AN-NAJAH NATIONAL UNIVERSITY FACULTY OF MEDICINE AND HEALTH

AN-NAJAH NATIONAL UNIVERSITY FACULTY OF MEDICINE AND HEALTH SCIENCES DEPARTMENT OF NURSING AND MIDWIFE Instructor : Miss. Samah Ishtieh STN: Manar Yameen Faten qandos 1 Majd wazani Nareman nassar

OUTLINE 1 - Introduction 2 - Definition 3 - Risk management process 4 - Risk Management Options 5 - Incident Report 6 - How to alleviate the fear ? ? 7 - How To Make An Incident Report ? ? ? 8 - Medication errors 9 - Diagnostic procedure 10 - Medical legal incident 11 - Role Of The Nurse Manager 2

INTRODUCTION Risk management is component of quality management , but it’s purpose is to identify , analyzes , and evaluate risks and then to develop a plane for reducing the frequency. Risk management is continuous daily program of detection , education , and intervention. 3

DEFINITION Risk : “hazard” , a chance of bad consequence. Risk management : is the practice of identifying potential risks in advance, analyzing them and taking precautionary steps to reduce the risk. 4

5

RISK MANAGEMENT OPTIONS 9 7

RISK MANAGEMENT OPTIONS (1)--Avoid: The best thing that you can do with a risk is to avoid it. If you can prevent it from happening, it definitely won’t hurt your project. The easiest way to avoid this risk is to walk away from the cliff, but that may not be an option on this project. (2)--Mitigate: If you can’t avoid the risk, you can mitigate it. This means taking some sort of action that will cause it to do as little damage to your project as possible. (3)--Transfer: One effective way to deal with a risk is to pay someone else to accept it for you. The most common way to do this is to buy insurance. (4)--Accept: When you can’t avoid, mitigate, or transfer a risk, then you have to accept it. 8

INCIDENT REPORTS INCIDINT REPORT are used to analyze the severity, frequency, and causes of occurrence within the five risk categories. Such analysis serves as a basis for intervention. Accurate and comprehensive reporting on both the pt. chart and in the incident report is organization and caregivers from litigation. essential to protect the Incident reporting is often the nurse’s responsibility. Reluctance to report incidents is usually to fear of the consequences. 9

HOW TO ALLEVIATE THE FEAR ? ? Holding staff education programs that emphasize objective reporting q Omitting inflammatory words and judgmental statements. q having a clear understanding that the purposes of the incident reporting process are documentation and fallow-up q never using the report, under any circumstances, for disciplinary action. q 10

CONT…. A reportable incident should include any unexpected or unplanned occurrence that affect apt. , family member, or staff. HOW TO MAKE AN INCIDENT REPORT ? ? ? 1. discovery. nurses, physician, pt. , 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 incident. 3. Investigation. the risk manager or representative investigates the incident immediately. 11

CONT…. 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 pt. or family , explaining exactly what happened. 6. Recording. the risk manager shoud be asure that all records, including incident report are filed in a central depository. 12

EXAMPLE OF RISK : Medication errors A reportable incident occurs when a medication or fluid is omitted , the wrong is administered or the medication is given to the wrong patient at wrong time in the wrong dosage or by the wrong rout. Diagnostic procedure Any incident occurring before, during, or after such procedures as blood sample stick , biopsy, xray examination , lumber puncture , or other invasive procedure is categorized as a diagnostic procedure incident. Medical legal incident If a patient or family refuses treatment as order and prescribed or refuses to sign consent forms , the situation is categorized as a medical – legal incident. 13

MEDICATION ERRORS : Patient A Weight was transcribed incorrectly from emergency room sheet. Double dose given the solution: Error discover after first dose and corrected second dose omitted. Patient B Patient C Tegretol dosage written in medex as ( Tegretol 100 mg chewable tab _ 50 mg PO BID )Tegretol 100 mg given PO at 1400. During round at 3: 30 pm 9%sodium chloride at 75 cc per hour hanging. Order was D 5 W. Fluid last checked at 2: 00 pm. Change to correct fluid. Doctor notified Meds checked at 1430 and error noted 50 mg Tegretol should have been given Doctor notified second dose held. 14

DIAGNOSTIC PROCEDURE : Patient A When I checked the IV site , I saw that it was red and swollen. For this reason , I discontinued the IV. When I remove the tape , I noted a small area on skin breakdown where the tape had been. There was also a small knot on the medial aspect of the left antecubital above the IV insertion site. Doctor notified Wound dressed. Patient B Patient found on the floor after lumbar puncture. Right side rail down. Examined by physician , BP 120/80 , T 98. 6 , R 72. No injury noted on exam. 15

MEDICAL LEGAL INCIDENT Patient A Patient B After a visit from a member of the clergy , patient indicated he was no longer in need of medical attention and asked to be discharged. Physician called. Doctor explained potential side effect if treatment was discontinued. Patient continued to ask for discharge. Doctor explain against medical advice (AMA) form. Patient signed AMA form and left at 1300 without medication. Patient refused to sign consent for bone marrow biopsy. States side effects not understood. Doctor reviewed reason for test and side effects three different times. Doctor informed the patient that without consent he could not perform the test. Offered to call in another physician for second opinion. Patient agreed. After doctor left , patient signed consent form. 16

PATIENT OR FAMILY DISSATISFACTION WITH CARE When a patient or family indicates general dissatisfaction with care and the situation cannot be or has not been resolved, then an incident report is filed. Patient A. mother complained that she had found child saturated with urine every morning. explain to mother that diapers and linen are changed at 0600 when 0600 feedings and meds are given. 17

Patients back , buttocks , and perineal areas are free of skin breakdown. Parents continue to be distressed. Discussed with primary nurse. Patient B. Mr. Smith obviously very angry. Greeted me at the door complaining that his wife had not been treated properly in our emergency room the night before. Wanted 18

to speak to someone from administration. Was unable to reach the administrator on call. suggested Mr. Smith call administrator in the morning. Mr. Smith thanked me for my time and assured me that he would call the administrator the next day. 19

ROLE OF THE NURSE MANAGER The nurse manager plays a key role in the success of any risk management program. Nurse manager can reduce risk by helping their staff view health and illness from the patients perspective. Usually the staffs understanding of quality differs from the patients expectations and perceptions. By understanding the meaning of the course of illness to the patient and the family, the nurse 20

will manage risk better because that understanding can enable the nurse to individualize patient care. This individualized attention produce respect and , in turn , reduces risk. A patient incident or a patients or a family expression of dissatisfaction regarding care indicates not only some slippage in quality of care but also potential liability. A distraught , dissatisfied , complaining patient is a high risk ; a satisfied 21

Patient or family is a low risk. A risk management or liability control program should therefore emphasize a personal approach. Many claims are filed because of a breakdown in communication between the health care provider and the patient. In many instances , after an incident or bad outcome , a quick visit or call from an organizations' representative to the patient or family can sooth tempers and clarify misinformation. 22

In the examples given , prompt attention and care by the nurse manager protected the patients involved and may have averted a potential liability claim. Once an incident has occurred. The important factors in successful risk management are: -1 Recognition of the incident -2 Quick follow-up and action -3 Personal contact -4 Immediate restitution 23

Thank you 24