When something goes wrong with a patient or a med

When the pump, vent, monitor or bed fails during care

When a device fails mid-shift, its screen is gone within minutes. What to chart, what goes in the report, and in what order.

7 min read built on 0 cases updated 2026-11-04

Written by a med-surg RN, ten years, day shift. Why there is no name on it · How this guide is made

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A pump stops or a vent alarms. Or a monitor shows a number that can't be right. You handle the patient first. Then you chart it. The chart gets the clinical story: what the device showed, what you did, who you told, how the patient did. Everything else goes in the device or safety report.

Key points

  • Patient first, then the machine. Vent fails, bag the patient. Pump fails, clamp the line or switch pumps. Monitor looks wrong, take vitals by hand. Chart after.
  • Write down what the screen says before anyone resets or swaps the device. Alarm text, error code, displayed rate, volume infused. Once the unit goes to biomed, those numbers are gone.
  • The chart gets four things, in time order: what the device showed, what you did, who you notified and what they said, and how the patient responded. With numbers.
  • The device report gets the rest: asset or serial number, where the unit is now, the biomed ticket, the device details. No guesses about the cause and no comments about staffing. Not in either place.
  • **Don't write incident report filed in the chart.** Where that fact goes is up to your facility's policy.

What to write

Device How it often gets charted How it reads better
VentilatorVent alarming, RT aware. Pt tolerated well.0214 vent alarm, display read Low Minute Volume, then went dark. Pt disconnected and manually ventilated with BVM on 100% O2. SpO2 88% at 0214, 95% at 0219. RT [name] at bedside 0217, pt placed on replacement vent 0221 at ordered settings (AC 14, VT 450, PEEP 5, FiO2 40%), verified with RT. Breath sounds equal bilaterally, ETT 23 cm at lip unchanged. Dr. [name] notified 0225, no new orders.
Infusion pumpHeparin pump malfunction. New pump obtained.1340 heparin infusion ordered at 18 mL/hr. Pump display showed rate 18 mL/hr, volume infused 96 mL since 0900 bag hung. Expected approx. 83 mL. Infusion stopped 1342. Pump removed from service and tagged. New pump programmed at 18 mL/hr, double-checked with RN [name], restarted 1355. Dr. [name] notified 1350 of approx. 13 mL above expected volume. Order received for STAT anti-Xa level, drawn 1405. No bleeding noted at IV sites, gums or urine.
MonitorMonitor not working right. VSS.0530 bedside monitor showed HR 38. Pt awake, talking, denies dizziness. Manual apical pulse 76 regular, manual BP 128/74. Leads checked, V-lead off chest, reapplied. Monitor reading 76 after reapplying. Telemetry tech [name] notified 0533, confirmed artifact.
Monitor (second pattern)SpO2 probe faulty.2210 SpO2 reading dropped from 96% to 81%, waveform flat. Pt resting, color pink, RR 16 unlabored. Probe moved to other hand, then replaced with new probe. Reading 95% with good waveform at 2214.
BedBed broken, pt fell. Incident report done.0105 found pt sitting on floor beside bed. Bed exit alarm did not sound. Alarm had been checked as on at 2300 rounds. Pt states slid off while reaching for urinal. Assessed: A&O x4, no head strike per pt, no visible injury, full ROM all extremities, VS 132/80, HR 84, SpO2 97% RA. Assisted to bed with 2 staff. Pt moved to new bed, alarm tested and sounding. Dr. [name] notified 0115, orders for neuro checks q1h x4. Charge RN [name] notified 0112.

Every entry on the right runs in the same order. Time, exact reading, what you did, who you told. Then the patient's actual numbers and findings.

Template

Chart note (nursing progress note)

[DATE] [TIME]
At [TIME] [DEVICE TYPE, e.g. ventilator / infusion pump / bedside monitor / bed] [WHAT THE DEVICE DID, e.g. alarmed / stopped / displayed reading / did not alarm].
Display showed: [EXACT ALARM TEXT OR ERROR CODE AND ANY READINGS, e.g. rate, volume infused, HR, SpO2].
Patient status at time of event: [VITALS WITH NUMBERS], [KEY FINDINGS, e.g. color, LOC, work of breathing, breath sounds].
Actions: [TIME] [ACTION 1, e.g. manually ventilated with BVM on 100% O2 / infusion stopped / manual vitals obtained].
[TIME] [ACTION 2, e.g. replacement device placed and programmed per order at SETTINGS, verified with NAME/ROLE].
Notified: [NAME, ROLE] at [TIME]. Response: [WHAT THEY SAID OR ORDERED, or "no new orders"].
Patient response: [TIME] [VITALS WITH NUMBERS], [FINDINGS].
Current status: [VITALS], [DEVICE NOW IN USE AND SETTINGS], [ANY FOLLOW-UP ORDERED, e.g. labs, neuro checks, reassessment time].
[YOUR NAME, CREDENTIALS]

