Sentinel event reporting form 2026

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The document is a Sentinel Event Report form that must be completed and submitted to the Division of Public and Behavioral Health whenever a sentinel event occurs at a medical facility, as mandated by various Nevada Revised Statutes. It includes sections for facility information, primary contributing factors, contributing departments, corrective actions taken, lessons learned, and additional comments.

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Click ‘Get Form’ to open the sentinel event reporting form in the editor.
Begin by entering the 'DATE OF SENTINEL EVENT' and 'REGISTRY NUMBER' at the top of the form. Ensure these details are accurate as they are crucial for tracking.
Fill in the 'FACILITY INFORMATION' section, including 'FACILITY LICENSE NUMBER', 'FACILITY NAME', and your name under 'REPORT COMPLETED BY'.
In the 'PRIMARY CONTRIBUTING FACTOR(S)' section, check up to four boxes that best describe the factors contributing to the sentinel event. This helps in identifying patterns.
Next, indicate any relevant 'CONTRIBUTING DEPARTMENT(S)' by checking up to four boxes that apply. This categorization aids in departmental reviews.
For 'CORRECTIVE ACTION(S)', select all applicable actions taken post-event. This is vital for future prevention strategies.
Finally, provide any additional comments or lessons learned in the designated sections before submitting your report.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What program is used to report an adverse or sentinel event?

MedWatch: The FDA Safety Information and Adverse Event Reporting Program. MedWatch, the FDAs medical product safety reporting program for health professionals, patients and consumers.

How do you report an adverse event?

Alternate reporting methods: .fda.gov/Safety/MedWatch or call 1-800-FDA-1088.

What is sentinel reporting?

Sentinel surveillance involves creating a reporting system that detects early signs of preidentified problems at certain sites. This method allows for a triggering mechanism to alert humanitarian responders during early warning phases.

What method is used to investigate adverse events or sentinel events?

Root cause analysis (RCA) is a process for identifying the causal factors of a medical error that may result in a sentinel event.

What is the name of the FDAs adverse event reporting system program?

FDA Adverse Event Reporting System (FAERS): FAERS is the database that contains adverse event reports, medication error reports, and reports of therapy quality issues that resulted in adverse events that were submitted to the FDA. FAERS covers drugs and biologics.

sentinel event form

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Do sentinel events have to be reported?

Such events are called sentinel because they signal the need for immediate investigation and response. Each accredited organization is strongly encouraged, but not required, to report sentinel events to The Joint Commission.

Which is an example of a reportable sentinel event?

The list of Sentinel Events includes, but is not limited to: Stage 3, 4, and unstageable pressure ulcer. Patient fall with serious injury or death. Unanticipated death with 48 hours of treatment.