Animal-Assisted Therapy Incident/Safety Event Report

Safety Event Report: Animal-Assisted Therapy (AAT)

Purpose and Record Placement: This is a safety/operational report for risk management, quality improvement, and patient safety workflows. It should remain separate from the patient's medical record unless institutional policy specifies otherwise. Clinical details relevant to patient care should be documented in a clinical note or addendum rather than mixed with quality/safety deliberations.

(Use objective, factual language throughout. Avoid blame or causality conclusions. Attribute statements to sources when appropriate. When information is unavailable, document "Unknown," "Not observed," or "Not applicable" and assign follow-up.)

Header Fields

Facility/Site: [Facility or site name]

Department/Unit: [Department or unit]

Event ID: [System-generated ID if available]

Report Status: [Initial / Addendum / Final]

Date/Time Report Created: [Date and time]

Confidentiality Label: [Per local policy, e.g., "Safety Event Report—Confidential"]

Event Classification

Event Category: [Incident (reached an identifiable person) / Near Miss (did not reach person) / Unsafe Condition (hazard identified, no specific exposed person)]

AAT Event Type(s): (Select all that apply)

• Fall or near-fall
• Bite, scratch, or skin break
• Allergic reaction or asthma symptoms
• Equipment issue (assistive device, leash/harness, wheelchair, barrier failure)
• Infection-control breach (saliva exposure, contamination, hand hygiene failure)
• Animal distress or behavioral escalation
• Handler issue or policy deviation
• Environmental hazard
• Other injury or exposure: [Specify]

Harm Level: [No harm evident / Mild harm / Moderate harm / Severe harm / Death / Unknown at time of report]

Sentinel or Serious Safety Event: [Yes / No / Uncertain] (Per facility definitions)

Location: [Building, floor, unit, room/bed, or specific area]

Encounter Setting: [Inpatient / Outpatient / ED / Rehab / Behavioral Health / Other]

Reporter and Discovery

Reporter: [Name, role/title, department, contact information] (Include only minimum necessary identifiers per policy)

Relationship to Event: [Direct witness / Responder / Notified later]

Discovery: [Who first recognized the event (role), date/time discovered, how discovered (witnessed, found after fact, reported by patient/family/handler, alarm, other), and immediate safety actions initiated at discovery]

Persons Involved

Patient(s): [Patient identifier per system norms if involved] (If applicable, include relevant risk factors: mobility impairment, fall risk, cognitive impairment, bleeding risk/anticoagulation, immunocompromised status, known animal allergy, open wounds, indwelling devices. Document whether AAT consent/assent was obtained.)

Staff/Visitors/Others: [List by role with names if required for follow-up]

Injured Party Type: [Patient / Staff / Visitor / Handler / Animal / None]

Therapy Animal and Handler Details

Animal: [Species, name, ID/registration number if applicable]

Handler: [Name and organization affiliation]

Vaccination/Health Status: [Current / Expired / Unknown]

Grooming/Bathing Compliance: [Yes / No / Unknown]

Equipment in Use: [Leash type, harness/vest, barrier, treats/toys, transport device]

Handler Present and in Control: [Yes / No / Unknown]

Session Context

[Session type (goal-directed therapy vs visitation; individual vs group), planned activity immediately preceding event, patient position/activity at onset, staff supervision level, relevant environmental conditions (floor condition, noise, crowding, presence of medical equipment or lines)] (If event occurred before session began, note "Session not yet started" and describe planned activities if relevant.)

Event Narrative

Summary: During AAT session in [location], [event type] occurred involving [who], resulting in [outcome].

[Detailed chronological narrative of events] (Include session start and key transitions, observed trigger/exposure if any, exact sequence of events, and immediate response actions. Use exact times when known; otherwise include best estimate with qualifier, e.g., "~14:10". Attribute statements to sources such as "per patient," "per handler," or "per witness." Use direct quotes only when safety-relevant.)

Timeline:

• Session start: [Time]
• Event occurrence: [Time]
• Discovered/recognized: [Time]
• Clinical assessment performed: [Time]
• Key interventions performed: [Time]
• Notifications completed: [Time]
• Animal left unit: [Time]

Witnesses: [List by role and contact information] (Distinguish direct witnesses from those notified later)

Artifacts: Photos taken: [Yes (storage location) / No]. CCTV reviewed/requested: [Yes / No]. Equipment retained for inspection: [Yes / No].

