The Centers for Medicare and Medicaid Services has ongoing initiatives to control costs and improve patient care. The term “Never Event” was first introduced in 2001 by the National Quality Forum (NQF), in reference to particularly shocking medical errors (such as wrong-site surgery) that should never occur. Over time, the list has been expanded to signify adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable.
Central catheter related blood stream infections are on this list of non-reimbursable, preventable never events.