Sentinel Event Alert 36: Tubing misconnections a persistent and potentially deadly occurrence

This Sentinel Event Alert has been retired as of March 2016.

It has been replaced with Sentinel Event Alert, Issue 53: Managing risk during transition to new ISO tubing connector standards.

Note: Retired Alerts are not available for any purpose, including for educational, research or legal purposes. Questions should be directed to The Joint Commission’s Legal Department at 630-792-5671.