Have you ever had a week in rescue that went smoothly? Yeah. Me either. By Friday (if there’s such a thing as the end of a week in rescue work) I’d cry in my jumbo margarita about my need for less chaos in rescue.
There’s that part of rescue that is always going to be busy. Unpredictable. Frenetic. Most of that chaos was wrapped up in bringing in a new dog and trying to figure out that dog’s plan.
That chaos in rescue I could handle. It’s inherent. It’s part of it.
It was the “uh-oh” events that were ten times more stressful, time-consuming, and expensive that anything else in my day-to-day work.
Have Less Chaos in Rescue by Recognizing Sentinel Events
Uh-oh events are events that are preventable. Teachable. Avoidable. Uh-oh events offer us an opportunity to move from “I wonder if there’s something I could have done differently” to “lets figure out if I could have done something different, and do it different in the future.”
The fewer uh-oh events we can have, the less stress, fewer extra expenses, less chaos in rescue!
Uh-oh events can happen anywhere in rescue: from transportation mishaps to vetting omissions to adoption screening to foster dog care and management.
Another word for “uh-oh” is sentinel event.
Sentinel Events In The Hospital Setting
I first became aware of the term “sentinel event” when working for an accredited hospital system.
As defined by the Joint Commission, a sentinel event is any unanticipated event in a hospital setting resulting in death, or serious physical or psychological injury, not related to the natural course of a patient’s illness.
When “Joint,” as we called them, visited the hospital for scheduled or unannounced visits, they asked to review detailed records. They wanted to know: did we have any sentinel events? If so, what happened? How did it happen? How did we investigate? Did we identify a need to amend our processes and protocols and training? What would we do differently to reduce the chances the same or similar sentinel event didn’t occur again? Did we make those amendments?
What constitutes a sentinel event in a hospital setting?
Which events are considered sentinel events in a hospital setting?
- every patient death until it is deemed natural course.
- patient falls that result in death or loss of function
- errors in blood transfusions
- patient abductions and elopements
- assaults of a physical or sexual nature causing death or permanent loss of function
- medication errors causing major permanent loss of function
[this is a partial list]
We also had to report and evaluate all “near miss” events or close calls – actions that would have become a sentinel event if no one intervened. As an example, all medication errors in the hospital were considered a “near miss.”
Expensive, Effective, and Builds A Team
Sentinel events were expensive for the hospital in terms of time, training, and in some cases, legal defense and liability. There were countless redirected employee hours for investigations, meetings, revisions to manuals, training, etc.
However, sentinel events also greatly improved patient care – in the revision of process and protocol and the implementation of training, when needed. Some of the policies you find in a hospital setting today came about because of a hospital’s response to a sentinel event.
A non-judgemental process focused on improving best practices
It is important to note: sentinel event investigations were not meant to be, nor did I ever experience them to be, a witch hunt. The purpose was not to find fault or lay blame or scapegoat, but to IMPROVE PROCESS. In other words, as a team, find out why an event or near-miss happened and make revisions in the day-to-day work to avoid a repeat event in the future.
Using a Sentinel Event Model in Dog Rescue
How do I think rescue agencies and foster programs can use a sentinel event model to reduce chaos in rescue?
Here are some common sentinel events in dog rescue:
- Dog bites
- Dog fights
- Dog elopement
- Emergency care for _____________. (think obstructions, self-injurious behavior, parvo, etc)
- Missed diagnosis
- Drug interactions
- Adoption returns
- Dog theft
- Any unexpected death of a dog
We really need to process the yucky stuff. Our dogs depend on us to do so.
We don’t like to talk about sentinel events in dog rescue. Whether it is because we rescue from our heart or we’ve turned our focus onto the next dog that needs us, when an uh-oh happens, we put all the yucky stuff in a box and move on.
We may rationalize it as “this is just part of rescue.”
And then, it happens again. Another dog needs stitches. Another emergency surgery for an obstruction. A theft or elopement. 10 adoption returns in a month.
Each of those type of events deserve a look-see to determine what is actually happening so that another dog can possibly be spared.
less chaos in my home
I kept having issues with my dog Otis and my foster dog, Emmy Lou. Normally able to live peacefully with each other, a few times a month, these two would get into a tangle, grab each other by the face, and refuse to let go. Thankfully, there were no injuries, but tension lingered in the air for days afterward.
Not fun for them, and certainly not fun for me.
It wasn’t until I stopped and really looked at the event did I understand the problem and identify the triggers that caused these two to redirect their frustrations and angst onto each other.
Most of the time, their scuffles happened when I returned home and let them out of their crates.
I was able to modify my behavior and management of high-energy moments in my household and as a result of my change in process, the fights between Otis and Emmy Lou reduced dramatically, to less than one every couple of months.
Some Examples of Sentinel Event Reviews to Have Less Chaos in Rescue
- A rescue agency amended its policy on pet door use following a spike in dog thefts and dog elopements.
