Sentinel Event

A1. Sentinel Event Review of the medical record for the specified patient (SP) was completed 09/16/12. The medical record revealed that the SP was a minor child with a diagnosis of history of frequent and recurrent tonsillitis and was scheduled to have the tonsils and adenoids removed 09/14/12 at 10:30 AM as an outpatient procedure. Review of the medical record for the day of 09/14/12 revealed that the SP was admitted to the pre-admission testing area at 9:00 AM. At 10:00 AM the SP was in the pre-operative area with the peripheral intravenous line in place and the pre-operative medications were being administered.At 10:30 AM the SP was in the operating room (OR) and the procedure was performed as scheduled. At 11:15 AM, the SP was moved from the OR to the post anesthesia care unit (PACU). At 12:15 PM, the SP was successfully recovered from the procedure and both the surgeon and the anesthesiologist cleared the SP to go home. The medical record revealed a nurse’s note by the pr e-operative nurse on 09/14/12 at 10:30 AM that documented a conversation between the pre-operative nurse and the SP’s mother where the mother stated she was leaving to run an errand involving an older sibling and left a cellular telephone number.The only documented instruction from the mother was for the nurse to call if the SP got out of surgery sooner than expected. In an interview with the PACU nurse conducted on 09/15/12 at 10:00 AM, the PACU nurse stated that on 09/14/12 at approximately 12:30 PM, the patient was released for home to her father, who was identified by his driver’s license; the PACU nurse stated that she provided written instructions for the patient’s post-operative care and follow up appointment to the father.The PACU nurse stated that the patient’s father verbalized understanding of the discharge instructions and left with the patient. The medical record lacked documentation of this encounter. The medical record also lacked documenta tion of any restrictions as to which parent was permitted to take the patient home. The patient’s mother arrived at the hospital on 09/14/12 at approximately 1:00 PM to take the patient home and was extremely distraught when she discovered her daughter was not in the PACU as she expected.There was a shift change at 1:00 PM and the oncoming nurses did not know that the patient was released to her father. As a result, security was called and a hospital-wide child abduction alert (code pink) was activated. In addition to hospital security, local law enforcement was also notified of the missing child. The SP’s mother told the hospital security officer that she and the SP’s father were divorced and she had full custody of the SP and the SP’s siblings. On 09/14/12 at approximately 1:30 PM, the SP was located at the father’s residence, in the care of the father.The SP’s father stated that he took the SP to his residence to wait for the SP’s mother to arrive. No charges were filed against the SP’s father. The hospital management and security personnel assured the SP’s mother that this incident would be investigated and processes would be put in place to prevent it from happening in the future. A2. Personnel There were several employees who had interactions with the SP and her mother during the outpatient hospital procedure. The first person was the hospital registrar who took the SP’s demographic information from the SP’s mother.The next person was the pre-operative nurse who took obtained the SP’s clinical information and medical history from the SP’s mother, performed the initial physical assessment (height, weight, vital signs, cardio-pulmonary, and head to toe), and obtained peripheral intravenous access. The people who then interacted with the SP were the surgeon, the anesthesiologist, and the operating room nurses. The surgeon also had an office visit with the SP and her m other in the days leading up to the surgery. The OR nurse took over care when the SP was moved from the pre-operative area to the OR.The OR nurse made the SP comfortable until she was under the anesthesia and began the recovery process after the surgery was completed. The next person who interacted with the SP was the post anesthesia care unit (PACU) nurse. The PACU nurse was responsible for monitoring the SP during the recovery phase when she was coming out from under the anesthesia. During the post anesthesia phase, the surgeon and the SP assessed and evaluated the SP. Both the surgeon and the anesthesiologist had to sign the papers to release the patient to the discharge nurse. Finally, the patient was transferred to the care of the discharge nurse.The discharge nurse released the SP to her father. After the SP’s mother came back to the hospital and reported the SP was missing, the Chief Nursing Officer (CNO) was immediately involved. The CNO met with the SP’s mothe r and alerted the security team and local police to the disappearance of the child. The local police were able to locate the SP at her father’s house approximately 30 minutes after she was reported missing. The CNO had the responsibility to the SP’s mother to launch the investigation into the cause of her disappearance and to implement a plan of correction so the incident could be prevented in the future. A3.Personnel Issues Several factors negatively affected the coordination of patient care by the employees on 