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
[Link] neonatal
[Link] perioperative
4. Inpatients intraoperative
[Link] 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.
[Link] 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
`
 The big A & The 25 Cs
1-Competence

2- Communication

3- Consent

4- Compassion

5- Consultation
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