![]() Each year, medical errors result in 44,000 to 98,000 deaths in the United States. This is not a news bulletin these statistics were revealed nearly a decade ago by the Institute of Medicine in its seminal report To Err is Human: Building a Safer Health System. A sentinel event is a Patient Safety Event that reaches a patient and results in any of the following: Death Permanent harm Severe temporary harm and intervention required to sustain life An event can also be considered sentinel event even if the outcome was not death, permanent harm, severe temporary harm and intervention required to sustain life. 1: Surgery or other invasive procedure performed on the wrong site resulting in serious harm or death. This is intended to aid consistency in reporting. Since then, studies show that medical errors are the eighth leading cause of death in this country, killing up to 195,000 Americans every year.ĭespite the hard work ongoing nationwide to analyze and reform healthcare systems and thus improve safety, severe errors or sentinel events still occur-and they can happen in any facility at any time. The specifications for the 10 national sentinel events were developed to provide clarity about what constitutes a sentinel event. ![]() ![]() Sentinel events aren’t confined to substandard organizations. Many involve highly respected healthcare systems and practitioners. The sole objective of the event investigation and analysis of an adverse event or near miss is the prevention of future adverse events. point where there was no communication and/ or. This article defines a sentinel event, explains why sentinel events may occur, and describes ways to handle them. The Joint Commissions policy on sentinel events includes retained foreign body as a re- viewable event. Sentinel events are so named because they indicate the need for immediate investigation and response. The Joint Commission defines a sentinel event as: “an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. The phrase, ‘or the risk thereof’ includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.” Serious injury specifically includes loss of limb or function. The Commission points out that the term sentinel event isn’t synonymous with medical error. Not all sentinel events stem from an error, and not all errors lead to sentinel events.
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