Assessment and Injuries

(Include subsections only for affected parties. If no injury occurred, document "No injury reported or observed at time of assessment" and any monitoring plan.)

Patient Assessment

[Symptoms reported, time-stamped vital signs, mental status, focused exam relevant to event type] (For falls: head strike Y/N/Unknown, loss of consciousness, visible injury, anticoagulation status. For bites/scratches: anatomic location, wound type/size, bleeding, contamination, neurovascular status. For allergic reactions: skin findings, respiratory findings, severity features. Include diagnostics ordered and results if available.)

Staff/Visitor/Handler Assessment

[Description of injury, immediate care provided, occupational health referral/disposition]

Animal Assessment

[Observable signs of distress or injury, precipitating stimuli if observed, handler's assessment and actions taken (water, rest, removal), veterinary evaluation needed: Yes / No / Unknown]

Immediate Interventions

(Include timestamps for each action)

• Safety Actions: [Activity stopped, scene secured, assistance called, patient assisted to safe position, animal removed from area, session terminated]
• Clinical Interventions: [Wound care, tetanus status review, antibiotic prophylaxis, allergy management, pain management, imaging ordered, neurological checks initiated]
• Infection Control Actions: [Hand hygiene performed, linens/barriers replaced, environmental cleaning requested/completed]
• Animal-Related Actions: [Handler instructed to end visit, animal observed for continued stress, program-specific actions taken]

Notifications

(Document name/role and date/time for each notification)

• Internal: [Attending/covering provider, nursing supervisor, therapy services leadership, AAT program coordinator, infection prevention, risk management/patient safety, security, environmental services] (Include only those applicable)
• Patient/Family Communication: Informed: [Yes / No / Deferred: reason]. [Date/time, participants, facts shared, patient questions/concerns, follow-up plan] (Do not speculate on causality; state that investigation will occur if cause unknown)
• External Reporting: [Animal bite/scratch reporting to local authorities, rabies risk consultation, medical device malfunction reporting, therapy animal organization incident report] (If not indicated, document "External reporting not indicated" with brief rationale)

Disposition and Follow-Up

Patient: [Disposition: remained in unit / transferred / discharged; monitoring or observation plan; return precautions given; follow-up appointments or referrals]

Staff/Handler: [Returned to duty / Restricted duty / Referred to occupational health; exposure follow-up plan if applicable]

Animal: [Cleared to return to program / Temporary suspension pending review / Permanent removal; veterinary follow-up if needed]

Tracking and Follow-Up Tasks: [Outstanding tasks with owner (by role) and due dates: witness statements, animal vaccination verification, rabies observation/quarantine confirmation, equipment inspection, patient follow-up call]

Contributing Factors (Preliminary)

(Preliminary assessment subject to formal review)

• Human Factors: [Supervision level, communication, protocol adherence—explanation]
• Patient Factors: [Mobility, cognition, behavioral response—explanation]
• Animal Factors: [Stress signals, startle response, fatigue, match for setting—explanation]
• Environment: [Clutter, cords, wet floor, crowding, noise, inadequate space—explanation]
• Equipment: [Device or barrier failure—explanation]
• Process/Policy: [Screening gaps, scheduling issues, training gaps—explanation]

Preventability Assessment: [Not preventable / Possibly preventable / Likely preventable / Unable to determine]. [Brief factual rationale without assigning blame]

Preventive Actions and Escalation

Immediate Actions Taken: [Same-day preventive measures: environment cleaned, hazards removed, safety huddle conducted]

Recommended Future Actions: [Recommendations for patient screening, animal-level changes, handler/staff training, environmental or process improvements]

Formal Review Escalation: Referred for formal review: [Yes / No]. [If yes: committee/owner and criteria met (e.g., severe harm, bite with skin break, anaphylaxis, repeated similar events, animal welfare concern)]

Attestation

Reporter Signature/Attestation: [Electronic signature] (I attest that this report is accurate to the best of my knowledge at the time of submission.)

Reviewer: [Role, name, date/time] (If applicable)

(If amendments are made, document what changed, by whom, when, and why. Do not overwrite the original narrative.)