Risk Management Leadership

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Risk Management Leadership
2015-02-17 18:49:09
Risk Management Leadership

Risk Management Leadership
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  1. Current "World of Healthcare": Our Patients and Families
    Sicker, More Complex


    Higher Expectations

    More informed, assertive

    Increased Co-Payments and Denials/Decrease access

    Decrease in Public Trust
  2. Current "World of Healthcare": Our Work Environment
    • Increase Nurse:Patient ratio
    • Frequent Interruptions
    • More technologically advanced
    • Shortages in workforce
    • Increase productivity ("do more with less")
    • Litigious society
    • Multitude of Regulations
  3. One who initiates a lawsuit seeking compensation for damages (ie: patient)
  4. Party against who a suit is brought demanding compensation (ie: hospital)
  5. Professional misconduct...failure to meet the standard of care of a profession which resulted in harm to another
  6. Failure to exercise due care resulting in harm or injury to another party
  7. Amount of money a court orders a defendant to pay the plaintiff
  8. Laws that specify the length of theme within which a person may file specific types of lawsuits
    Statue of Limitations
  9. "Let the master answer"...legal doctrine that makes an employer responsible for consequences of the acts of a servant of employee while acting within the scope of employment
    Respondeat Superior
  10. Def of Standard of Care
    A reasonably prudent person with similar training and expertise would exercise under the same or similar circumstances
  11. Nurses and Physicians operate under ____ standards of care
  12. Hospitals operate under ___ standards of care
    Community (locality rule)
  13. Medical malpractice is based on ____
    standard of care

    (ie: how would a reasonably competent nurse conduct themselves with regard to skills, knowledge and degree of caring in a similar situation)
  14. Sources of Standard of Care:
    • State nurse practice acts
    • American Nursing Association (ANA)
    • Joint Commission
    • Case Law and Published Opinions by Judges
    • State Statutes and administrative Codes
    • Hospital Policies
    • Authoritative Nursing Texts and Journals
    • Locality Rule/Community Standard
  15. IOM Report: To Err is Human
    44-98,000 people die in the hospital each year due to medical errors

    Events related to medical errors are the 3rd leading cause of death in the US after heart disease and cancer

    Errors are caused by faulty systems and processes, NOT people

    Healthcare professionals pay with loss of morale and frustration at not being able to provide the best care possible
  16. 6 Aims of Improvement for Healthcare (IOM March 2011)
    • Safe
    • Effective
    • Patient-centered
    • Timely
    • Efficient
    • Equitable
  17. Average ICU pt experiences ___ errors per day
    2 errors

    (this equates to 2 dangerous landings per day and 32,000 checks deducted from the wrong account per hour)
  18. In order to assert negligence, one must prove all of the following:
    • Duty owed
    • Breach of Duty
    • Proximate cause
    • Injury or Damages
  19. Reasons why professionals are sued:
    Failure to assess the pt and take adequate history

    Failure to observe and monitor the patient

    Failure to perform a procedure properly

    • Failure to supervise patients resulting in a fall
    • Failure to perform or communicate information to the physician

    Failure to follow a physician's order promptly and correctly
  20. Ways to supervise patients and prevent falls:
    Check patient every 2 hours or more for toilet needs

    Visually check the patient every hour

    Chart your observations, time your entry!
  21. How to protect yourself from being sued:
    Good nurse/patient relationship

    Listen to your patient and family

    Ask for help when you are not sure or overwhelmed

    Good documentation

    Good communication
  22. Things TO put in the patient chart:
    Patient behavior (especially noncompliant)


    Neat, Legible entries
  23. Things NOT to do when charting:
    • Advertise of incident reports
    • Try to settle disputes or assign blame
    • Keep secrets
    • Don't get personal
  24. 10 Basic Charting Guidelines:
    Time, Date and Sign all entries

