Adverse Events and Data Management
Alice Robertson
HCS/482
January 19, 2015
Kym Pfrank

Adverse Events and Data Management
The term “adverse event” describes harm to a patient as a result of medical care. An adverse event indicates that the care resulted in an undesirable clinical outcome and that an underlying disease did no cause the clinical outcome. Adverse events include medical errors, such as the use of incompatible blood products, incorrect dispensing and administration of medications. Medication errors can result in patient harm including death.
Adverse events, near misses, incidents of any kind are to be reported and put in a system called Incident Response Improvement System (IRIS). All IRIS reports get reviewed by a primary reviewer and the risk manager daily. They follow up on all reports and see trends happening whether it is weekly or monthly. They are also able to compare trends from any time period they select. If trends are seen it is imperative to follow up with staff to find out why there is a rise. What can we do to make sure these events never happen again? These reports get printed in a flow sheet and are shared daily in our safety huddles. The reports stay opened until closed by the appropriate managers. Each report is followed up by the risk manager and will not be closed until each issue is fixed or corrected.
Adverse drug events according to the Center for Disease Control and Prevention cost 3.5 million in extra medical costs each year, and 40% of the costs are estimated to be preventable. (2012). I would begin by collecting information about our medication errors during a span of time, so I can see if there is a particular reason for the rise of events. I would use the IRIS reporting system, which can also run analytical reports. I would run reports on those individual patients on the Meditech system used for patient care