what is medicares never events policy

Despite the widespread usage of the term “never events,” the National Quality Forum (NQF) refers to these events as “serious reportable events” in all of their definitions and references. In this editorial, we use the popular - but likely improper - term “never events” as it further illustrates the public’s perception of adverse occurrences. Although the preferred terminology reverts to “serious reportable events”, this definition may be unlikely be given the prevalence of the viscerally moving term “never event.”

The NQF is a nonprofit organization that aims to improve the quality of healthcare in the United States . In 2002, the NQF published a first report which defined 27 so-called “serious reportable events” in healthcare. These encompass serious adverse events occurring in hospitals that are largely preventable and of concern to both the public and to healthcare providers. One additional event was added to the updated report in 2006, leading to a total 28 “never events” defined by the NQF . While most on the list of “serious reportable events” include obvious unacceptable errors, such as wrong site surgery or discharge of an infant to the wrong person, not all NQF events are preventable at all times or indicative of obvious negligence . A goal of quality improvement measures should be to institute a reduction of “never events” to zero. Achieving that goal via the cycle of reporting, intervention, and measurement of subsequent outcomes must necessarily begin with a culture of openly reporting these defined events within an institution