APS Sample Report Submissions

Sample report submissions to hone writing skills

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It's your turn to practice!

Take the scenario assigned to you and, using the knowledge gained in this course and the image above as a guide, write a sample report you would submit to appropriate agencies. If the information appears to lack information, think about questions you may need to ask. In the sections below, write your sample reports for each scenario.

Scenario #1

Mrs. Jones is a 70 year old female who was admitted to Sunny Side nursing home 2 years ago. Mrs. Jones requires assistance with most all ADL’s. On Monday May 6, 2019 at 9;30 am CNAs Jane Peterson and Jill Smith took Mrs. Jones to the shower room. While in the shower area CAN Peterson transferred Mrs. Jones from the wheel chair to the shoer chair. During the process Mrs. Jones slipped from Peterson’s grasp and fell hitting her head on the grab bar. Peterson tried to catch her, only injury seen was a red mark on the left side of her face, near her cheek. It was reported later to Nurse Weston that Mrs. Jones right pinky finger is bruised on the inside of her palm area and along the outside of her finger as well. Nurse Weston called the facility physician and called the family members. The next day Mrs. Jones was taken to the hospital for x-rays and determined that the right hand was broken.

Scenario #2

04/12/19 at 4:21pm there was a report of bruising to the right side of the groin area and the patient does not remember or know how it happened. The patient is a 78-year-old female named Smith. Nurse Jones reported what she saw to the charge Nurse. This happened at ABC Nursing home. There were 3 other staff on duty in the area.

Scenario #3

Charge Nurse received a call regarding a woman named Princess. Who resides are BDR Nursing Home. Princess is 82 years old. Princess’s son is the POA for medical. On 8-9-2018 in the late afternoon Princess fell in her room. She reported left leg and ankle pain. She was yelling and combative. CNA Jones saw CNA May covering her mouth with his hand when she was screaming in the room.

Scenario #4

Resident had a fall this morning on 3-12-2019 at 9:15 am. She is a post-surgical patient that has not done well recovering from her anesthesia. Upon further assessment by Nurse Smith it was determined the resident needed to be seen in the ER to confirm she did not damage her recent hip surgery. Upon return from the hospital staff was notified that she had a rib fracture from her recent fall.