- A rescue agency, who’d historically relied on verbal reports, created a home-visit form and revised the manual to move toward a more standardized process. (Home visit reports, in general, have high variability.)
- A rescue agency improved its record-keeping processes by implementing a new storage system and records review after struggling to identify a stray dog microchipped to their agency.
- A south-to-north rescue agency amended its vetting process after a number of dogs were transferred out of state with undiagnosed infections.
- A rescue agency’s foster program saw a decrease in exiting foster homes after implementing a mentorship program.
- A rescue agency instituted a foster training module on recognizing and managing end-of-life behaviors in hospice foster dogs.
Putting A Sentinel Event Review Model into Practice
To implement a sentinel event review in your rescue agency, you first need to identify what is a sentinel event, and what is an event that can be addressed by a bit of coaching?
Not every uh-oh in rescue is a big deal.
Think about those events that cost the rescue extra money, or that put the agency at risk for liability. Ask your team to make a list of dogs that have had “an event” in the last year or two of your agency’s work. What happened? Was it preventable? How easy is it to implement a new process, protocol, or procedure and get your staff on board with the change?
Sentinel Events - Reviewing Vetting Protocols
Years and years ago, there was a female dog that had a pretty nasty urinary tract infection. As you know, there are many causes of urinary tract infections and some of those bacteria can be quite stubborn. A common course of antibiotics for a UTI is around two weeks.
She didn’t clear. We tried a different antibiotic. Another two weeks. She still had a UTI. We gave her a longer course of antibiotics. She still didn’t clear.
The foster was tasked with making sure the dog had repeat visits to the vet for testing. Added supplements because of the antibiotic hardship to the gut, dealt with nausea, and struggled to get her foster dog to swallow the medication.
Now, we were up to over two months worth of treatment, three different medications, and our dog still had a UTI. THEN, we sent urine out for a culture to determine which antibiotic would attack the bacteria causing her infection. Once we determined the appropriate medication, the dog’s UTI cleared up quickly.
We asked ourselves the question: how often do we get these stubborn UTI cases? How much money would we have saved upfront if we’d asked for a urine culture at the time the UTI was diagnosed? We took the case a bit further and asked ourselves if we should change our intake policies governing urinalysis or if we should immediately order urine cultures on every dog diagnosed with a UTI.
This is an example of reviewing a sentinel event to reduce chaos in rescue.
Sentenel Events - Addressing Dog Bites
We used to hold the belief that all dog bites are preventable, and if we just managed things better, a dog won’t bite. Turns out, that is a lie.
We went through some growing pains as we reviewed our process for dealing with bites in our agency. Bites create a lot of chaos in rescue. They instill fear in an inexperienced foster home, they cause damage (both physically and emotionally) to people and other pets, bites can cause death. We have a responsibility to safety, and all bites are a big deal.
Through case review, looking at literature, and in discussing cases with veterinary behaviorists and behavioral consultants, we settled on an addition to our policies governing adopting out dogs with bite histories. At the time I departed the rescue agency, we felt like we had a solid approach to addressing dog bites that gave the best to our dogs, families, and community.
I’ve used a sentinel events review for an accident that happened during a foster’s renovation. A swimming pool near miss. Addressing separation anxiety. Dealing with fearful dogs. Heartworm protocols. Transportation near misses. A transport catastrophe. Fecal testing. Misses during home visits…
… I could go on and on.
Sentinel Events Are Teachable Moments
Uh-ohs in rescue are opportunities to learn, to adjust, to change, to improve, to lessen the chaos in rescue.
I promise you. If you will take a moment with your team and look at a sentinel event with a careful eye, you will adjust something. You’ll try something different. You’ll save money, you’ll have less chaos in rescue.
Your Turn
How do you see using a sentinel events review model for your agency? What would it look like? What sentinel events in your agency would trigger a review?
Would you, as a foster person, implement a sentinel events review process in your own home? How would you go about it?
I don’t like sentinel events, but sometimes they happen. I prefer they happen less. Sometimes sentinel events cost me money, sometimes they cost the agency money, sometimes both. Usually, sentinel events are innocent mistakes, not reckless decisions. Sometimes, like the time a foster dog yanked the peanut butter covered rubber spatula off of the handle and swallowed it whole, or when a dog ate grapes carelessly left on the side table are a bit of a ” thunk on the forehead” moment.
I’ve said, “duh!” to myself often, after which I sit down, think it through and evaluate the need for a change in process. My dogs benefit and my household benefits. The agency benefits, too.
Have you experienced any sentinel events in your foster home or agency? Was there a review? What was the outcome? Do you think a review board would be beneficial to your agency? Why or why not?
If you’ve had any sentinel events in your foster home or rescue agency that you’d like to process with me, get in touch. I’d be happy to give you my feedback.
