chapter 10 | Quality and Safety 143within the organization must be made aware of
the event; they must investigate and understand
the causes of the event; and they must make
changes in the organization’s systems and
processes to reduce the probability of such an
event in the future (jcaho.org/ptsafety_frm.html).The subset of sentinel events that is subject to
review by JC includes any occurrence that meets
any of the following criteria:
■The event has resulted in an unanticipated death
or major permanent loss of function, not related
to the natural course of the patient’s illness or
underlying condition.
■The event is one of the following (even if the out-
come was not death or major permanent loss of
function): suicide of a patient in a setting where
the patient receives around-the-clock care (e.g.,
hospital, residential treatment center, crisis
stabilization center), infant abduction or discharge
to the wrong family, rape, hemolytic transfusion
reaction involving administration of blood or
blood products having major blood group incom-
patibilities, surgery on the wrong patient or
wrong body part (jcaho.org/ptsafety_frm.html)
Adhering to nursing standards of care as well as the
policies and procedures of the institution greatly
decreases the nurse’s risk. Common areas of risk for
nursing include:
■Medication errors
■Documentation errors and/or omissions
■Failure to perform nursing care or treatments
correctly
■Errors in patient safety that result in falls
■Failure to communicate significant data to
patients and other providers (Swansburg &
Swansburg, 2002)
Risk management programs also include attention
to areas of employee wellness and prevention of
injury. Latex allergies, repetitive stress injuries,
carpal tunnel syndrome, barrier protection for
tuberculosis, back injuries, and the rise of antibiotic-
resistant organisms all fall under the area of risk
management (Huber, 2000).
Adhering to standards of care and exercising the
amount of care that a reasonable nurse would
demonstrate under the same or similar circumstances
can protect the nurse from litigation. Understanding
what actions to take when something goes wrong is
imperative. The main goal is patient safety. Reporting
and remediation must occur quickly (Huber, 2000).
Once an incident has occurred, you must com-
plete an incident report immediately. The incident
report is used to collect and analyze data for future
determination of risk. The report should be accu-
rate, objective, complete, and factual. If there is
future litigation, the plaintiff ’s attorney can sub-
poena the report. The report should be prepared in
only a single copy and never placed in the medical
record (Swansburg & Swansburg, 2002). It is kept
with internal hospital correspondence.
Nurses have a responsibility to remain educated
and informed and to become active participants in
understanding and identifying potential risks to
their patients and to themselves. Ignorance of the
law is no excuse. Maintaining a knowledgeable,
professional, and caring nurse-patient relationship
is the first step in decreasing your own risk.The Economic Climate
in the Health-Care SystemFor many years, decisions about care were based
primarily on providing the best quality care, what-
ever the cost. As the economic support for health
care is challenged, however, health-care providers
are pressured to seek methods of care delivery that
achieve quality outcomes at lower cost.Economic Perspective
The economic perspective is rooted in three funda-
mental observations:
1.Resources are scarce.Due to scarce resources,
three choices result:
■The amount to be spent on health-care services
and the composition of those services
■The methods for producing those services
■The method of distribution of health care,
which influences the equity with which these
services are distributed
2.Resources have alternative uses.As a result of
this scarcity, the choice to expend resources in
one area eliminates the use of those same
resources in another area. If more nursing
homes are going to be built, for example, then
there will be fewer hospitals, less housing, less
education, or other uses of those same
resources.