CHATARPATI SHIVAJI SUBHARTI HOSPITAL

ANECDOTAL RECORDING FORM

OBSERVER: Mrs.Neetu (ward incharge; medical surgical dept) OBSERVATION DATE: 17/05/2018
OBSERVATION TIME: 10 am
STUDENT NAME : Ms.Neelam ; medical ward (staff nurse )
DESCRIPTION OF THE INCIDENT: The staff was assigned the patient of bed no:3 diagnosed with seizures ;due to the staff’s
negligence the patient had a fall from the bed and sustained some injuries .
DESCRIPTION OF THE LOCATION : male medical ward (Chatarpati shivaji subharti hospital)
ACTIONS /NOTES : The staff was asked to write an explanatory letter along with the demotion to economically low
section.

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