Sentinel Event Research Paper

Definition

“A sentinel event is a Patient Safety Event that reaches a patient and results in any of the following death, permanent harm, severe temporary harm and intervention to sustain life” (Joint Commission 2015). Basically a sentinel event happens when the healthcare team or employee causes harm to a patient when it could have been avoided. Sentinel Event Policy was made by the Joint Commission to prevent sentinel events from happening, keep patients safe. The sentinel event that occurred with Lewis Blackman was caused by a medication error.

Compare and Contrast

A medication error is a sentinel event. They both cause harm to the patient. All medication errors can be avoided if you follow the Six Rights to Medication Administration which is the Right medicine, Right

A sentinel event results in death or harm of a patient. Both medication and sentinel events can be avoided with the goal of patient safety.

Synopsis of Lewis’s Story

The death of Lewis Blackman is a tragedy. He could still be alive today if the nurses and doctors had provided him with the appropriate care. After Lewis’s surgery he was administered a powerful painkiller called Toradol, which can cause internal bleeding and ulcers. On the third day after surgery Lewis started complaining of abdominal pain and stated his pain level five out of five. The nurse just thought that he was having gas pain and did nothing about it. This is a clear sign that he is suffering adverse side effects from the painkiller. The mother kept trying over and over to get a veteran doctor to examine Lewis but instead was given a resident doctor. When