALIZA M. AREA/UNIT: STATION 5B
BULLAN, and Ms. Sarah A. Grimaldo

EVENT:
This is an explanation regarding the complaint of Ms. Leilanie Castillo. The relatives of the patient claimed they
bought and given the said medication to nurse station that day. But upon initial investigation, there were no
medication brought to nurse station that time. still the relatives strongly claimed that the medicine were given to
the nurse on t=duty that time but we found out it is just on the bedside throughout that day.

IMMDIATE ACTION(S) TAKEN:

Informed and reported to the head nurse regarding the incident.

REPORTED BY: NOTED BY:

____________________________ ______________________________
Signature over Printed Name Unit Manager

Please accomplish this report within 24 hours upon occurrence: Must be submitted immediately to the
Area Manager/ Patient Care Coordinator on duty.