April 23, 2018

In This Issue
Opioid Prescribing for Pain Continues to Decline in Maine
MMA is 165 Years Old on Saturday, April 28, 2018
MMA Listening Session in Presque Isle on Tuesday, May 15 6-8pm
MMA Board Meets on Wednesday, April 25, 2018
Hanley Center Health Leadership Development Class XI Graduates Twenty-nine Healthcare Leaders
MICIS: Next Steps in Addressing Maine's Opioid Crisis
AMA, Specialty Societies Ask CMS to Reduce 2018 MIPS Reporting Period
Consumers for Affordable Health Care to Honor MMA EVP Gordon Smith at 30th Anniversary Celebration on June 7th
Maine Education Department Announces School Immunization Changes
24 Maine Hospitals Report Sentinel Events
Doctors Without Borders Coming to Maine May 1st
Looking for Help in Paying for Medical School?
Take Control of Debt - April 24 Webinar Presented by Baystate Financial
Final Legislative Call of the Session This Tuesday, April 24th
Legislative Report: Adjournment?
FREE 8-Hr. MAT Waiver Training Being Offered in Dover, NH - Friday, April 27th
Maine Society of Eye Physicians and Surgeons Spring Educational & Business Meeting - Friday, May 4th
Introduction to Lean in Healthcare Full-Day Workshop on Tuesday, May 8
Maine Chapter, American College of Surgeons Annual Meeting in Kennebunkport, ME - May 18-20
One River, One Ocean: June 2-14, 2018
New Free CME on Alzheimer's Risk, Detection, and Management
Peer Navigation Program from Facing Our Risk of Cancer Empowered (FORCE)
Online Learning Opportunities Offering CME Credits - from the Northern New England Practice Transformation Network
Outpatient Internal Medicine Physician Bangor, Maine
Family Practice Physician - Bucksport Regional Health Center
Relocate to Beautiful Southwestern Maine - Medical Director/Family Practice Physician
Psychiatry Faculty, Division of Child & Adolescent Psychiatry
Psychiatric Medical Director
Maine's Largest FQHC in need of Physician for Geriatric Program
Multiple Family Med Opportunities in Beloved Community Health Centers
Outpatient Only - Internal Medicine with Loan Repayment & Sign-on Bonus
Internal Medicine Outpatient Physician
Clinical Cardiology Opportunity
Opportunities at the VA for Volunteer Physicians

Search Back Issues


Follow Us:
24 Maine Hospitals Report Sentinel Events

[from the Maine Hospital Association's Hospital Update]

Hospitals reported the majority of sentinel events, although another nine events were reported by other facilities covered under the sentinel event law.

The number of events reported represents a 13.2 percent increase in reported events from 2016 to 2017, a fact that the Sentinel Event Team (SET) took as due to increased surveillance rather than an increase in events.

The report said that 20 percent of the events occurred on a weekend or a holiday. 

Of the 27 different categories of sentinel events, eight categories made up 83 percent of the total events:

  • Stage 3 or 4 and unstageable pressure ulcers at 83 (31 percent);
  • Fall with serious injury at 43 (16 percent);
  • Unanticipated death within 48 hours of treatment at 32 (12 percent);
  • Unanticipated death at 21 (8 percent);
  • Wrong-site surgery at 15 (6 percent);
  • Unanticipated transfer to another facility at 9 (3 percent);
  • Death or serious injury from a medication error at 9 (3 percent); and
  • Unintended retention of a foreign object at 8 (3 percent).

Pressure ulcers have been in the top three most frequently reported sentinel events over the past seven years, the report said.  Falls with patient death or serious injury continue to remain the second most reported sentinel event.  Reported events show that falls frequently occur when the patient is getting up to use the toilet.

The SET continues to see issues, such as the failure to use the surgical timeout process, contribute to continued wrong-site surgeries.  The SET questioned if timeouts are being performed accurately and with the required attention. 

The most common action items from the root cause analysis stemming from these sentinel events are policies and procedures, education and training, and evaluation.

The SET plans to focus on the following goals for 2018:

  • Continue to provide technical assistance and consultations, as requested, to facilities;
  • Continue to assess facilities’ compliance with the sentinel event law by conducting on-site reviews.  On-site reviews at all hospitals that have not yet been reviewed will be completed in 2018;
  • Continue to enhance the sentinel event database with relevant information and analyze complaint data to identify trends in events, track individual facility events and use data effectively;
  • Continue to publish the quarterly sentinel event newsletter;
  • Review and revise the sentinel event rules to clarify reporting criteria and other modifications;
  • Continue to develop collaborative workgroups to discuss challenges and best practices related to patient safety;
  • Collaborate with facilities to ensure compliance with notifying the SET of an event within one business day of the event being discovered, and submission of a root cause analysis and associated requirements with 45 days of reporting; and
  • Look at methods to review outpatient provider-based practices listed on facilities’ licenses for compliance with the program and reportable events.


< Previous Article | Next Article >

[ return to top ]

To ensure delivery of Maine Medicine Weekly Update,
please add 'info@mainemed.com' to your email address book or Safe Sender List.
If you are still having problems receiving our communications,
see our white-listing page for more details: http://www.commpartners.com/website/white-listing.htm

Unsubscribe here

For more information or to contact us directly, please visit www.mainemed.com | ©