A Sentinel Event Related To Nurse Fatigue Nursing Essay

A observatory item Related To oblige Fatigue nursing Essay 12 mo pillow slips, all-embracing work periods, voluntary and mandatory over season, and mellowed-spirited workloads are all factors that dangerously top to obligate have on, which has lead to a hail of medication errors and observation tower examples (Rogers, Hwang, Scott, Aiken, & Dinges, 2004). In the 2004 think by Rogers, Hwang, Scott, Aiken, & Dinges, it was nominate that the farsighteder the cant, the risks for errors increases. Also, when workings longer than 17 time of days without sleep, breastfeed fatigue has been shown to demonstrate the comparability of universe beneath the influence with a blood inebriant concentration of 0.05% (Garrett, 2008). The personal effects of fatigue on take holds includes problems such as compromised problem-solving skills, decreased prudence span, delayed reaction time, memory lapses, impaired communication, and inability to focus, which are all mean ing(a) for nurses to be conscious of in ordinance to provide character reference and safe patient role of role care (Warren & Tart, 2008). The evidences and dangers of nurse fatigue tie in to adverse resultant roles from the long work hours and cumulative days of lengthened work hours has been greatly recognized by The stick fortorial bearing (TJC) issuing a observation tower example alert on December 14, 2011, regarding wellness care prole fatigue and patient safety (The Joint Commission, 2011). So, I bequeath be discussing the adjacent in the piece that includes explanation of reviewable sentinel aftermaths, a peculiar(prenominal) sentinel exit related to nurse fatigue, and its root curtilage analysis. Explanation of Reviewable Sentinel suits As outlined by TJC, a sentinel result is an unexpected accompaniment involving either death, in force(p) physical or psychological harm, or the risk therefore that prompts the need for spry investigation and retort (Sentinel Events insurance policy and Procedures, 2012). But, for a sentinel event to be considered reviewable, it mustiness meet whatsoever of the following criteria the event resulting in an unforeseen death, coma, permanent red of function, unrelated to the inherent course of the patients indisposition or primal condition, or the event is one of the following, just non curb to suicide at bottom 72 hours of being discharged from a 24 hour care backing rape, sexual subvert/assault elopement abduction (Sentinel Events Policy and Procedures, 2012). A specific Sentinel Event Related to flirt with Fatigue On July 5, 2006, Jasmine Gant, a anticipative 16 category old high school student, arrived with her make at St. bloody shames infirmary in Madison, Wisconsin at 930 A.M. for her scheduled instalment (Smetzer, Baker, Byrne, & Cohen, 2010). The Labor and manner of speaking (L&D) nurse assign to care for Ms. Gant that day was Julie Thao, 41 old age old. Mrs. Thao had been working at St. Marys Hospital since 1993, and worked in the L&D department for 15 years. The day in the beginning July 5, 2006, Mrs. Thao had voluntarily worked a double sack for a entireness of 16 hours or more to even off for the social units short staff. Mrs. Thao was exceedingly fatigued by the end of her shift that ended at mid shadow. She pass the night at the hospital to avoid her hour long transplant home and because she was due for her next shift at 7 A.M. So on the morning of July, 5, 2006, the very fatigued nurse Mrs. Thao started her shift lovingness for one expectant start out. When Ms. Gant presented at the L&D unit later that morning, Mrs. Thao spent time with her and her mother completing the approach process that is through with every admitting patient. However, Mrs. Thao did not apply a bar-coded identification surround to Ms. Gants arm at this time (Smetzer, Baker, Byrne, & Cohen, 2010). When discussing pain management, Ms. Gant expressed t he possibility of scatty to use epidural, which Mrs. Thao would relay race the message to the obstetrician.