Dealing with risks in patient care
Quality management
Nicole Ahrens
Leitung Qualitätsmanagement, klinisches Risikomanagement und Beschwerdemanagement
Gotenstraße 1
42653 Solingen
Phone:
0212
-166-2694
Mail:
ed.negnilosmukinilk@elocin.snerha
Qualitätsmanagement Ärztlicher Dienst Pflegedienst Personalmanagement Medizincontrolling Krankenhaushygiene Betriebliches Gesundheitsmanagement Betriebsrat
Conference frequency: quartalsweise
Risk management
Nicole Ahrens
Leitung Qualitätsmanagement, klinisches Risikomanagement und Beschwerdemanagement
Phone:
0212
-166-2694
Fax: 0212-166-2130
Mail:
ed.negnilosmukinilk@elocin.snerha
Qualitätsmanagement Ärztlicher Dienst Pflegedienst Personalmanagement Medizincontrolling Krankenhaushygiene Betriebliches Gesundheitsmanagement Betriebsrat
Conference frequency: quartalsweise
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management Verfahrensanweisung Reanimation (11.04.2023) |
| RM05 |
Pain management QM-Handbuch Akutschmerztherapie (12.08.2022) |
| RM06 |
Fall prophylaxis Arbeitsanweisung Sturzprophylaxe (01.03.2018) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) Arbeitsanweisung Dekubitusprophylaxe (17.09.2018) |
| RM08 |
Regulated handling of custodial measures Verfahrensanweisung Umgang mit freiheitsentziehenden Maßnahmen (01.03.2018) |
| 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 Verfahrensanweisung Anwendung der OP-Checkliste (15.08.2018) |
| RM15 |
Preoperative, complete presentation of necessary findings Verfahrensanweisung Anwendung der OP-Checkliste (inkl. Team-Time-Out) (15.08.2018) |
| RM16 |
Procedure to avoid procedural and patient mix-ups Verfahrensanweisung Sichere Patientenidentifikation (12.11.2018) |
| RM17 |
Standards for recovery and postoperative care Arbeitsanweisung Aufwachraum (24.07.2023) |
| RM18 |
Discharge management Verfahrensanweisung Interdisziplinäres Entlassungsmanagement (11.06.2021) |
Fault reporting systems
Conference committee
Conference frequency: monatlich
Measures
Patientenarmbänder Seitenmarkierung OP-Checkliste Team-Time-Out Einsatz besser unterscheidbarer Materialien
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 20.12.2023 |
| 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 jährlich |
Conference committee
Conference frequency: halbjährlich
| No. | Explanation |
|---|---|
| EF03 |
KH-CIRS (German Hospital Association, German Nursing Council, German Medical Association) |
| EF06 |
CIRS NRW (North Rhine and Westphalia-Lippe Medical Associations, North Rhine-Westphalia Hospital Association, North Rhine and Westphalia-Lippe Associations of Statutory Health Insurance Physicians, German Medical Association) |