Describe what happened did something go wrong? Date of incident
How did it affect the patient?
How did the patient react? How did this affect the patients treatment?
How did it affect you?
How has it affected your confidence? What anxiety or concern did this cause you?
Could it have been avoided?
With hindsight could you personally have acted differently and thus prevented this incident occurring?
What is the error path which caused this incident?
What learning or development needs has this highlighted for you personally? Was this a gap in your knowledge? Do you need more training?
What learning or development needs has it highlighted for others?
Was this something that could have happened to anyone with your level of training? Has this incident raised wider questions effecting both yourself and other practitioners?
Adapted from - http://www.bmjlearning.com/planrecord/assessment/cirIntro.jsp
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