09/14/12. First, the communication between the admission personnel and the SP’s mother was ineffective when the registrar failed to obtain privacy information and/or ask about any custody situation. Second, the pre-operative nurse did obtain the custody information and the mother’s cellular telephone number and documented these on her clip board. However, the pre-operative nurse failed to report this as important information to the operating room nurse upon transfer of the SP from the pre-operative area to the operating room.As a result, the operating room nurse did not alert the PACU nurse to this important information upon transfer of the SP from the OR to the PACU area. The hospital failed to have hand off policies and procedures in place when a patient was moved from one area of surgery to another. They depended solely on their electronic record and did not have any reporting requirements in place when a patient was moved from the admission to pre-operative to operative to post-operative areas. There was a cultural/language barrier between the PACU nurse and the Hispanic discharge nurse making verbal communication very difficult.Other factors of poor communication were staffing ratios and the perspectives and attitudes of the staff. In interviews conducted with the registrar, the pre-operative nurse, the PACU nurse, and the discharge nurse after the sentinel event, they all had a negative, finger pointing attitude of doi ng the minimum to get by and not taking responsibility for the sentinel event. There was also a cumulative feeling among the staff of fear of reprimand or of being ignored in expressing thoughts about the security of pediatric patients in the surgery area, â€Å"Organizational structure has a direct impact n the communication within an organization. The way the hierarchy of an organization is designed either invites feedback, open-mindedness and effective communication or stifles, controls and restricts the ability of subordinates to freely express thoughts, feelings and ideas (Papa 2012). † In the post sentinel event interview, the pre-operative nurse expressed an idea about matching hospital wrist bands for both the child and the parent. This was a good idea, but no system for matching wrist bands was in place.The pre-operative and post-operative areas were understaffed that day making communication among the nurses hurried and ineffective, ultimately creating gaps in commu nication and contributing to the sentinel event. The fact that the surgical area was so short staffed left very little time for the nurses to give hand off reports. As a result, many important details were overlooked. The CNO failed to ensure that the required monthly staffing meetings were held among the surgical team members.Finally, the security personnel were not even called for several minutes after the SP was reported as missing and the security manager failed to perform the â€Å"code pink† child abduction drills on a quarterly basis as required by the hospital’s policy. A3a. Improve Interactions The initiative to improve interactions among the personnel working on 09/14/12 included a new policy implemented on 10/01/12 regarding obtaining custody information and privacy information at the point of registration for any minor child whether it is in the emergency room, inpatient, or outpatient areas of the hospital.This policy included a stipulation that three thin gs are established: a list of people who are permitted private information, a list of people who are permitted to take the patient out of the hospital, and a four digit pin number established by the parent. Information and/or the patient themselves will only be released strictly to a person who is both on the privacy list and who have the pin number. A policy and procedure was also implemented on 10/01/12 in the outpatient surgery area which included detailed procedures for patient hand off when the patient was moved from one area to the next.A new patient hand off form was created which included basic demographic data, medical history, allergies, medication profile, the privacy list, pin number, and any other pertinent custody information for minor children. The registrar must document that both a verbal report and the written report were given to the pre-operative nurse. The pre-operative nurse must then document this same information was relayed both verbally and in writing to th e OR nurse and the OR nurse is also required to document this same information was relayed both verbally and in writing to the PACU nurse.The hand off forms must be signed by both the person reporting off and the person receiving the report and filed in the patient’s paper chart or scanned into the patient’s electronic medical record. A mandatory in-service meeting for all staff was held on 09/28/12 to teach the staff the new policy and procedures. Also, the required monthly staff meetings for the entire surgical team (including physicians) will be implemented to serve as a town hall approach discussion to get any complaints or suggestions by the staff out in the open.In addition to the monthly staff meeting, there will be required in-service education for the staff for the next twelve months including patient safety, child abduction prevention, improvisational workshops to prompt discussion among staff, patient hand-off, time out before discharge, patient