The National Quality Forum Releases 2011 Serious Reportable Event (SRE) Update

July 1, 2011    |   By: Calevir

The NQF has released “Serious Reportable Events in Healthcare – 2011 Update: A Consensus Report”, including updates to 25 SREs, and adding four new SREs.

New SREs are events resulting in death or serious injury related to the loss of biological specimens, failure to communicate test results, neonates associated with labor or delivery in a low risk pregnancy, and metallic objects in MRI areas. Updates also address SREs in settings other than hospitals, including outpatient/office-based surgery centers, skilled facilities and office-based practices.


PSO Case Law: Ungurian v. Beyzman, et al., 2020 PA Super 105:

A recent Pennsylvania case shows how courts narrowly interpret the PSQIA, ignoring the D & A pathway and the clear language of the Final Rule. (Ungurian v. Beyzman, et al., 2020 PA Super 105). The cour

Joint Commission New Sentinel Event Alert 61: Managing the Risks of Direct Oral Anticoagulants:

The Center for Patient Safety wants to share this important harm-prevention advice from The Joint Commission and its Sentinel Event Alert: Managing the Risks of Direct Oral Anticoagulants. The Joint Commis

CPS Safety Watch/Alert – Culture Can Improve the Control of Multi-Drug Resistant Organisms:

Issue: A number of events reported co CPS’ Patient Safety Organization (PSO) demonstrate poor handoff communication about the patients’ infectious disease status Examples include: Patient with

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