Risk Management

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Risk Management

• Patricia Raya, RN, C, MBA

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Mission of Risk Management

• The purpose of Risk Management is to reduce, and
  when possible, eliminate the risk of injury to
  patients, visitors, employees, volunteers and
  medical staff, as well as to protect the
  hospitals financial resources.
• Actual/potential problems are identified.
• These problems are investigated and the results
  of the investigation are shared with the
  appropriate departments.

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DOCUMENTATION

• Two very important reasons for accurate
  documentation are professional responsibility and
  accountability.
• Documentation is part of the responsibility for
  patient care
• One significant function of the nurse is their
  evaluation of the patients response to the
  nursing care
• Documentation must clearly communicate judgment
  and evaluation of the status of the patient
• Charting and documentation will be used in a
  medical malpractice case. It provides valuable
  evidence regarding the patients condition,
  treatments, and response to treatments

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DOCUMENTATION

• Legal aspects of charting techniques
• The medical record communicates vital information
  about the patient to a variety of professionals.
• It is used in the evaluation of patient care in a
  medical malpractice claim
• Documentation should reflect significant
  information about the patient

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DOCUMENTATION

• Correct entry errors properly. Draw a line
  through the error, but let it remain readable.
  Write mistaken entry above or beside the
  original words. Date and initial this mistaken
  entry. Write the correct information
• Do not lose or destroy medical records
• Do not add to someone elses notes
• Document noncompliance
• Document a patients refusal or inability to
  provide information or complete information
• If unauthorized items are found at the bedside,
  it needs to be documented
• Document a patient, family member or visitors
  tampering with a medical device or medical
  equipment
• Do not use the chart to criticize others

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DOCUMENTATION

• Dangerous abbreviations
• The use of abbreviations in the medical records
  is a leading cause of error.
• Some symbols and abbreviations have the potential
  for misinterpretation or confusion, which can
  lead to incorrect patient care and medical errors
• SBMC provides a list of acceptable abbreviations

• It is advised, that if an abbreviation is not on
  the accepted list, do not use it
• The list of acceptable abbreviations is available
  on each unit/department of the Medical Center.
  It is also available in the mini formulary
  distributed to all new residents and physicians

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Do Not Use List

• DO NOT USE LIST
• QD
• QID
• U
• MSO4
• IU
• MS
• MgSO4
• QOD
• Trailing zero following a decimal point (2 gms
  not 2.0 gms)
• Decimal point without a leading zero (0.25 mg not
  .25 mg)
• OS, OD, OU for left, right and both eyes
• AS, AD, and AU for left, right and both
  ears

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INCIDENT REPORTS

• In order to provide a safe, secure environment
  for patients, visitors, volunteers and medical
  staff a centralized Incident Reporting System has
  been established and maintained for the
  identification and reduction of risks.
• An incident is any unusual occurrence, accident,
  or mishap, which is not consistent with the
  routine operation of the hospital, or routine
  care of the patient as defined by the policies
  and procedures of Saint Barnabas Medical Center
  and regulatory bodies. The incident may be an
  error, poor outcome, or an accident, which could
  have or has resulted in a patient injury.
• All incidents involving patients, visitors,
  students, volunteers, or physicians will be
  reported immediately on the Hospital Incident
  Report form or Medication Incident Report form.
• It is important for the Incident Report to be
  filled out completely and thoroughly.

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INCIDENT REPORTS

• The Incident Report is a confidential management
  tool used to report promptly, accurately, and
  objectively and document hospital events.
  Incident reports are reviewed and investigated as
  necessary.
• The Incident Report is for investigation,
  trending, and/or preventive actions. It is NOT
  to be copied without approval from the Risk
  Management Department.
• A Critical Event is an incident that requires
  intense analysis of a process. A
  multidisciplinary team approach is utilized to
  develop and implement new/revised policies to
  enhance the process to avoid further incidents.
• The Incident Report is for the purpose of
  recording accurately the facts surrounding an
  incident, and to provide the data and the
  knowledge necessary for the review of such
  incidents by the Risk Management Department.
• This data is used to reduce the financial risks,
  improve the care to patients in the hospital, and
  create a safe environment.

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INCIDENT REPORTS

• The first person to discover the event should be
  the person to write the report. The
  manager/supervisor should also sign the report
• The narrative description should be a
  chronological summary of the circumstances
• Name, date, age and status of the patient
  involved should be included
• Report should be factual and concise

• Most events need to be reported to the Risk
  Management Department within 24 hours, some
  events (patient equipment failure, unexpected
  fetal demise, OR death) need immediate
  investigation and should be called in to the Risk
  Management Department

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INCIDENT REPORTS

• The following are examples of the types of
  occurrences that should be reported
• Falls
• Medications errors or omissions
• Patient equipment failure
• Incorrect Counts (OR)
• IV Infiltration
• Burns
• Fires
• Damage to property
• Patients that sign out AMA

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INCIDENT REPORTS
WHEN IN DOUBTFILL IT OUT
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Potential Compensatory Events

• A PCE is a hospital event that could possibly
  result in a claim for monetary compensation due
  to harms incurred while on hospital property.
• A hospital event is an unusual occurrence,
  accident or mishap which is not consistent with
  the routine operation of the hospital or the
  routine care of patients.

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Potential Compensatory Events

• The PCE is a tool to inform and alert the
  insurance carrier and the legal department of the
  hospital event that could lead to potential
  claims against the hospital for damages.

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CRITICAL EVENTS

• A Critical Event is an unexpected occurrence
  involving death or serious physical or
  psychological injury, or the risk thereof, in
  which a performance process or lack of a
  performance process may have contributed to the
  event.

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CRITICAL EVENTS

• A Critical Event meeting is held to review the
  incident ASAP.
• Risk Management conducts an investigation about
  the incident and the impact to patient care,
  visitors, staff and the hospital.
• Interventions are discussed and agreed upon and
  implemented. Follow-up is delegated to
  appropriate departments and individuals.

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RISK MANAGEMENT