By Team Dragons

RISK REDUCTION IN EMERGENCY DEP.

SENERIO-----1A 45-year-old female had gone to ED triage and reported feeling chest discomfort since 1 hr. She developed cardiac arrest 15 minutes after her arrival in the waiting room.

The purpose of ED triaging is to quickly assess and categorize incoming patients and to identify emergent patients. Patients who are under triaged are at risk for deterioration while waiting.

SENERIO----2

TEAM MEMBERS AREZULFAT KAMALUDINACHAMAMA MATHEWLAKSHMI DURAISWAMICENLIN NAZRETH LILLLYKUTTY JOSERUSY THANKACHAN FROM A&E DEP. KHOULA HOSP.

DEFINITION

Healthcare risk is thechance of an adverse outcome resultingfrom clinical investigation, treatment or patient care.

1.WHAT IS RISK?

National Patient Safety Agency 2007,NHS

.

This is the activities/measures taken by health care authority to prevent or mitigate the occurrence or reoccurrence of a real or potential (patient)safety event.

2.RISK MANAGEMENT

(WHO, World Alliance for Patient Safety 2009)

OBJECTIVES

Identify, assess &manage the risk in order to ensure the safety of both patient and staff.

Facilitate, promote and/or ensure appropriate implementation of risk management in day-to-day working

Reorganize systems and policies designed to optimize risk management in the hospital

setting.

IMPORTANCE OF RISK MANAGEMENT IN EMERGENCY DEPARTEMENT

•Emergency department, which by its nature has weaknesses vulnerable to mistakes and dissatisfaction.

• To protect the patient and to lower litigation rate, the function of modern risk management is to ensure that every patient is handled in a correct & human manner to ensure patients safety.

Risk assessment questions

1. What can

go wrong?

2. How often?

4. Is there a need for action?

3. How bad?

RISK MANAGEMENT PROCESS

IdentificationTrailing:-One effective way of identification of potential risk is to follow the patient's trail. From triage registration, waiting hall, clinical encounter, investigation, treatment , documentation and disposal.

Risk classification • ACTIVE FAILURE

• Action slip or failure (e.g. picking up the wrong medicine, wrong label)

• Cognitive failure (e.g. ignorance or misinterpreting a situation)

• Violations (deviations from safe medication practices, procedures or protocols) and breakdown in documentation communication and teamwork.

• LATENT FAILURE• Fallible decisions made by

management levels. • Examples are:-

• Heavy work load• Inadequate knowledge and

supervision.• Stressful environment,

rapid change within an organization and maintenance of equipment.

COMMON RISKS1.Inaccurate triage categorization.2. Prolonged waiting time3. Failure in resuscitation management.4. Failure in communications among caregivers & patient.5. Accidental fall.6. Improper pain management7.Shortage of health care workers.8.Failure in documentation.9.Failure in following standard protocol.10.Not seeking help when necessary.11.Medication errors,etc…

In triageAssign an extensive

knowledgeable triage nurse .Triage nurse should re asses the waiting patients timely.

He/she should have adequate training ,competent skills and language. Should be critical thinker &decision maker .

If any doubt chose the higher acuity to avoid under triage.

Successful management of polytrauma depends on the immediate diagnosis and management of the most life-threatening injuries.The systematic approach to a critically ill patient by a team competent group of nurses and physicians preserves a team’s focus and prevents errors Authority should arrange mandatory courses for all A&E staff to improve the professional knowledge . So that all staff will be competent in managing any emergency situation without any failure in patients care.

IN RESUSCITATION ROOM

Medication safetyMedication errors are a serious public health threat, causing patient injury and death and sharply increasing health care costs.

Staff should aware about high-alert medications which are known to cause severe injury to patients when administered.

CONT..Minimize verbal orders and require that medication orders to be entered electronically.Design smooth workflow within the ED in a

manner that improves communication, minimize interruptions and provides for double checks and verbal confirmations before medications are given to the patient.

DOCUMENTATION If care is not documented assume it was not rendered. Nurses’ notes are recognized as documentary evidence.

IT SHOULD BE: Factual, Accurate, Complete and Timely

Communication Ineffective communication is the most frequently cited category of root causes of sentinel events. Effective communications can: Improve patient safety. Improve quality of care . Decrease length of patient stay. Improve patient and family satisfaction. Enhance staff morale and job satisfaction

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RECOMENDATIONS Creation of a standing Risk Committee can provide focus on risk as an important part of emergency dep. also can encourage discussions of ongoing risk reduction tools and programs.

QI programs help avert risk through the processes of collecting data, performing chart reviews, promoting appropriate documentation in a peer-to peer-format and improving the quality of care delivery.

Cont…Preventable trauma deaths should be reviewed in trauma meeting.

Protocols, policies & procedures should be regularly reviewed and updated

Routine reporting of incidents should be performed as a daily activity and special rewards should be given to nursing staff who report incidents, to motivate them towards incident reporting as a means of risk identification and prevention rather than punishment.

Diplomatic and careful handling will pay great dividends.

AUDIT SHOULD BE DONEON

Patient record

Personnel performance

Protocols , policies and procedures

Facilities and equipment

Incident reports

CONCLUSIONReducing risk and ensuring safety require greater attention to systems that help to prevent and mitigate errors.

In order to improve the skills &knowledge authority should arrange in-service courses &work shops.

Risk management and quality improvement efforts in healthcare organizations are rallying behind patient safety and finding ways to work together more effectively and efficiently to ensure that their organizations deliver safe and high-quality patient care.

CONT..

While RM & QI department may separately address matters related to the event, they can also share responsibilities.

The risk manager will assist with the disclosure of the event to the patient and family . Both quality improvement and risk management may be involved in conducting a root-cause analysis of the event and preparing an action plan for preventing similar events.

REFERENCEShttp://www.acep.org/education/graduate-medical-education/academics/risk-management-outline-andresources-for-educators/2012Risk management in emergency department Hong Kong Journal of Emergency Medicine , North District Hospital, Accident & Emergency Department, 9 Po Kin Road, Fanling, New Territori es, Hong KongMartin PB, Federico F. Risk management’s role in performance improvement. Chapter 2, Volume 2. In: Carroll R, ed. Risk management handbook for health care organizations. San Francisco (CA): Jossey-Bass; 2006:23-35.American Society for Healthcare Risk Management (ASHRM): PDF FILE