Mrs. Johnson is a 67-years-old female, a

Mrs. Johnson is a 67-years-old female, a senior resident from a long-term care facility who recently had a minor surgical procedure (hip replacement) done at Mackenzie hospital, Richmond Hill, Ontario. Prior to surgery, Mrs. Johnson was ambulatory and somewhat stable. Upon return to the home, the evening nurse reads the report from the hospital which contains the following information: Vital signs [ BP 110/70, RR 16, HR 60, temperature 37], condition of surgical dressing [no erythema nor drainage] (on left hip), and reports that the patient has been eating well. Mrs. Johnson is alert upon arrival. Four days later before discharging the patient you notice that Mrs. Johnson is coughing with complain of Shortness of Breath and tactile fever. Her temperature is now 38.9, HR is 90, BP is 100/60, Respiratory Rate is 20 and oximeter shows 89% of Oxygen saturation. There are no notes about her change in her status on the chart or in the shift change report. She has communicated to the other rooms without any restrictions she says, “I was bored and needed to socialize with the other patients”. Mackenzie Hospital is one of the central locations for admitting COVID-19 patients at York Region. Due to overwhelming numbers of the patients, some are placed in other departments, and it is challenging to isolate all the patients with the flooding flow of patients’ visitors as well. PMH: long term chronic smoker, hysterectomy at age 60, DM type 2, mastectomy at age 45 Using course material and other relevant resources, including Best Practices and Leadership actions and standards, provide a meaningful answer to the following question and incorporate the latest COVID-19 issues accordingly: 1. What was the adverse event in this case? Why did it occur?2. Did an error occur? If so, what is the classification and why?3. What safety standards should have been done in this case?4. What documentation and communication are needed to support safety for Mrs. Johnson?5. What safety related actions need to be taken after this event?6. How would you report this event to the patient safety committee and the patient/family to ensure a better safety plan for future?

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