SCRMC Patient Safety Module

or staff should be reported by completing a “Reportable Event” form. This
will be reviewed by your director and then sent to Administration. Employee
injuries should be reported on an “Employee Occurrence Report” and sent
to Employee Health. Any variance related to medications should be reported
on the “Error Hotline” at 4227 or on a “Medication Variance Report.”
Nurses may be responsible for reporting Sentinel Events. A sentinel event is
an unexpected occurrence involving death or serious physical or
psychological injury, or the risk thereof. Serious injury specifically includes
loss of limb or function. The phrase “or risk thereof” includes any process
variation for which a recurrence would carry a significant chance of a serious
adverse outcome. Types of sentinel events may include but are not limited to:
any patient death, coma, medication error, suicide, patient elopement,
procedure performed on wrong patient or wrong site, any assault, falls, and
hemolytic transfusion reactions. Report “near misses” that could have
resulted in any of these outcomes. Report these events immediately to your
director or supervisor. Your most important action following a reportable
event or medication variance is to assess your patient and respond to their
needs. A report should be filled out with documentation of the situation. A
complete investigation of the incident will include ways to prevent the error
from recurring.
Question
A reportable event covers the following situations _____________________
______________________________________________________________
A sentinel event is _______________________________________________
______________________________________________________________
The nurse’s most important action following a reportable event or medication
variance is to ________________________________________________.
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