The Joint Commission's Sentinel Event Policy, implemented in 1996, is designed to help health care organizations to identify sentinel events and take action to prevent their recurrence. A sentinel event is an unexpected occurrence involving death or serious physical--including loss of limb or function--or psychological injury, or the risk thereof. "Risk thereof" means that, although no harm occurred this time, any recurrence would carry a significant chance of a serious adverse outcome. Any time a sentinel event occurs, the health care organization is expected to complete a thorough and cr…
