Joint Commission Revises Sentinel Event Definition, Policy

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Joint Commission Revises Sentinel Event Definition, Policy

JULY 2021

The Joint Commission’s Office of Quality and Patient Safety (OQPS) revised its definition of a sentinel event and clarified some of the event-specific examples in the Sentinel Event Policy, according to a July 21 release. The revisions clarify expectations regarding a healthcare organization’s partnership and collaboration with OQPS and include editorial revisions to improve the flow of the chapter.

Starting January 1, 2022, the new revisions to the Sentinel Event Policy will apply to all Joint Commission accreditation and certification programs, except for the Health Care Staffing Services and Integrated Care certification programs, according to the release.

OQPS revised the definition to clarify the differences between severe harm, which may or may not be permanent, and permanent harm, regardless of severity. The revised definitions include:

  • Sentinel event: A patient safety event (not primarily related to the natural course of the [patient’s] illness or underlying condition) that reaches a [patient] and results in death, severe harm (regardless of duration of harm), or permanent harm (regardless of severity of harm).
  • Severe harm: An event or condition that reaches the individual, resulting in life-threatening bodily injury, including pain or disfigurement, that interferes with or results in loss of functional ability or quality of life that requires continuous physiological monitoring or a surgery, invasive procedure, or treatment to resolve the condition.
  • Permanent harm: An event or condition that reaches the individual, resulting in any level of harm that permanently alters and/or affects an individual’s baseline.

The final substantive revisions clarify the expectations for healthcare organizations’ collaboration with OQPS, according to the release, which include the following:

  • Removed redundant verbiage and duplicative content.
  • Clarified guidance on how to complete a comprehensive systematic analysis and development of an action plan to align with current Joint Commission requirements.
  • Reorganized content to flow in a more logical order.
  • Clarified content to determine whether a patient safety incident meets criteria for sentinel event review.

The most current version of the Sentinel Event Policy can be found in the SE chapter in the E-dition or Comprehensive Accreditation Manual.