Alice-Hospital

Dealing with risks in patient care

Quality management

Herr Manfred Fleck

QM-Beauftragter

Dieburger Straße 31
64287 Darmstadt

Phone: 06151-402-1400
Mail: ed.latipsoh-ecila@kcelf.derfnam

Abteilungs- und Stationsleitungen, Belegärzte, Vertreter der Verwaltung

Conference frequency: bei Bedarf

Risk management

Koordinator

Jörg Vetter

Dieburger Str. 31
64287 Darmstadt

Phone: 06151-402-1060
Fax: 06151-402-881060
Mail: ed.latipsoh-ecila@rettev.greoj

Abteilungs- und Stationsleitungen, Belegärzte, Vertreter der Verwaltung

Conference frequency: bei Bedarf

Risk management instruments and measures

No. Explanation
RM01

Comprehensive quality and/or risk management documentation (QM/RM documentation) is available

BITQMS (08.09.2019)

RM02

Regular further education and training measures

RM03

Employee surveys

RM04

Clinical emergency management

BITQMS (08.09.2019)

RM05

Pain management

BITQMS (08.09.2019)

RM06

Fall prophylaxis

BITQMS (08.09.2019)

RM07

Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”)

BITQMS (08.09.2019)

RM08

Regulated handling of custodial measures

BITQMS (08.09.2019)

RM09

Regulated handling of occurring malfunctions of devices

BITQMS (08.09.2019)

RM12

Use of standardised information sheets

RM13

Application of standardised surgical check lists

RM15

Preoperative, complete presentation of necessary findings

BITQMS (08.09.2019)

RM16

Procedure to avoid procedural and patient mix-ups

BITQMS (08.09.2019)

RM17

Standards for recovery and postoperative care

BITQMS (08.09.2019)

RM18

Discharge management

BITQMS (08.09.2019)

Fault reporting systems

Conference committee

Conference frequency: bei Bedarf

Measures

„Aufgrund der eingegangenen CIRS-Meldungen konnte in verschiedensten Bereichen Maßnahmen zur Steigerung der Patientensicherheit umgesetzt werden“.


No. Explanation
IF01

Documentation and procedural instructions for handling the error reporting system are available

As of: 08.09.2022

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: bei Bedarf


No. Explanation

Other

EF03

KH-CIRS (German Hospital Federation, Action Alliance for Patient Safety, German Nursing Council, German Medical Association, National Association of Statutory Health Insurance Doctors)