ENS Event | |
|---|---|
15:00 Dec 7, 2021 | |
| Title | NON-AGREEMENT State Report - Dose Misadministration |
| Event Description | The following is a summary of information received via telephonic conversation from the Radiation Safety Officer at Saint Vincent Indianapolis Hospital:
At 1000 EST on December 8, the health physicist became aware that on the previous day a patient was treated with the wrong plan parameters. The patient was given a dose on the same organ as the assigned patient on the treatment report with nearly the same prescribed dose. The total dose was 3030 cGy, which is 1 percent higher than the prescribed dose of 3000 cGy that the patient was prescribed. The treatment was completed with no unintended harm to the patient. The second patient was not affected by the error. The event is being reported under 10CFR35.3045(a)(2) for an administration of a dose or dosage to the wrong individual. A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient. |
| Where | |
|---|---|
| Saint Vincent Indianapolis Hospital Anderson, Indiana (NRC Region 3) | |
| License number: | 13-00133-02 |
| Organization: | Saint Vincent Indianapolis Hospital |
| Reporting | |
| 10 CFR 35.3045(a)(2) | |
| Time - Person (Reporting Time:+44.32 h1.847 days <br />0.264 weeks <br />0.0607 months <br />) | |
| Opened: | Edward Wroblewski 11:19 Dec 9, 2021 |
| NRC Officer: | Brian Lin |
| Last Updated: | Dec 9, 2021 |
| 55635 - NRC Website | |
Saint Vincent Indianapolis Hospital with 10 CFR 35.3045(a)(2) | |
WEEKMONTHYEARENS 556352021-12-07T15:00:0007 December 2021 15:00:00
[Table view]10 CFR 35.3045(a)(2) NON-AGREEMENT State Report - Dose Misadministration 2021-12-07T15:00:00 | |