Assignment 2 Course Project Part III Create Fictitious Incid

Assignment 2 Course Project Part Iii Create Fictitious Incidentswe

Create three fictional incidents related to the risk area of surgery. For each incident, provide a detailed description including what happened, where, when, and who was involved. Explain the cause of each incident, addressing how and why it occurred. Each scenario should be concise, approximately one page in length, covering all the required elements. Additionally, cite all sources used in your analysis using proper APA citation style on a separate page. Ensure your document is well-structured, free of spelling and grammatical errors, and submit it to the W3: Assignment 2 Dropbox by the specified due date.

Paper For Above instruction

In the realm of surgical practice, risk management is a critical component that involves proactively identifying, analyzing, and mitigating potential adverse events. One effective approach within this framework is the creation of fictitious incident scenarios, which serve as a means to understand vulnerabilities and enhance preparedness. This paper presents three plausible fictional incidents within the surgical risk domain, detailing the circumstances and causes behind each event.

Incident 1: Surgical Instrument Retained in Patient Cavity

Details: During an elective abdominal surgery at a metropolitan hospital, a surgical instrument — specifically, a sponge — was inadvertently left inside the patient's abdominal cavity. The incident occurred on March 15, 2023, involving a 45-year-old male undergoing a gastrectomy. The surgical team comprised the lead surgeon, two assistants, a scrub nurse, and a circulating nurse. The patient was in the operating room when the incident was identified post-operatively during imaging studies.

Cause: The primary cause of the retained sponge was a breakdown in the standard sponge count procedure. Despite adherence to counting protocols, distractions in the operating room and inadequate communication between team members led to a miscount. The sponge counting was hurried due to an emergent situation earlier in the surgery, and the oversight was not corrected before wound closure.

Incident 2: Anesthesia Complication Leading to Postoperative Neurological Deficit

Details: A 60-year-old woman underwent spinal fusion surgery for degenerative disc disease at a community hospital on August 22, 2022. The operation was planned and uneventful until postoperative recovery, where the patient exhibited signs of lower limb paralysis and sensory loss. The incident was identified within hours after surgery, and the patient was transferred to the intensive care unit for further assessment and management.

Cause: The incident was caused by an inadvertent over-insertion of the epidural catheter, resulting in nerve root compression. Contributing factors included insufficient verification of catheter placement during the procedure, misinterpretation of imaging, and a lack of standardized checklists for ensuring correct catheter positioning. The complication was compounded by delayed recognition of the neurological symptoms in postoperative monitoring.

Incident 3: Allergic Reaction to Surgical Adhesive Leading to Airway Obstruction

Details: During a minor outpatient skin excision procedure at a specialized dermatology clinic on May 10, 2023, a patient experienced an acute allergic reaction immediately after the application of a surgical adhesive to close the wound. The reaction led to swelling of the airway tissues, causing partial airway obstruction. The incident was rapidly identified during close postoperative observation, and emergency interventions were initiated to secure the airway.

Cause: The allergic reaction was caused by hypersensitivity to the adhesive's chemical components, which the patient was unknowingly sensitive to. Contributing causes included inadequate preoperative allergy screening and failure to review the patient’s allergy history comprehensively. The incident highlights the importance of thorough allergy assessments and the need for alternative wound closure methods in susceptible individuals.

Conclusion

Developing fictitious incidents such as these allows healthcare professionals to scrutinize potential vulnerabilities within surgical practice. Analyzing the causes emphasizes the importance of adherence to protocols, meticulous verification procedures, comprehensive patient assessments, and effective communication. Such proactive risk management strategies are essential to minimizing adverse events and enhancing patient safety in surgical environments.

References

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• Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, 353, i2139.
• National Patient Safety Agency. (2018). Safety in the operating theatre. NHS Digital.
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• Williamson, H. A., et al. (2012). Surgical safety checklists and patient outcomes: An overview. Annals of Surgery, 255(5), parsed2-960.
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