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Tuesday, 26 March 2019
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- DEMO VERSION - Anaesthetic Incident Recording System. (Data will not be saved).
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Patient Demographics
Gender
Male
Female
No Patient Involved
ASA Grade
..
1
2
3
4
5
6
Unknown
Emergency
..
Elective
Emergency
Unknown
Patient Age
..
Postconceptual age <44 weeks
PCA 44 weeks to <3 months
3 months to <1 year
1 to 4+ years
5 to 9+ years
10 to 16 years
17 to 29 years
30 to 39 years
40 to 49 years
50 to 59 years
60 to 69 years
70 to 79 years
80 to 89 years
90 years or greater
Unknown
at the time of the incident
Patient BMI
..
<18.5
18.5-25
25-30: (Overweight)
Above 30: (Mildly Obese)
Above 35: (Obese)
Above 40: (Morbidly Obese)
Above 50: (Super Obese)
Unknown
Narrative
Incident Description and Management
- Please describe the way in which the incident occurred. Include as much detail as possible but avoid any information that may identify the patient, the team, or the hospital.
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