rior to beginning work on this discussion, Read theSentinel Emotional Events: The Nature, Triggers, and Effects of Shame Experiences in Medical Residents(Links to an external site.) A sentinel event is a patient safety incident in which a patient dies, suffers lasting damage, or suffers severe, temporary injury. These occurrences pose an urgent danger to a patients safety and may result in revoking a hospitals license. If its a sentinel incident, the hospital and the Joint Commission will look into it. If a sentinel incident is detected, an action plan will be developed to avoid future errors. Medication errors, patient suicide, wrong-site surgery, therapy delays, patient mortality, transfusion errors, and neonatal deaths are common sentinel occurrences. Moreover, this discussion post is tied to a case study of a perinatal sentinel event while providing necessary recommendations to prevent its occurrence in the future. After conducting some investigation, I discovered a sentinel incident of 2006 at St. Marys Hospital in Madison, Wisconsin. Jasmine Gant, a sixteen-year-old girl, was supposed to deliver her baby but died during delivery due to a medicine mix-up. To prevent a bacterial infection from spreading to the baby, the staff gave her an epidural anesthetic intravenously instead of penicillin. Besides, epidural anesthesia is administered into a fluid-filled sac surrounding the spine to numb the pelvic region during delivery (DeMarco
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