Incident categories | Frequency | Percentage |
Equipment related | 5 | 25 |
Pressure bag applied on a used drip with 250 mls air | 1 |
|
No suction pressure as suction bottle cap broken | 1 |
|
Suction tube disconnected | 1 |
|
Malfunction of operation table just after spinal | 1 |
|
Oxygen analyzer was not working | 1 |
|
Narcotic | 3 | 15 |
Unlabeled narcotic | 1 |
|
Expired Injection Pethidine in stock | 1 |
|
Inj. Morphine given by pharmacy instead of Inj. Fentanyl | 1 |
|
Infection control | 3 | 15 |
Fungus in spinal pack | 1 |
|
Sterile glove torn by sharp nails not noticed by primary person | 1 |
|
No proper mask cap inside OR | 1 |
|
Ampoule | 2 | 10 |
poor quality ampoule lead to glass cut | 1 |
|
Vasopressor not available in OR | 1 |
|
Miscellaneous | 7 | 35 |
Nurse left patient during spinal anaesthesia | 2 |
|
Pre-operative evaluation and patient swap | 1 |
|
Power cable kept on arm rest of OR table | 1 |
|
Patient c/o pain in PACU but no one attending her | 1 |
|
All surgical staff left OR and patient without information | 1 |
|
Elective LSCS taken without consent | 1 |
|
Total | 20 | 100 |