    Write legibly in ink

    Use only hospital approved standard abbreviations

    Be concise and complete

    Be specific and objective

    Display thought processes

    Make all entries promptly

    Make continuous entries

    Make certain entries are consistent and avoid contradictions

    Make alterations carefully
  25. According to Documentation in the EMR..."If it is not written down....."
    It never happened
  26. Documenting Medical Errors: DON'Ts
    Point fingers at others

    Use words like "accidentally", "regrettably", or  "too busy"

    Not referring to incident report or risk management

    Not airing concerns about workload or staffing
  27. Documenting Medical Erros: DOs
    Keep it factual and objective

    Chart your actions, what was ordered, what was given and patient response

    Remember your charting is your best defense
  28. Freedom from accidental injury or risk of harm
  29. The work of patient safety is to:
    • Reduce or mitigate harm
    • Improve health outcomes
  30. Safety requires:
    • knowledge
    • trust
    • system re-design
  31. Patient safety requires understanding of:
    • Safety as a system
    • People are fallible
    • There is a body of knowledge and experience to draw from
  32. On average, there are ___ sentinel events per hospital per year (mostly never reported)
  33. Any unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
    Sentinel Event

    (serious injury specifically including loss of limbs or function)
  34. The phrase "or risk thereof" includes any:
    process variation for which a recurrence would carry a significant chance of a serious adverse outcome
  35. Types of Sentinel Events:
    (any unanticipated death not related to the natural course of the patient's illness or underlying condition; suicide of patient; major permanent loss of limb or function not related to the natural course of the patient's illness or underlying condition)

    Infant abduction

    Infant discharged to wrong patient

    Rape by another patient or staff

    Hemolytic transfusion reaction involving administration of blood or blood products having a major blood group incompatibilites

    Surgery on wrong patient or body part
  36. Root cause of Sentinel Events

    (hand-offs prime time for communication breakdown...reconciliation of medications)
  37. Purpose of group: Root Cause Analysis
    To conduct an interdisciplinary review of an unexpected patient outcome in order to improve the patient care we provide
  38. Root Cause Analysis IS:

    Oriented toward system and process improvements

    Incorporates information from a variety of different sources

    Action oriented
  39. How is an ethics consult done:
    • Date/Time Consult
    • -give reason for the consult and who requested it
    • -brief synopsis of the patient's overall condition
    • -discussion with pt if possible, family, attending physician, and staff
    • -if patient is unable to communicate always ask if there is an advance directive or what the patient expressed to the family

    • Give opinion using the frameworks for Ethical Analysis
    • Document appreciation for the consult and make sure the attending physician knows the opinion
  40. Essentials that MUST be documented:
    • Assessments
    • Converstations
    • PT interactions (use quotes)
    • Family interaction
    • Risks/Informed Consent
    • Orders
    • Non-Compliance
    • Instructions to patient
    • Changes in condition
    • Time/Date and Sign all entries
    • Write legibly in Ink
    • Only hospital approved abbreviations
    • Concise and complete
    • Specific and Objective
    • Display though processes
    • Make all entries promptly 
    • Make continuous entries
    • Make sure entries are consistent and avoid contradictions
    • Make alterations carefully
  41. Common causes of medication errors:
    • Failed communication
    • Poor drug distribution practices
    • Dose miscalculations
    • Drug- and drug device-related problems
    • Incorrect drug administration
    • Lack of patient education
  42. STAR system
    • Stop
    • Think
    • Act
    • Review

    ***use when giving high risk drugs or are distracted/hurry
  43. Guidelines for Reducing Potential Liability Claims:
    Know applicable state statutes pertaining to nursing practice and comply with them

    Encourage open communication with patients

    Always chart completely and objectively, avoiding conclusive and subjective statements

    NEVER enter into chart wars with coworkers or physicians....Medical records are not the place to air your grievances

    Know the proper chain of command when encountering a problem with a physician's treatment of a patient

    • Never speak with an attorney about a patient without informing Risk Management
    • (Questionable inquiries from persons outside the hospital should be directed to your supervisor or the Risk Manager)