Dr. Safaa Hussein Mohammad Lecturer Medical &Surgical Nursing
ISSUES IN RISK MANAGEMENT - The legal setting - Malpractice - Avoid Malpractice - The medical record - Patients rights
Identifying and analyzing situations or practices that create financial risk for the hospital and medical staff. Develop strategies to eliminate avoid or minimize the risk.
- To manage risks to the quality of services provided &the safety of patients,their carers &visitors. - To manage risks to staff & subsequent risk to service quality. - To manage risks of failing to meet national &local priority targets. - To manage risks to the efficiency of services. - To manage risks to the reputation of the hospital.
- To identify the major sources of risk to hospital, staff & visitors. - Develop regular statistical & qualitative risks manage reports. - Establish mechanisms to maintain & develop structures &processes for cohesive approach, to management of clinical & non clinical risk. - Conduct operational reviews of departments to identify deficiencies& potential areas for improvement.
- Recognition &acknowledgement of risks to patient safety &medical/ health errors with a focus on improving Processes & systems. - Initiation of actions that reduce these risk - Reporting the findings & action taken to improve Processes & systems. - Minimizing of individual blame or retribution for involvement in a medical health care errors. - Organizational learning about medical health care errors. - Sharing of acknowledgement to effect behavioral changes to minimize risk to patients.
Clean Care Is Safer Care
- Access to care & continuity of care - Patient &family rights - Assessment of patient - Care of patients - patients &family education - Quality improvement & patient safety - Prevention &control of infection - Governance leadership & direction - Facility management & safety - Staff qualification & education - Management of information.
- Root cause analysis - External assessments - Incident reports Complaints - Claims - Clinical audit - Performance monitoring.
1. Hospital mortality 2.Early neonatal 3.Inpatients perioperative 4. Inpatients intraoperative 5.Cesarean sections 6. Readmissions 7. Unscheduled inpatients admission occurring the same day following ambulatory surgery 8 Unscheduled returns to special care units within 48 hrs.' (ICU,CCU,NICU ) 9. Registered patients time in emergency room discharge disposition ( time > 4 hrs. ) 10. Patients who leave the emergency room prior to completion of treatment
- Adult code blue outcome - Patient satisfaction surveys - Patient complains - Use blood & blood components - Departmental peer review from sampling of discharges.
1.Identify patients correctly. 2. Improve effective communications. 3. Improve the safety of high alert medications. 4. Eliminate wrong site, wrong patients, wrong procedure surgery. 5. Reduce the risk of health care associated Infections. 6. Reduce the risk of patient harm resulting from falls
Integrated Incident Risk Management Aims
-He approves( with the committee) the Integrated risk management plan -He carries out risk management activities through communication with all medical committees.
- They are responsible for risk management within the scope of heir departments. - Ensure that all staff within their departments are provided education regarding policies procedures,any new processes that staff support & comply with the Integrated risk Management
- They are responsible to acquire & maintain the knowledge &skills they need to care for patients. - Staff educated patients & their families on their responsibilities regarding safety - Staff are required to report errors & perceived risk once identified
- They have the responsibility to provide accurate &complete information about present complains, hospitalization, medications &other matters relating to their health. - They are responsible for reporting perceived risks in their care & unexpected changes. - The Patients &Families are responsible
- Early reporting & investigations of incidents that have the potential for liability exposure. - Collaborating with risk management on strategies to reduce risks.
- Maintain good communications with your patient. - Maintain good communications with other members of the health care team. - Appropriate documentation. - Adverse outcomes. - Clinical service policies &protocols.
Clear, two way conversation is a key element in preventing malpractice claims
- Hospital acquired infection. - Improper use of anesthesia. - Failure to treat an illness. - Improper administration of drugs -Failure in order proper tests. - IN correct treatment of a diagnosed illness.
- Failure to consult with a specialist - Failure to monitor a patient - Failure to stabilize a patient. - Improper use of a medical device - Birth injury or birth trauma due to physician, nursing or hospital negligence. -Surgical procedures that are done without patient consent.
Percentage of all clims asserted 2002-2006,N=1,164 claims.
40-60% of all medical malpractice claims are avoidable with systemic risk management
- Introduce- your self to all patients &pay attention to non-verbal cues. - Personally care for each patient. - Avoid medical jargon &be punctual for meetings with patients &families. - Avoid criticizing other physicians or another physicians management of your patients. - NEVER gurgantee outcome of a treatment.
- Treat all patients with courtesy &consideration. - Arrange for physician coverage for your - patient while you are off. - Prescribing medications over the phone is not a devisable. - Request consultations when indicated &appropriate.
-Document it If you haven t document it, you didn t do it
- Clear &unambiguous - Complete - Errors - Alteration &late entries - Limit the records to patient care - document consent discussion - document instructions to the patient - Adverse outcome
Discussion Discharge instructions Telephone call Any &all findings Patients refusal of care Changes in the physical exam or clinical course.
Considerate & respectful care Effective pain management Receive care in a safe environment Be informed about your condition. Informed consent Privacy regarding disclosure of health information Know the physician responsible for coordinating your care.
Know how the hospital is connected professionally with other hospitals or health care agencies. Refuse to be examined,observed or treated by students or other hospital staff. Be advised of experimentation affecting your care.. Be informed of the alternative treatments. Expect reasonable continuity of care. Pastoral care &spiritual services. Make an advanced directive. Prompt life saving treatment
Have pain adequately assessed & treated. Refuse treatment. Have reasonable requests responded to promptly Interpreters at no cost. Request a different physician. Confidentiality.
View and receive copies of your medical records in accordance with state law &hospital policy. Receive copies of bills. What rules apply to your Conduct as a patient. Of a disabled person to receive equal care. Receive information relative to financial assistance and free health care. Receive medical services about discrimination. Be free of restraints except in circumstances defined by hospital policy. Be informed of unanticipated outcomes.
Be considerate of the rights of other patients & hospital personnel. Refrain from the use of tobacco products while hospitalized. Smoking is not allowed on the hospital campus. Be respectful of the property of other people &the hospital. Cooperate with all caregivers, ask questions if you do not understand the course of treatment and what is expected of you. Keep appointments & notify the hospital if you must cancel or reschedule.
Provide accurate and complete information about past illnesses hospitalizations & medications. Report unexpected changes and perceived risk in your care to your health care team. Accept the consequences if you refuse treatment or do not follow doctors orders. Recognize that the hospital will not tolerate weapons, threats to staff & substance abuse issues. Pay hospital bills promptly, provide necessary information for insurance processing and seek answers to any questions you have about your bill. Complete the patient satisfaction survey so we can improve service and maintain high standards of patient care.
- Diagnosis - Nature of proposed treatment - Name of the procedure - Description in Layman's terms - Risk associated with that treatment Alternatives & associated risk - Risk of no treatment `
1-Competence 2- Communication 3- Consent 4- Compassion 5- Consultation The big A & The 25 Cs
6-Chaperone 7- Confirmation 8-Completion 9- Correction 10- Caution
11-Contract 12- Common sense 13- Complaints 14-ckeck list 15-Coordination
16- Collections 17- Calls 18- Customer 19- Courage 20- Credential
21- Confidentiality 22-Comments 23- Counsel 24- Current 25- Calm
High quality hospital care Clean &safe environment Involvement in your care Protection of your privacy Help when Leaving the hospital Help with your billing claims
An easy way to prevent infection Hand washing is a simple habit that can help keep you healthy The First Line Of Defense Against Germs
THANK YOU