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Supporting Documents

Supporting Documents - Common Formats for Event Reporting - Hospital Version 1.2

AHRQ's Common Formats for Event Reporting - Hospital Version 1.2 (CFER-H V1.2) was released as three generic and nine event-specific forms. These forms allow for the collection of information, in relevant detail, about any patient safety concern reported in an acute care hospital. Structured questions on the generic forms are designed to capture basic information along the spectrum of harm for incidents (a patient safety concern that reached the patient), near misses (a patient safety concern that did not reach the patient), and unsafe conditions. Specific information on events is captured via narrative texts. For the most commonly occurring patient safety concerns, event specific-forms collect clinical structured information to complement the information collected on the generic forms.

This page contains the supporting documents that would help PSOs to complete the local implementation and transfer of the data to the PSOPPC and Network of Patient Safety Databases (NPSD).

Disclaimer: The paper forms for each of the events are primarily for illustrative purposes.

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User Guide/Quick Guide

The Users Guide is a comprehensive overview of the Common Formats development, implementation, and maintenance process, and can be used to understand the AHRQ Common Formats framework. The Quick Guide provides a high-level overview of the data reporting process. The Glossary provides terms that are considered central to the Common Formats or their implementation.

CFER-H_V1.2_Users_Guide Posted on: 11/18/2022, 4,837 KB

CFER-H_V1.2_Quick_Guide Posted on: 03/23/2016, 164 KB

Healthcare Event Reporting Form (HERF), Patient Information Form (PIF), and Summary of Initial Report (SIR)

The HERF is designed to be completed by the individual who witnessed, first discovered, or is most familiar with the details of the event. The HERF captures information on incidents, near misses, and unsafe conditions and solicits only basic information to start the reporting process.

CFER-H_V1.2_Healthcare_Event_Reporting_Form_(HERF)_Form Posted on: 04/20/2020, 203 KB

The PIF supplements the HERF in cases where an event reached the patient(i.e., incidents). The PIF also collects demographic information and additional information about the impact of the event on a patient (e.g., level of harm, unplanned interventions).

CFER-H_V1.2_Patient_Information_Form_(PIF)_Form Posted on: 04/20/2020, 202 KB

The SIR is designed to be completed for all incidents, near misses, and unsafe conditions reported on a HERF. It represents everything that is known about the event or unsafe condition at the time when the initial report is completed and could be used by PSOs or providers to support a root cause analysis at the local level.

CFER-H_V1.2_Summary_of_Initial_Report_(SIR)_Form Posted on: 04/20/2020, 247 KB

CFER-H_V1.2_HERF_PIF_and_SIR_Event_Description Posted on: 04/20/2020, 79 KB

CFER-H_V1.2_Sample_Healthcare_Event_Reporting_Form_(HERF)_Patient_Information_Form_(PIF)_and_Summary_of_Initial_Report_(SIR)_Aggregate_Report Posted on: 04/20/2020, 261 KB

Blood or Blood Product

A Blood or Blood product event or unsafe condition involves the processing and/or administration of Blood or a Blood product. Patient Safety concerns for this module includes incidents, near-misses, and unsafe conditions that occur in a hospital and do not require that a patient outcome be identified.

For more information about the Blood or Blood Product module, please refer to the following documents:

CFER-H_V1.2_Blood_or_Blood_Product_Event_Description Posted on: 04/20/2020, 44 KB

CFER-H_V1.2_Blood_or_Blood_Product_Aggregate_Report Posted on: 04/20/2020, 78 KB

CFER-H_V1.2_Blood_or_Blood_Product_Form Posted on: 04/20/2020, 226 KB

Device or Medical/Surgical Supply, including Health Information Technology

A Device or Medical/Surgical supply, including Health Information Technology (HIT) event or unsafe condition involves a defect, failure, or incorrect use of a device. An HIT-related event or unsafe condition involves a defect in, or failure or incorrect use of an HIT device. Patient safety concerns for this module include incidents, near misses, and unsafe conditions, and do not require that a patient outcome be identified.

For more information about the Device or Medical/Surgical Supply, including HIT module, please refer to the following documents:

CFER-H_V1.2_Device_or_Medical_Surgical_Supply_including_HIT_Event_Description Posted on: 04/20/2020, 653 KB

CFER-H_V1.2_Device_or_Medical_Surgical_Supply_including_HIT_Aggregate_Report Posted on: 04/20/2020, 158 KB

CFER-H_V1.2_Device_or_Medical_Surgical_Supply_including_HIT_Form Posted on: 04/20/2020, 313 KB

Fall

A Fall event is considered a sudden, unintended, uncontrolled, downward displacement of a patient's body to the ground or other object (e.g., onto a bed, chair or bedside mat). Patient safety concerns for Fall include only incidents that occur in a hospital.