rights, dive rsity training, verbal communication, nonverbal communication, shift change reporting, patient satisfaction, and patient education. A4. Quality Improvement The identification and data gathering quality improvement method was used in the root cause analysis of the sentinel event.First the problem was identified; the processes needing improvement were pediatric safety and staff communication. These processes were identified through the post sentinel event interviews of the staff, administrative staff post sentinel event huddles, and surgery staff post sentinel event huddle (including security staff). The data was gathered from the SP’s medical records and a timeline was created starting when the SP entered the hospital and ending when the SP left the hospital with her father. This timeline included an analysis of what was actually done by each employee and also what should have been done to prevent the sentinel event.The question of why was asked when inactions were determined to be what resulted in the sentinel event. Along with the SP’s medical record, all other medical records for minor children who received outpatient surgery at the hospital during the first two weeks in September were also analyzed to determine that the inactions on the part of the outpatient surgery staff were a systemic problem and that this was not an isolated case. Staffing ratio policies were reviewed and security policies on â€Å"code pink† drills were also reviewed.Staff meetings were held weekly where feedback was provided to staff during the root cause analysis process regarding performance indicators and benchmarking against other hospitals of similar size in the areas of patient hand offs, staff to patient ratios and performance of security drills including child abduction drills. After the data was gathered, all involved in the sentinel event were gathered and a list of causes of the sentinel event was created. This list was used in creating the recommendat ions to improve staff communication and creating the process change to ensure that the sentinel even does not recur.B1. Risk Management Program The process of obtaining custody information and privacy information at the point of registration for any minor child, in all areas of the hospital, will be managed and directed by the head Quality Improvement Officer of the hospital. The new policy also has a requirement to prevent the sentinel event from happening again; at the point of registration any minor child under the age of 18 will have a bar-coded band put on their wrist or if they are less than four years old, on their ankle.The parent(s) or legal guardian(s) will be required to wear a wrist band with a matching bar code. Before the child is discharged home, both wrist bands will be scanned with the computer bar code scanner to ensure the wrist bands match. Only the parent(s) or guardian(s) with proof of legal custody will have the wrist band. Additionally, at the point of regist ration, the parent(s) or guardian(s) will be asked to choose a four digit pin number which will be noted in the electronic medical record under the security tab.At the point of discharge, the parent(s) or guardian(s) will be required to give the four digit pin number before the child is released to them for discharge. These measures are to be implemented by 10/05/12 with 100% compliance expected by 10/12/12. Starting on 10/05/12, the Quality Improvement Officer will audit 25% of all admission paperwork on a weekly basis to ensure compliance with the new policy. The Quality Improvement Officer will keep a log of this audit process and the outcomes of the audits. If a registrar is found to be out of compliance with the requirement, disciplinary action will occur.Starting 10/05/12, the Nurse Manager of the outpatient surgery area is required to audit 25% of the outpatient medical records on a weekly basis for compliance with the new patient hand off policy and procedure which applies t o adult and minor child patients. She will also keep a log of this audit process and the outcomes of the audits. The Quality Improvement Officer and the Nurse Manager of the outpatient surgery area will hold bi-weekly meetings with the heads of each department in the hospital to review the audit results and to obtain feedback from each department regarding the new policies and procedures.The Nurse Manager of the outpatient surgery area will hold bi-weekly meetings with the outpatient surgery staff to review the audit results and to obtain feedback on the new admission process for minor children and the new patient hand off process for all patients. Starting 10/01/12, the Nurse Manager of the outpatient surgery area will also be responsible for closely monitoring the daily staffing ratios and ensuring that adequate staff is working during each shift.Also starting 10/01/12, the head of the security department will be responsible for performing the â€Å"code pink† drills monthl y and documenting these in the security log book. New security cameras will also be installed in the outpatient surgery area, at all exit doors, by 10/12/12. B1a. Resources The resources needed to support the changes to prevent the sentinel event from recurring are the medical staff, corporate compliance staff, administrative staff, human resources, and outside compliance consultants.The legal team was