Question

Review an article related to a sentinel perioperative event. Be sure to summarize the article. Include the following: What is a sentinel event? Give background information on the patient (i.e. age, past medical history, admitting diagnosis). Discuss the cause of the sentinel event, if it resulted in any complications (i.e. injury, trauma, death). Discuss preventable measures related to this event (i.e. raise side rails, review of 5 rights of medication administration, etc.). What did you learn from the article?

Answer 1

• Anticipated event in healthcare settings resulting in death or serious physical /psychological injury to a patient,which is not related to patient course of illness.
• Backgroundinformation of the patient- for the prevention of sentinel event during the perioperative period background of the patient should be checked.

1.age-during the perioperative period patient age should be confirmed .it helps in administration of anaesthesia which is to be calculated according to age and patient body weight.if patient age is not verified and less amount has been administered then it will be less effective for the patient and if more amount of anaesthesia has been administered to the patient it may lead to death of the patient.

2.past medical history-patient past medical history should be verified otherwise it may lead to the death the patient or unexpected complications during the perioperative phase. for example if the patient is having thrombocytopenia and it has not been verified before the surgery then during surgery it may lead to the severe bleeding and patient may develop anaemia and hypovolemic shock.

3.admitting diagnosis-confirm diagnosis for the patient is very important for the proper treatment. it will give an idea where is the problem and which surgery need to be done.

• Causes of sentinel event

1. Improper history collection
2. Past medical and surgery history has not been taken
3. No proper diagnostic measures has been used
4. before surgery vital signs has not been checked b
5. surgery patient eaten anything as we know before surgery patient should be nil by mouth.
6. after surgery patient vital signs has not been checked.
7. Patient aspirated
8. During surgery if any article retained inside the body which may lead to the infection and can cause complication
9. During surgery and after the surgery if aseptic technique not used for the procedure then it will cause infection and it may cause complication.

• Preventive measures of sentinel event-

1. Proper history collection
2. Proper identification of past medical and surgical history.
3. Providing side rail to the patient for the prevention of fall
4. Administer medication by using 5rights of patient i.e- right patient,right medication,right dose,right time and right route.
5. Proper documentation of vital signs .
6. Maintenance of intake output chart.
7. Use of aseptic technique for the procedure.