For more information about the Fall module, please refer to the following documents.

CFER-H_V1.2_Fall_Event_Description Posted on: 04/20/2020, 40 KB

CFER-H_V1.2_Fall_Aggregate_Report Posted on: 04/20/2020, 90 KB

CFER-H_V1.2_Fall_Form Posted on: 04/20/2020, 234 KB

Healthcare-associated Infection (HAI)

An HAI event is a localized or systematic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s). An HAI is acquired during the course of receiving treatment for other conditions within a healthcare setting, with no evidence that the infection was present or incubating at the time of admission. Patient safety concerns for the HAI category include only incidents that occur in a hospital.

For more information about the HAI module, please refer to the following documents:

CFER-H_V1.2_Healthcare-associated_Infection_Event_Description Posted on: 04/20/2020, 47 KB

CFER-H_V1.2_Healthcare-associated_Infection_Aggregate_Report Posted on: 04/20/2020, 85 KB

CFER-H_V1.2_Healthcare-associated_Infection_Form Posted on: 04/20/2020, 231 KB

Medication or Other Substance

A Medication or Other Substance event involves medications, biological products, nutritional products or medical gases. Patient safety concerns for this module include incidents, near misses, and unsafe conditions and do not require a patient outcome be identified. This module pertains to both inpatient and outpatient pharmacies located within the hospital.

For more information about the Medication or Other Substance-related module, please refer to the following documents:

CFER-H_V1.2_Medication_or_Other_Substance_Event_Description Posted on: 04/20/2020, 50 KB

CFER-H_V1.2_Medication_or_Other_Substance_Aggregate_Report Posted on: 04/20/2020, 108 KB

CFER-H_V1.2_Medication_or_Other_Substance_Form Posted on: 04/20/2020, 289 KB

Perinatal

A Perinatal event involves an adverse outcome occurring to the mother, fetus(es), or neonate(s) during the perinatal period and involves either the birthing process or an intrauterine procedure. The perinatal period extends from the 20th week of gestation through 4 weeks (28 days) post-partum.

For more information about the Perinatal module, please refer to the following documents:

CFER-H_V1.2_Perinatal_Event_Description Posted on: 04/20/2020, 44 KB

CFER-H_V1.2_Perinatal_Aggregate_Report Posted on: 04/20/2020, 98 KB

CFER-H_V1.2_Perinatal_Form Posted on: 04/20/2020, 246 KB

Pressure Ulcer

A Pressure Ulcer event involves a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with sheer and/or friction. The Pressure Ulcer category includes only incidents that occur in a hospital.

For more information about the Pressure Ulcer module, please refer to the following documents.

CFER-H_V1.2_Pressure_Ulcer_Event_Description Posted on: 04/20/2020, 51 KB

CFER-H_V1.2_Pressure_Ulcer_Aggregate_Report Posted on: 04/20/2020, 84 KB

CFER-H_V1.2_Pressure_Ulcer_Form Posted on: 04/20/2020, 236 KB

Surgery or Anesthesia

A Surgery or Anesthesia event involves surgery or other invasive procedure (e.g., colonoscopy), or the administration of anesthesia. Patient safety concerns for the Surgery or Anesthesia category include incidents and near misses. They also pertain to both inpatient and outpatient procedures occurring in a hospital.

For more information about the Surgery or Anesthesia module, please refer to the following documents.

CFER-H_V1.2_Surgery_or_Anesthesia_Event_Description Posted on: 04/20/2020, 53 KB

CFER-H_V1.2_Surgery_or_Anesthesia_Aggregate_Report Posted on: 04/20/2020, 142 KB

CFER-H_V1.2_Surgery_or_Anesthesia_Form Posted on: 04/20/2020, 286 KB

Venous Thromboembolism

A Venous Thromboembolism (VTE) comprises one or both of the following: (1) a deep vein thrombosis (DVT) or (2) a pulmonary embolism (PE). Patient safety concerns for the VTE category include only incidents that occur in a hospital.

For more information about the VTE module, please refer to the following documents.

CFER-H_V1.2_Venous_Thromboembolism_Event_Description Posted on: 04/20/2020, 47 KB

CFER-H_V1.2_Venous_Thromboembolism_Aggregate_Report Posted on: 04/20/2020, 72 KB

CFER-H_V1.2_Venous_Thromboembolism_Form Posted on: 04/20/2020, 224 KB