NEVER EVENTS

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QUICK FACTS

  • “Never” Events are the most egregious type of errors that should never happen. Ranging from surgery in the wrong site to criminal maliciousness.
  • The researchers, reporting online in the journal Surgery, say they estimate that 80,000 of these so-called “never events” occurred in American hospitals between 1990 and 2010 — and believe their estimates are likely on the low side.
  • In the same study, it is found that Death occurred in 6.6 percent of patients, permanent injury in 32.9 percent and temporary injury in 59.2 percent.(Source: Johns Hopkins University)

NEVER EVENTS

Overview

In December of 2012, Johns Hopkins University released a Report identifying several categories of completely preventable medical mistakes known as “Never Events.”  A Never Event is an inexcusable error that never should occur.

Categories

The following categories of shocking, extreme and indefensible Never Events include:

Safety Measures To Prevent Never Events

Although human error can always occur, the following safety measures can reduce Never Events from occurring:

  • Operating Room Time Outs – prior to beginning surgery confirmation as to the patient and planned procedure is obtained.
  • Performing accurate counts before and after a surgical procedure of the surgical tools and sponges.
  • Marking the correct site of the surgical procedure.
  • Instituting policies and procedures for communication among the surgical team.

Frequency

Unfortunately, Never Events are not as rare as one may think.  According to Johns Hopkins University, an estimated 80,000 Never Events occurred in US hospitals between 1990 and 2010.  During this time period:

  • The wrong surgical procedure was performed on patients an estimated 20 times per week.
  • The wrong body part was operated on by surgeons an estimated 20 times per week.
  • A foreign object, such as a surgical instrument, a surgical towel or a surgical sponge was left in patients an estimated 40 times per week.

Patients between 40-49 were the most vulnerable for a Never Event.  Also, the most Never Event mistakes were made by surgeons less than 60 years old.

Sadly, these Never Events continue to occur today at the rate of approximately 4,000 new cases each year.  These lapses in medical care which are unambiguous, preventable and clearly identifiable represent a major healthcare quality problem that causes needless injury and millions of dollars in otherwise unnecessary medical care each year.

Again, “Never Events” are totally preventable medical mistakes. If you or a loved one has suffered a “Never Event,” call our knowledgeable and experienced office today.

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