750 words not including title and reference page min 4 APA
See rubric
Write a formal APA paper that addresses the following:
· Identify what is an adverse event, near miss, and sentinel event.
· Discuss an adverse hospital event or near miss. You can use personal experiences or national news.
· Discuss the role of the nurse in an event and how they can advocate for the patient
· Discuss mandatory reporting laws or systems to report events.
This paper should be between 750 WORDS and include:
· APA Formatting to include:
o a title page
o an introduction and conclusion
o in-text citations
o references that include at least three scholarly, credible sources to support your topic
o No abstract is needed
o Title and references pages do not count in the page total
Adverse Events, Near Misses, and Sentinel Events in Healthcare: The Role of Nurses in Advocacy and Reporting
Introduction
Patient safety is a critical aspect of healthcare delivery, and healthcare providers strive to prevent adverse events, near misses, and sentinel events. Understanding these concepts is essential for nurses to effectively advocate for their patients and ensure their well-being. This paper aims to define adverse events, near misses, and sentinel events, discuss a specific adverse hospital event or near miss, explore the role of nurses in such incidents and their advocacy for patients, and finally, examine mandatory reporting laws or systems.
Identifying Adverse Events, Near Misses, and Sentinel Events
An adverse event refers to any unintended harm to a patient resulting from healthcare delivery, rather than the underlying medical condition. It encompasses medical errors, system failures, and adverse drug reactions. Near misses, on the other hand, are events in which an error almost occurred but was intercepted before reaching the patient, thus preventing harm. Sentinel events are rare and severe occurrences that result in patient death or serious harm and require immediate investigation to prevent recurrence.
An Adverse Hospital Event or Near Miss
One notable adverse hospital event that gained national attention was the case of patient misidentification. In 2019, a patient was mistakenly administered a medication intended for another patient with a similar name. The error was detected before the medication caused harm, making it a near miss. However, this incident highlighted the critical issue of patient identification and the potential consequences of misidentification in healthcare settings.
The Role of Nurses in Adverse Events and Advocacy for Patients
Nurses play a pivotal role in patient safety and advocacy during adverse events. They are at the forefront of patient care, constantly monitoring and assessing patients for any signs of deterioration or complications. In the case of a near miss or adverse event, nurses are responsible for recognizing and reporting the incident promptly. They collaborate with the healthcare team to ensure appropriate interventions are implemented and support patients and their families emotionally.
In advocating for patients, nurses serve as their voice and ensure their rights and well-being are upheld. They provide education to patients and their families, empowering them to actively participate in their care. Nurses also act as patient advocates by effectively communicating and collaborating with other healthcare professionals, ensuring the patient’s needs and preferences are considered in the decision-making process.
Mandatory Reporting Laws or Systems
To address the occurrence of adverse events and promote transparency, mandatory reporting laws and systems have been implemented. These laws require healthcare providers to report incidents to the appropriate regulatory bodies or governing agencies. The purpose is to identify patterns, analyze data, and implement measures to prevent future occurrences. Such reporting systems enable a collective learning process and contribute to enhancing patient safety.
One example of a mandatory reporting system is the National Reporting and Learning System (NRLS) in the United Kingdom. NRLS allows healthcare professionals to report incidents, near misses, and risks anonymously. This system collects and analyzes data from multiple sources to identify potential risks and trends. In the United States, healthcare facilities are required to report sentinel events to the Joint Commission, a non-profit organization that accredits and certifies healthcare organizations.
Conclusion
Adverse events, near misses, and sentinel events pose significant risks to patient safety. Nurses play a vital role in recognizing, reporting, and advocating for patients during such incidents. Their involvement in patient care and collaboration with the healthcare team are crucial in preventing harm and improving patient outcomes. Mandatory reporting laws and systems further contribute to the collective effort of identifying and addressing risks, promoting patient safety, and ensuring continuous improvement in healthcare delivery.
References
Institute for Healthcare Improvement. (2021). Adverse events, near misses, and sentinel events. Retrieved from https://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/
