In hospitals and nursing homes nationwide, events, mistakes and errors that should have never happened are known as “never events.” The National Quality Forum (NQF), a nonprofit organization whose goal is to develop strategies to effectively measure healthcare quality in the country, has coined the term to raise public awareness about the frequency and severity of these errors.

In 2002, they released a list of 27 Serious Reportable Events (SREs), later updated in 2006. The list’s purpose was threefold: to stabilize the reporting of events within the healthcare sector, to increase the public’s ability to access this information and to increase the accountability of the consumers on behalf of providers.

Eventually, some of the events on the list began to be known as “never events.” Recently, the Centers for Medicare and Medicaid Services (CMS) began to refuse payment for certain events. In other words, as far as the federal government is concerned, some medical errors should never happen in the hospital or nursing home. If they do, the government will not pay the negligent provider for the care that the patient requires after suffering from a never event.

What are Some Never Events?

The following list covers some never events and errors that Medicare and Medicaid will not pay for:

·         Leaving a foreign object inside the body after a surgery is performed

·         Air embolism

·         Urinary tract infections resulting from catheter insertion

·         Pressure sores or ulcer

·         Infections resulting from vascular catheters

·         Injuries acquired in the hospital including burns, dislocations and fractures, as well as intracranial and crushing injuries

·         The use of mismatched blood

The Policy’s Effect on Nurses

The new nonpayment policy will allow nurses a chance to take charge and prevent avoidable events. More than half of all never events on the list pertain to nurses, especially patient falls and pressure ulcers. Nurses have a tremendous effect on patient care and outcomes, so now nurses are viewed as an investment instead of a cost.

When more nurses are added to a hospital or clinic’s staff, the overall quality of the patient care is most likely to improve, thus decreasing the number of preventable incidents. This is clearly the best way that nursing administrators can push for future financial investments in nursing.

Prevention Strategies for Nurses

By training musses on prevention strategies, hospitals can greatly increase patient safety while protecting profits.

Optimal Assessment

Nurses can use standard, evidence-based tools to perform risk assessments as soon as the patient is admitted to the facility. They are required to visually identify patients who may be at risk, including those who wear a Stay Alert for Fall Event (SAFE) sticker. Nurses can also promote critical thinking and ensure they accurately stage the patient’s condition through proper documentation of the wounds.

Targeted Care Mandates

Nurses have the ability to simplify standard protocols to ensure the patient will comply with the procedure. They must prioritize interventions and intervene early.

360-Degree Support

Nurses must provide staff support and use effective reminders to reposition patients on time. Patient care assistants should also be allowed to share tasks, when appropriate. Overall, nurses should empower patients and their families by using teach tools, demonstrations and technologies that help the overall condition of those affected.

Innovations for Complex Patients

Cutting-edge technology can be used in conjunction with standard treatment to facilitate better healing. Cost-effective alternatives for patient observation can also be effective, including video surveillance for patients who have a high risk of falling, for example. Nursing schools in California, New York, Chicago, Houston and other metropolitan areas are leading the way by training students in these new technologies.

One of the many benefits to adopting this list is that it is an important step to providing better care and ensuring both patient safety and awareness. While accidents do occur and will continue to occur, the reporting of these errors and not receiving payment for improper treatment will help to lower the number of never events that occur.

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