Dealing with risks in patient care
Quality management
Claudia Mohm
Qualitätsbeauftragte
Graf-Siegfried-Str. 115
54439 Saarburg
Phone:
06581
-82-1150
Mail:
ed.grubraas-hk@mhom.c
Risikomanagement Fr. Irene Schuster - Pflegedirektorin, Projektmanagement - Hr. F. Bergmann - stellv. Pflegedirektor; Qualitätsmanagement - Fr Mohm - Laborleitung, Hr. P. Schmusch (LKH), Hr. T. Weber
Conference frequency: monatlich
Risk management
Irene Schuster
Risikomanagement
Graf-Siegfried-Str. 115
54439 Saarburg
Phone:
06581
-82-1301
Fax: 06581-82-1703
Mail:
ed.grubraas-hk@retsuhcs.i
Risikomanagement Fr. Irene Schuster - Pflegedirektorin, Projektmanagement - Hr. F. Bergmann - stellv. Pflegedirektor; Qualitätsmanagement - Fr Mohm - Laborleitung, Hr. P. Schmusch (LKH), Hr. T. Weber
Conference frequency: monatlich
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available Konzept und Leitlinie (22.07.2022) |
| RM04 |
Clinical emergency management MegaCode Training; SOP Notfallteam (19.07.2023) |
| RM05 |
Pain management Leitlinie Schmerzmanagement (26.03.2018) |
| RM06 |
Fall prophylaxis Leitlinie Sturzprophylaxe (01.02.2022) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) Standard (27.10.2020) |
| RM08 |
Regulated handling of custodial measures Verfahrensanweisung (19.05.2023) |
| RM09 |
Regulated handling of occurring malfunctions of devices Meldung per Ticketsystem; Störmeldeformular (01.02.2022) |
| 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 PräOP Besprechung_Risk (11.09.2023) |
| RM15 |
Preoperative, complete presentation of necessary findings Prä und Intra OP_Befundansicht (11.09.2023) |
| RM16 |
Procedure to avoid procedural and patient mix-ups OP Checkliste; PräOP-Einleitung -Team Time Out (30.06.2022) |
| RM18 |
Discharge management Entlassmanagement (05.09.2022) |
Fault reporting systems
Conference committee
Conference frequency: bei Bedarf
Measures
bei Bedarf
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 02.09.2022 |
| IF02 |
Internal evaluation of the received reports taken monatlich |
| IF03 |
Training of employees in handling the error reporting system and in implementing the findings from the error reporting system taken bei Bedarf |
Conference committee
Conference frequency: monatlich
| No. | Explanation |
|---|---|
| EF03 |
KH-CIRS (German Hospital Federation, Action Alliance for Patient Safety, German Nursing Council, German Medical Association, National Association of Statutory Health Insurance Doctors) |