Sentinel Events
Listing of Sentinel Events
Q: When was the listing of The Joint Commission reviewable Sentinel Events changed?
A: The most recent changes occurred back in 2007. That followed on several changes that were made through 2006.
The complete list of reviewable Sentinel Events events is as follows:
• 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
or
• The event is one of the following (even if the outcome was not death or major permanent loss of function unrelated to the natural course of the patient’s illness or underlying condition):
o Suicide of any patient receiving care, treatment and services in a staffed around-the-clock care setting or within 72 hours of discharge
o Unanticipated death of a full-term infant
o Abduction of any patient receiving care, treatment, and services
o Discharge of an Infant to the wrong family
o Rape
o Hemolytic transfusion reaction involving administration of blood or blood products having major blood group incompatibilities
o Surgery on the wrong patient or wrong body part
o Unintended retention of a foreign object in a patient after surgery or other procedure
o Severe neonatal hyperbilirubinemia (bilirubin >30 milligrams/deciliter)
o Prolonged fluoroscopy with cumulative dose >1500 rads to a single field, or any delivery of radiotherapy to the wrong body region or >25% above the planned radiotherapy dose