When families in Washington, D.C., and the surrounding areas are searching for the best nursing home facility for their aging loved ones, they rely on their research and the reputation of the facilities. However, when preventable harm occurs to residents from medication or diagnostic errors, a casual Internet search often will often not reveal the prevalence of adverse effects at the facility.
Unfortunately, things are not always as they appear, and some facilities do not have the standard of care that their reputation suggests. When harm occurs to a loved one from the negligent actions of nursing home staff or medical providers, it is important to act quickly to hold responsible those parties that are accountable for their actions.
Understanding a serious reportable event
A serious reportable event (SRE) is an incident that causes injury or death to a patient from a negligent lapse or error by medical providers or healthcare facility staff. Several years ago, the National Quality Forum (NQF) identified “never events” such as these in an effort to track and investigate SREs so as to reduce their frequency across the medical community.
The NQF created six categories of preventable SREs, which include:
- Surgical events, where a medical provider performs surgery on the wrong body part, patient, or leaves foreign material in the surgical site.
- Products or device events, such as contaminated drugs or faulty medical devices.
- Patient protection events, such as suicide while in care, or patient release without permission.
- Care management events, including medical or prescription errors and incompatible blood products.
- Environmental events, such as falls or injury from restraints, or incorrect gas or oxygen line injuries.
- Criminal events, such as physical or sexual assault.
Governmental oversight of SREs
The Centers for Medicare and Medicaid Services (CMS) has a non-reimbursement policy regarding Medicare costs for healthcare facilities that have been the subject of an investigation of SREs. CMS also collects data to assist providers that must look into allegations of SREs at a long-term care facility.
A report on adverse events found that one in three Medicare recipients experienced injury or harm during the first 35 days of their stay in a nursing home, and that almost 60% of these events were preventable. The most common SREs causing hospitalization or death were:
- Medication errors.
- Excessive bleeding from anticoagulant medications.
While agency oversight is important, it cannot replace the care and concern that family members must maintain when watching over their loved ones.