Reviews and appraises safety and risk aspects of patient care procedures and new programs.
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Wide Monitoring Systems Assignment
Risk Management Risk management is a component of quality management, but its purpose is to identify, analyze, and evaluate risks and then to develop a plan for reducing the frequency and severity of accidents and injuries. Risk management is a continuous daily program of detection, education, and intervention.
A risk management program involves all departments of the organization. It must be an organization-wide program, with the board of directors’ approval and input from all depart- ments. The program must have high-level commitment, including that of the chief executive officer and the chief nurse.
A risk management program:
1. Identifies potential risks for accident, injury, or financial loss. Formal and informal communication with all organizational departments and inspection of facilities are essential to identifying problem areas.
2. Reviews current organization-wide monitoring systems (incident reports, audits, committee minutes, oral complaints, patient questionnaires), evaluates completeness, and determines additional systems needed to provide the factual data essential for risk management control.
3. Analyzes the frequency, severity, and causes of general categories and specific types of incidents causing injury or adverse outcomes to patients. To plan risk intervention strategies, it is necessary to estimate the outcomes associated with the various types of incidents.
4. Reviews and appraises safety and risk aspects of patient care procedures and new programs.
5. Monitors laws and codes related to patient safety, consent, and care.
6. Eliminates or reduces risks as much as possible.
7. Reviews the work of other committees to determine potential liability and recommend prevention or corrective action. Examples of such committees are infection, medical audit, safety/security, pharmacy, nursing audit, and productivity.
8. Identifies needs for patient, family, and personnel education suggested by all of the foregoing and implements the appropriate educational program.
9. Evaluates the results of a risk management program.
10. Provides periodic reports to administration, medical staff, and the board of directors.
Nursing’s Role in Risk Management In the organizational setting, nursing is the one department involved in patient care 24 hours a day; nursing personnel are therefore critical to the success of a risk management program. The chief nursing administrator must be committed to the program. Her or his attitude will influence the staff and their participation. After all, it is the staff, with their daily patient contact, who actu- ally implement a risk management program.
High-risk areas in health care fall into five general categories:
● Medication errors ● Complications from diagnostic or treatment procedures ● Falls ● Patient or family dissatisfaction with care ● Refusal of treatment or refusal to sign consent for treatment
Nursing is involved in all areas, but the medical staff may be primarily responsible in cases involving refusal of treatment or consent to treatment.
Medical records and incidence reports serve to document organizational, nurse, and physician accountability. For every reported occurrence, however, many more are unreported. If records are
faulty, inadequate, or omitted, the organization is more likely to be sued and more likely to lose. Incident reports are used to analyze the severity, frequency, and causes of occurrences within the five risk categories. Such analysis serves as a basis for intervention.
Incident Reports Accurate and comprehensive reporting on both the patient’s chart and in the incident report is essential to protect the organization and caregivers from litigation. Incident reporting is often the nurse’s responsibility. Reluctance to report incidents is usually due to fear of the consequences. This fear can be alleviated by:
● Holding staff education programs that emphasize objective reporting ● Omitting inflammatory words and judgmental statements ● Having a clear understanding that the purposes of the incident reporting process are
documentation and follow-up ● Never using the report, under any circumstances, for disciplinary action.
Nursing colleagues and nurse managers should not berate another employee for an incident, and never in front of other staff members, patients, or patients’ family members. Peer review analysis, however, is a valuable tool to evaluate incidents (Hitchings et al., 2008).
A reportable incident should include any unexpected or unplanned occurrence that affects or could potentially affect a patient, family member, or staff. The report is only as effective as the form on which it is reported, so attention should be paid to the adequacy of the form as well as to the data required.
Reporting incidents involves the following steps:
1. Discovery. Nurses, physicians, patients, families, or any employee or volunteer may report actual or potential risk.
2. Notification. The risk manager receives the completed incident form within 24 hours after the incident. A telephone call may be made earlier to hasten follow-up in the event of a major incident.
3. Investigation. The risk manager or representative investigates the incident immediately.
4. Consultation. The risk manager consults with the referring physician, risk management committee member, or both to obtain additional information and guidance.
5. Action. The risk manager should clarify any misinformation to the patient or family, explaining exactly what happened. The patient should be referred to the appropriate source for help and, if needed, be assured that care for any necessary service will be provided free of charge.
6. Recording. The risk manager should be sure that all records, including incident reports, follow-up, and actions taken, if any, are filed in a central depository.
Examples of Risk The following are some examples of actual events in the various risk categories.
Medication Errors A reportable incident occurs when a medication or fluid is omitted, the wrong medication or fluid is administered, or a medication is given to the wrong patient, at the wrong time, in the wrong dosage, or by the wrong route. Here are some examples.
Patient A. Weight was transcribed incorrectly from emergency room sheet. Medication dose was calculated on incorrect weight; therefore, patient was given double the dose