Risk Management / CQI

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Risk Management / CQI

• Nutr 564 Management
• Summer 2005

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Risk Management / CQI
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Risk Management / CQI

• Objectives
• Review issues on patient safety
• Identify components of quality assurance
  processes
• Describe a culture of safety
• Characterize risk situations in health care

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I N S T I T U T E O F M E D I C I N E Shaping the
Future for Health November 1999
TO ERR IS HUMAN BUILDING A SAFER HEALTH
SYSTEM Health care in the United States is not as
safe as it should be--and can be At least 44,000
people, and perhaps as many as 98,000 people,
die in hospitals each year as a result of medical
errors that could have been prevented, according
to estimates from two major studies
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Patient Safety

• 2005 proposed budget for patient safety is 84
  million.
• The Centers for Medicare Medicaid Services
  (CMS) has made it clear that patient safety is
  indistinguishable from quality of care.

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Risk Management / CQI

• What are Medical Errors?
• Medical errors happen when something that was
  planned as a part of medical care doesn't work
  out, or when the wrong plan was used in the first
  place
• Where do they happen
• Medical errors can occur anywhere in the health
  care system
• Hospitals Clinics
• Outpatient Surgery Centers Doctors' Offices
• Nursing Homes Pharmacies
• Patients' Homes

http//www ahrq gov/consumer/20tips htm
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Concept Discussion

• What is an SOC?
• Review the table on P. 5 of the Docs Need SOCs.
  Can you add any additional activities where a
  health centers quality counts?
• What type of teams might best support the quality
  improvement process outlined in this document?

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Risk Management / CQI

• Quality Assurance
• is a dynamic, systematic process that assures
  the delivery of high-quality care to clients

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Risk Management / CQI

• QA Process
• Identify or define the problem
• Establish a method to evaluate the problem
• Set a timeline for data collection
• Collect the data
• Analyze the results
• Discuss the findings and make conclusions
• Suggest alternatives to rectify the problem
• Try a solution evaluate
• Develop a system to monitor the success
• Implement a system to reevaluate the plan with
  set time criteria

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Risk Management / CQI

• Clinical Indicators
• Measurement tool used to monitor and evaluate
  quality
• Process indictor
• Outcome indicator
• Rate-based indicator

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Risk Management / CQI

• Process Indicator - measures an activity
• Easy to Measure
• May not directly impact safety

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Risk Management / CQI

• Outcome Indicator
• Measures what happens after an activity

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Risk Management / CQI

• Rate-based indicator
• Assesses an event for which a certain proportion
  of the events that occur are expected

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Prevention Quality Indicators

• The PQIs are a set of measures that can be used
  with hospital inpatient discharge data to
  identify "ambulatory care sensitive conditions"
  (ACSCs).
• ACSCs are conditions for which good outpatient
  care can potentially prevent the need for
  hospitalization, or for which early intervention
  can prevent complications or more severe disease.

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Prevention Quality Indicators
Prevention Quality Indicators developed by
Stanford University under a contract with the
(AHRQ)

• Diabetes short-term complication AR Perforated
  appendix AR
• Diabetes long-term complication AR Pediatric
  asthma AR
• Chronic obstructive pulmonary disease Pediatric
  gastroenteritis
• Low birth weight rate Hypertension AR
• Congestive heart failure AR Dehydration AR
• Bacterial pneumonia AR Urinary tract infection AR
• Angina admission without procedure Uncontrolled
  diabetes AR
• Adult asthma AR
• Rate of lower-extremity amputation among patients
  with diabetes
• AR admission rate

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In-Patient Quality Indicators

• Complications of Anesthesia Death in
  Low-Mortality DRGs
• Decubitus Ulcer Failure to Rescue
• Foreign Body Left During Procedure Iatrogenic
  Pneumothorax
• Selected Infections due to Medical
  Care Postoperative Hip Fracture
• Postoperative Respiratory Failure Birth Trauma
  Injury to Neonate
• Postoperative Sepsis Postoperative Wound
  Dehiscence
• Accidental Puncture or Laceration Transfusion
  Reaction
• Postoperative Physiologic and Metabolic
  Derangements
• Postoperative Pulmonary Embolism or Deep Vein
  Thrombosis
• Postoperative Hemorrhage or Hematoma
• Obstetric Trauma with or without 3rd Degree
  Lacerations Vaginal with
• Instrument Vaginal without Instrument
  Cesarean Delivery

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Risk Management / CQI

• Elements of successful CQI projects
• Team effort in design
• Employee involvement at all levels
• Quality is part of job description
• Safety in participation
• Continuous effort

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Culture of Safety

• Ideal
• People would report error
• System would assess error
• Take corrective action
• Monitor for additional sources of error
• without fear of punishment

Liang BA, MD, PhD, JD
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Concept Discussion

• Review the questionnaire Hospital Survey on
  Patient Safety Culture. What is your reaction
  to this questionnaire?
• How do you envision using such a questionnaire in
  a facility?
• Does the document Docs Need SOCs convey a
  culture of safety?

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Culture of Safety

• A safety culture can be defined as
• a set of values, beliefs, and norms about
• what's important,
• how to behave, and
• what attitudes are appropriate when it comes to
  patient safety in a workgroup.
• The safety culture is the product of
• individual and group values,
• attitudes,
• perceptions,
• competencies, and
• patterns of behavior that determine the
  commitment to, and the style and proficiency of,
  an organization's health and safety management.

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Culture of Safety

• A safety culture
• A positive safety culture is characterized by
• communications founded on mutual trust,
• by shared perceptions of the importance of
  safety, and
• by confidence in the efficacy of preventive
  measures.

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Culture of Safety

• The ten dimensions of patient safety culture
• Supervisor/manager expectations and actions
  promoting patient safety
• Organizational learningContinuous improvement
• Teamwork within units
• Communication openness
• Feedback and communication about error
• Nonpunitive response to error (no shame and
  blame)
• Staffing
• Hospital management support for patient safety
• Teamwork across hospital units
• Hospital handoffs and transitions

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Culture of Safety

• Dr. David Hunt (CMS)
• Intent An organization must intentionally look
  for adverse events and the systems that may need
  attention. The intention is for improvement of
  systems, not malpractice avoidance.
• 2. Relevance What is being looked at is
  important. There are several relevant topics from
  which to choose.
• 3. Transparency If the problem is hidden under
  shame and blame, it will not be transparent only
  by bringing it out in the sunlight can problems
  be addressed.

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Concept Discussion

• Does the document Docs Need SOCs convey a
  culture of safety?

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Risk Management / CQI
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Risk Management / CQI

• Risk Management
• Clinical and administrative activities undertaken
  to identify, evaluate, and reduce the risk of
  injury to patients, staff, and visitors and the
  risk of loss to the organization itself

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Risk Management / CQI
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Concept Discussion

• Seattle Times article
• Picture this same scenario 20 years ago.
  Describe what you envision would be a traditional
  management approach to such an event? Do you
  agree with the approach described in this
  article?
• What factors might influence a familys decision
  to take legal action?

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Concept Discussion

• Other safety issues in a health care facility.
• What are high risk areas in food service?
• How can a culture of a safety be applied to staff
  training

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Risk Management / CQI

• Clinical Nutrition and Food Service Systems
• High risk areas