Joint Commission Sentinel Event: Preventing Unintended Surgical Instrument Retention

The Joint Commission has issued a sentinel event alert focused on the prevention of unintended retention of foreign objects.

The average total cost of care per incident is estimated to be from $166,000 to more than $200,000.

The Joint Commission recommends:

•    Development of a counting system to ensure all surgical instruments are accounted for
•    Implementation of an evidence-based, facility-wide protocol for prevention
•    Effective communication between all team members
•    Careful documentation
•    Safe selection and use of technology

More Articles on Quality Issues:
10 Steps to Improve Medication Adherence
Study: 50% Accuracy in Surgical Safety Checklists
50 State Statistics on Medicare Reimbursements

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