Message to charge nurse or manager

[CHARGE NURSE / MANAGER NAME],
At [TIME] in room [ROOM], the [DEVICE TYPE] for [PATIENT INITIALS OR MRN PER POLICY] [WHAT HAPPENED IN ONE LINE].
Patient is currently [STABLE / STATUS WITH VITALS]. [PROVIDER NAME] notified at [TIME]; orders: [ORDERS OR NONE].
The device is out of service, tagged, and [LOCATION, e.g. in soiled utility / held at nurses station for biomed].
Replacement unit in use: [ASSET NUMBER IF REQUIRED BY POLICY].
I am completing the [SAFETY / DEVICE REPORT NAME PER YOUR FACILITY] now.
[YOUR NAME], [EXTENSION]

Device or safety report (facility reporting system)

Date/time of event: [DATE] [TIME]
Location: [UNIT, ROOM]
Device: [TYPE], manufacturer [MANUFACTURER], model [MODEL], asset/serial [NUMBER]
Disposable components involved: [e.g. tubing set, circuit, probe, with LOT NUMBER if available], retained: [YES/NO]
What the device did: [OBSERVED BEHAVIOR, e.g. stopped infusing without alarm / displayed error / screen went dark]
Exact display at time of event: [ALARM TEXT, ERROR CODE, SETTINGS SHOWN, VOLUME INFUSED]
Settings ordered vs. settings on device: [ORDERED] / [DISPLAYED]
Was the device reset or power-cycled: [YES/NO, BY WHOM, AT WHAT TIME]
Immediate actions taken: [e.g. manual ventilation, infusion stopped, backup device placed at TIME]
Patient effect: [NONE OBSERVED / DESCRIBE WITH VITALS AND FINDINGS]
Notified: [PROVIDER, TIME] [RT / CHARGE RN, TIME] [BIOMED, TIME, TICKET NUMBER]
Current location of device: [WHERE IT IS, TAGGED OUT OF SERVICE: YES/NO]
Reported by: [YOUR NAME, CREDENTIALS, CONTACT]

Words to avoid

Word or phrase Why it hurts Use instead
malfunctioned, faulty, brokenA conclusion about the cause. You may not know the cause yet.What the display showed, or what the device did: stopped infusing, alarm did not sound, display went dark.
pump error, vent alarmWhich error? It doesn't say.The alarm text or code exactly as the screen showed it, e.g. Occlusion Downstream, Error 41.2.
tolerated well, VSS, WNLSays nothing about what happened during the failure.The vitals and findings before, during and after, with times.
machine gave the wrong doseBlames the device and still leaves out the numbers.Ordered rate, displayed rate, volume infused vs. expected. Let the numbers make the point.
incident report completedIt belongs to safety reporting. The clinical record isn't the place.Leave it out of the chart. Follow your facility's policy.
again, as usual, third time this weekA complaint about the equipment. It doesn't describe care.Device history goes in the device report.
accidentally, somehowA guess at how the failure happened.What you observed. Nothing more.

IV pump malfunctioned, replaced, and nothing else

The most common mistake is a chart note that says IV pump malfunctioned, replaced and nothing else. Meanwhile the safety report next to it is detailed.

The device usually gets reset, swapped or sent to biomed within minutes. After that, your note is the only clinical record of what the screen said at that moment and what the patient was doing. And malfunctioned is a conclusion you drew. You didn't observe it. Did the pump run fast? Stop? Alarm for no reason? How much fluid or drug actually went in? Did anyone check the patient? The word doesn't say.

The chart is also the only document that lines up device time against patient time. Alarm at 0214, bagging at 0215, RT arrived 0218, SpO2 back to 95% by 0225: that sequence shows a nurse who saw the problem and acted. Without the times, the record has a gap. Someone reading it later can't tell if the gap was ten seconds or ten minutes.

The opposite mistake causes trouble too. People copy the device report into the chart: the serial number, biomed says this pump has failed before, third bad pump this month, incident report completed. None of that is patient care. It goes in the device or safety report, where your facility's quality and risk teams can act on it.

Bottom line

Before the machine leaves the room, write down what its screen said. Then chart the patient's numbers and the times you acted.

Official guidance

  • When equipment fails, the patient's safety comes first. Assess them, then switch to backup equipment or manual support (a bag on a vent patient) while you sort out the device. (AORN, Tracheostomy Education)
  • On a ventilated patient, check vital signs before the machine. Then make sure the settings running on the vent match the most recent order. (StatPearls, NCBI, Tracheostomy Education)
  • Only trained staff, usually the respiratory therapist, should change vent settings, and RT should hear about any adjustment. (StatPearls, NCBI, Tracheostomy Education)
  • Before you power-cycle or replace a failed device, write down the error message and the exact failure. The report will need them. (AORN, Home Medical Inc.)
  • Take the failed unit out of service, tag it and call biomedical or technical support. Don't put it back into use. (AORN, Home Medical Inc.)
  • Once you've stepped in, document the change in the patient's condition, what you did and how it turned out. (NSO), Home Medical Inc.)

What this rests on

No published decision turned up for this question. We looked, and the searches are in the record. So this article stands on published guidance and on how the question is asked on the floor, not on a court opinion. That is a weaker footing than the rest of the guide, and you should know it before you rely on it. The decisions behind the other articles are all in one place.

From nurses online

Quoted as written. Opinion, not a source.

Other guides

Advice, not law.