Beginning June 30, 2005, Wyoming implemented a mandatory reporting program for all licensed medical facilities. By adopting the NQF's template of 27 ‘Never-events’ that should never occur, Wyoming joins 7 other states through 2006 that have adopted the NQF template since 2003 (CT, IL, IN, MN, NJ, OR, WA) for their adverse event reporting programs.1
The intent of the Wyoming legislation was to create unambiguous standards within the reporting program. However, ambiguity of definitions still persists. For example, Wyoming's "safety events" are defined as
" . . unexpected occurrences involving death or serious physical or psychological injury or the risk thereof. . "
Wyoming does not define ‘the risk thereof,’ thereby leaving the definitions of these qualifying terms to the individual reporter. This lack of definition may be important since Wyoming makes no explicit provision for ‘near-miss’ medical errors. It is arguable that the term ‘. . . or the risk thereof,’ in Wyoming's ‘safety’ definition might be construed by reporters to include ‘near-miss’ events. Lacking explicit guidance from the law, the intent and interpretation of the legislation is unclear.
Wyoming defines some of the terms used in the "safety event" definitions, but not all of them. For example, Wyoming law defines "injury" but does not further clarify ‘serious physical or psychological injury’.
Furthermore, several of the 27 Wyoming definitions, similar to the NQF definitions, also use the term ‘death or serious disability’ to define the reportable outcomes, but the Wyoming definition of "disability" is patterned after the WHO definition rather than in accord with the NQF, which separately defines "serious" and "disability."2
1 While starting in 2003 with JCAHO definitions of selected ‘sentinel events,’ Maine received a December 2005 report with recommendation from the Maine Quality Forum [PDF] to adopt NQF definitions. However, in late-2006, Maine has not made that conversion.
2 Despite definitions that vary from NQF definitions, Wyoming is not alone among States on this issue. For example, the NQF definition of "disability" is more consistent with, but certainly not identical to definitions used in Minnesota and New Jersey.