A nurse is assisting with teaching a newly licensed nurse about incident reports. Which of the following information should the nurse include?

Incident reports are internal quality-improvement documents used to objectively record the facts of an unexpected event. Identifying all people involved — including witnesses and staff present — provides a complete, factual account that helps the organization analyze the event and prevent recurrence. This information is factual rather than interpretive and supports a thorough investigation. Including personal opinions is incorrect because incident reports must remain objective; subjective commentary can undermine the credibility of the document and create legal liability. Identifying the person responsible for the error is also inappropriate; the report focuses on what happened, not on assigning blame to an individual, which could discourage honest reporting and violate a just-culture principle. Finally, noting in the medical record that an incident report was completed is expressly prohibited in most facilities. The medical record is a communication tool for the care team and becomes discoverable in litigation; cross-referencing an incident report in the chart defeats the confidentiality protections afforded to quality-improvement records. The incident report itself should never be mentioned in the client's chart, and its existence should not be referenced in nursing notes. Therefore, identifying other people involved is the correct piece of information to include in teaching about incident reports.