immediately involved in the sentinel event to minimize the risk involved in an event such as child abduction. The finance department will provide the financial resources to purchase the new bar coded band system and the new security cameras. The staff will need to be trained on the new policies and procedures by the education department. Also, it is essential that each shift and each department have an adequate staffing ratio which is the responsibility of the hospital administration and the CNO.Human resources, administration, and the CNO were involved in interviewing and counseling the staff involved in the sentinel event. They will have an ongoing responsibility to follow up with the staff to ensure compliance with the new policies and procedures. Outside compliance consultants were also utilized in completing the root cause analysis, creation of the plan of correction, and implementing the plan of correction. C. Sources Papa, J. (2012, May 9). General format. Retrieved from http://www. ehow. com/about_6071356_communication-organizational-structure. html

Buddhist Temple Visit

Buddhism is religion that is based off of peace and spirituality taught by the teachings of Buddha, also known as Siddhartha Gotama. Many who follow its teachings believe Buddhism to be more of a way of life or lifestyle choice rather a religion. Buddha is not a god, but one man that taught his followers a path of enlightenment from his experiences and values. Buddha’s main teachings were the Four Noble Truths and the Noble Eightfold Path. The Four Noble Truths were teachings about suffering, pain, disease, happiness, loneliness, and aging.It explained why we as humans can overcome certain obstacles in our lives by looking at the more spiritual side of things such as â€Å"Happiness is not something ready-made. It comes from your own actions. † (Dalai Lama). The Eightfold Path is the teachings of being moral, being aware of our actions and thoughts, developing compassion for others, and most importantly gaining wisdom from the understanding of The Four Noble Truths. I visited the Vietnamese Buddhist Center in Sugar Land this past Sunday and it was a sight to behold.The center was surrounded by a green metal fencing with some sort of crest or emblem that looked similar to an steering wheel on an old ship. Driving into the center, the main road was split then split into two smaller roads. The road to the left led to a parking lot, while the road to the right led to a smaller parking lot surrounded by small buildings that seem to be places of worship. The scenery that over hung the roads were statues of lion heads, beautiful trees and flowers in all sorts of colors.The main statue however was a huge tall Buddha in the middle of large pond filled with Koi Fish. There was a small tiled area that visitors could take pictures of the statue in its amazing and beautiful nature. The aura of the place was one of peace and tranquility. The small tiled visitor area was then extended by an overhanging wooden bridge leading to a large tiled courtyard with small trees that was around the perimeter. In the middle of the courtyard was two rows of small trees that were placed vertical to the steps of a large temple, which was the main place of worship.Behind the main temple was another small courtyard was two smaller buildings for worship to the left and the right of the courtyard. Another large building was to the back which looked fairly newly built. It seemed to be a place of serving food that contained no meat but some sort of meat substitute that was not artificially made from what the servers were telling me. Then to the right of that building was a small warehouse that looked to house desks and whiteboards for the weekly Vietnamese classes that are being held there.Outside of the warehouse was a basketball goal for the students that would come for Sunday school, and a small parking lot for more visitors. As I took off my shoes before entering the main temple before the first worship session began, I began to feel a sense of peace within myself as well those that were atten ding the worship session. Inside the main temple was a huge statue of Buddha surrounded with white silhouettes of the Lotus flower, which seems to be the symbol of peace. Tens of incense jars filled with sand litter the alter the room.The room smelled like incense, pleasant and peaceful. There were twenty rows of small cushions that were used for kneeling and sitting, and twenty rows of small raised shelves that were used for holding the prayers that were going to be recited during that session. People were filling the room really quickly, and seats were being taken fast. The elders were given their seats first, and if an elder came a tad late, someone would give them their spot and moved to the side of the room. Everyone was dressed somewhat casually. Most of the older occupants were wearing work clothes like the men wearing slacks and a nice fitted collared shirt, while the women would wear either a dress or slacks and nice top or blouse. The younger occupants, ones of my age or younger, would just be wearing casual school clothes like jeans and a tee shirt. In such a religious place, I have not yet witnessed a young female wearing short-shorts or any revealing outfit for that matter. The room was filled with a mild chatter of Vietnamese and English.Most