Never events in healthcare: definition, prevention, and impact

¶ … role of an employee of a medical organization who is attending a general meeting with its management to discuss some changes regarding the Quality Assurance program due to the occurrence of a "never event." Here we will address the questions which will be put forward by the nursing staff and try to find a proper solution which is acceptable by all of the parties involved in the organization. Let's look at this in detail.

Term definition

The term "never event" is given to any sorts of critical medical errors which are supposed to be avoided at all cost. Some of the events which can be classified under this category include wrong-site surgery, delay in treatment of the patient, patient fall, patient suicide, operation or post-operation complications, medical errors and so on. Although the reduction of the Never Event is one of the top most priority of medical institutions, it is observed that one of the main reason for their occurrence is lack of standard operating procedures among the staff, proper management of entire institution or finally just the human error factor. Now, let's look at some of the responses which our chosen employee can give.

Addressing the staff

"Addressing the staff immediately in the correct manner is very important." (Brown, 1992). Here are some of the ways which can help any individual in doing this process effectively.

Stating the facts

Interpreting the facts in simple manner

Stating own feelings regarding it

Validate the relationship

Saying "Help me understand"

Requesting for behavior change

Asking for their feelings regarding how they feel about some particular event

Validating Statements

Validating statements of the nurses in our chosen case is very important as it is the root to solving the key problem(s). Examining the validity of statements can involve examining the basic facts, history related to the person who is making the statement, conformation from other sources or doing in-depth research regarding the statement being made. "Experience can greatly help in solving the problem but here it can also help in judging validity." (Kleiner, 2006).

Examining Validity

There are various different methodologies which can help in achieving this crucial aim, some of them are as follows.

Comparison with facts

Any professional analyst which checks the validity of statements being made must have a thorough and broad sense of knowledge regarding the subject matter. Here in our case the employee should have great knowledge of the ongoing facts, conditions and that of other related material. It should also take note of taking different sources as a mean for information gathering and validation. "A good analyst never jumps straight to a conclusion but looks at all of the different possible angles regarding the problem and its solution." (Hall, 2007).

Reliability of the source

In many cases the statements made by others are not true but based on biased sources, in this case the analyst must confirm from other sources if such is a case before making any judgment. The analyst should also be flexible enough to make amendments in its judgments.

Prevention methodologies

Our chosen employee can take various different measures for implementation in order to prevent a recurrence of Never Event, some of these measures are as follows.

Regarding medicines

"The doctors and nurses can make sure they have all the knowledge regarding the medicines, where they are kept and so on." (Kinnaman, 2007). Here, it is noted that if medicines are not provided on time then it can result in serious injuries or even fatalities. This factor greatly reduces the medication error event which is one of the foremost of the Never Event.

Regarding surgeries

Making sure that all the necessary items regarding surgery is available as well as distilled properly, in many cases the infection resulting from infected equipments can cause severe damage to the patient.

Mutual consent

"The mutual partnership between doctor and nurses with the patient should be very constructive, the patient should be encouraged to share more on what it feels and what it wants." (Hospital peer review, 2010). This greatly helps the psychology of the patient as it gives him the feeling of care and trust. This can be a great factor for motivation for those individuals who are about to go through a serious surgery and it also makes the medical professionals concentrate more on their work making them less vulnerable to any sort of Never Events.