Dealing with risks in patient care
Quality management
Jana Abig
Qualitätsmanagementbeauftragte
Eichelbach 9
98574 Schmalkalden
Phone:
03683
-645-357
Mail:
ed.mukinilk-htebasile@gibA.anaJ
Leitungskräfterunde
Conference frequency: monatlich
Risk management
Jana Abig
Qualitätsmanagementbeauftragte
Eichelbach 9
98574 Schmalkalden
Phone:
03683
-645-357
Fax: 03683-645-108
Mail:
ed.mukinilk-htebasile@gibA.anaJ
Leitungskräfterunde
Conference frequency: monatlich
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available Konzept Risikomanagement (19.06.2023) |
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management Polytrauma Notfälle mit vitaler Bedrohung Notfälle ohne vitale Bedrohung Verantwortlichkeiten vitale Bedrohung mit Alarmierungsliste (05.09.2023) |
| RM05 |
Pain management Manual Schmerztherapie (08.09.2023) |
| RM06 |
Fall prophylaxis Pflegestandard Sturzprophylaxe Sturzprotokoll (06.01.2022) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) Prozessablauf Dekubitus Dokumentationsbogen Dekubitus Arbeitsanweisung Dekubitusprophylaxe Dekubitus in der ZNA (23.08.2021) |
| RM08 |
Regulated handling of custodial measures Umgang mit Fixierungen Ärztliche Anordnung und Durchführung von Fixierungen (29.11.2022) |
| RM09 |
Regulated handling of occurring malfunctions of devices Konzept Risikomanagement (10.03.2020) |
| RM10 |
Structured implementation of interdisciplinary case discussions/conferences Case review conference
|
| RM12 |
Use of standardised information sheets |
| RM13 |
Application of standardised surgical check lists |
| RM14 |
Preoperative summary of predictable critical surgical steps, surgical time and expected blood loss Team Time Out (27.01.2020) |
| RM15 |
Preoperative, complete presentation of necessary findings Team Time Out (27.01.2020) |
| RM16 |
Procedure to avoid procedural and patient mix-ups Checkliste zur Vermeidung von Eingriffsverwechslungen (10.07.2019) |
| RM17 |
Standards for recovery and postoperative care Protokoll Aufwachraum Pflegestandard OP/Anästhesie OP-Satzung (01.09.2019) |
| RM18 |
Discharge management VA Entlassungsmanagement (07.10.2022) |
Fault reporting systems
Conference committee
Conference frequency: quartalsweise
Measures
Eingesetztes System: CIRS EKSM Erhöhung der Patientensicherheit beim Umgang mit Medikamenten Vermeidung von Eingriffsverwechslungen mehrfache Kontrolle der Patientenidentität
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 18.08.2020 |
| IF02 |
Internal evaluation of the received reports taken quartalsweise |
| IF03 |
Training of employees in handling the error reporting system and in implementing the findings from the error reporting system taken jährlich |
Conference committee
Conference frequency: bei Bedarf
| No. | Explanation |
|---|---|
| EF03 |
KH-CIRS (German Hospital Association, German Nursing Council, German Medical Association) |