conversations that I could comprehend were mostly of those catching up with each other and wondering how each other was doing and such. The younger occupants would be talking about the latest craze in music or movies. It suddenly got quiet as there was three loud bangs from striking of the gong to commence the prayers. The head monk for that prayer came out from one of the side doors in a traditional orange robe holding a microphone in his right hand, and prayer sheets in his left. He thanked us all for coming today and briefly explained he prayer we were going to be reciting. The prayer was for those that had lost a loved one, and for them not to be sad as their loved ones have found peace and tranquility as the moved on into the steps of enlightenment and eventually reincarnation. He then turned to the giant Buddha towards the front of the room and began reciting as everyone joined in and recited along. Everyone was on their knees having their hands together as they recited the prayer either from memory or from the pieces of paper that had three pages of prayers in Vietnamese.I could not read the prayers so I just silently glanced at them and tried to make sense of where we were in the prayers. Then one of the monks hit the small drum which everyone bowed for a few short seconds then returned to their original positions. Then a few moments later the drum was struck again, everyone bowed, but now stood up instead of returning to their knees. Then again, the small drum was struck, everyone bowed then returned to being on their knees. The prayer was now being recited faster as a drum was being struck with a beat in quick succession.This was repeated three times and when the prayers were being done recited, the head monk told those that have lost a loved one to follow him into the incense room. I followed about four families into that room. The room had pictures of everyone that had passed away that was a member of the temple. Families that were in that room had a special prayer and ceremony to honor their loved one. The monk said that one member of the family shall come up to the alter, drink a sacred tea and pour a small cup in honor of their loved one.A drum was struck as everyone started to recite a prayer. During the reciting, another monk came and tapped the four members that represented their families with some sort of sacred text. Then the prayer stopped as the four members went to the front, poured their tea, drank it, and poured it for their deceased loved one. Before everyone excited the room, every person was given three incense to pray and let their deceased loved ones know of their prayers today.They would bow three times, pause to pray, went up to the alter, placed their incense into the jar, returned to their spot, and lastly bow three times once more. That was my experience in a Buddhist Temple, the peace and tranquility of the people, and the monks was quite wholesome. Being a young adult, I never really understood the importance of religion and culture, but after visiting a place like this†¦ It really opened my eyes to how a religion can bring peace and everlasting faith within a person.

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ISO Standards and Excellence - (work sheet ) CLO 5 Assignment

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Autism in Qatar Term Paper Example | Topics and Well Written Essays - 1250 words

Autism in Qatar - Term Paper Example Despite various governments not heeding this noble advice, the effect of such ignorance presents easily foreseeable outcomes. Such inclusion is no doubt one of the many reasons through which poverty and social disruptions can be endured, in addition to reducing the burden of disability to the society. The arising question then is â€Å"can inclusion of the people with disability in various aspects of the society contribute to their empowerment and hence reduced level of depependence in Qatar.† Like many other nations in the Middle East and the world at large, the problem of autism in Qatar has attracted substantial attention. Autism, like other forms of disabilities has been touted to ramifications on both the social and economic aspects of various countries across the globe. Their non-inclusion in day to day activities, more especially social and economic activities has been found to not only have negative consequences on the affected individuals but also on the families as well as the community. Baron-Cohen & Bolton (1993) found that integration and accommodation of people with disabilities into the work force are a critical way of public expenditure reduction, reduction of cost incurred by the families, and also ensuring that the ASD affected persons are able to engage in productive work. Formulation of policies and plans that integrate persons with disabilities into each and every aspects of social and economic life, ranging from education, vocational rehabilitation a s well as employment will no doubt offer immense benefits to both that affected individuals and the society at large (Bertrand et al., 2001). The recent past has seen more and more people getting diagnosed with ASD and consequently extreme emphasis is being placed on their social inclusion and involvement in aspects of social and economic life. Sadly, in various nations, Qatar inclusive, the disabled persons among them the disabled, are