Dealing with risks in patient care
Quality management
MBA Christian Ober
Qualitäts- und Risikomanagement
Bonner Talweg 4-6
53113 Bonn
Phone:
0228
-506-2122
Mail:
ed.nnob-kg@tnemeganamsteatilauq
Sitzung der Qualitäts- und Risikomanagementbeauftragten, 54 Mitglieder aus allen Abteilungen und Funktionsbereichen
Conference frequency: quartalsweise
Risk management
Christian Ober
Qualitäts- und Risikomanagement
Bonner Talweg 4-6
53113 Bonn
Phone:
0228
-506-2122
Fax: 0228-506-32122
Mail:
ed.nnob-kg@tnemeganamsteatilauq
Risikomanagerin und Risikobeauftragte aus den Abteilungen/Funktionsbereichen
Conference frequency: halbjährlich
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available Handbuch Risikomanagement BBT, Jährliche Managementbewertung nach DIN EN ISO (27.09.2021) |
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management Notfallmanagement (15.12.2020) |
| RM05 |
Pain management Leitfaden Akutschmerztherapie (13.06.2023) |
| RM06 |
Fall prophylaxis Sturzprophylaxe (03.07.2023) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) Dekubitusprophylaxe (03.07.2023) |
| RM08 |
Regulated handling of custodial measures Verfahrensanweisung Freiheitsbeschränkende Maßnahmen (02.07.2020) |
| RM09 |
Regulated handling of occurring malfunctions of devices VA zur Umsetzung der MPBetreibV (16.01.2023) |
| 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 Anwendung der WHO-OP-Checkliste (21.12.2020) |
| RM15 |
Preoperative, complete presentation of necessary findings Anwendung der WHO-OP-Checkliste (21.12.2023) |
| RM16 |
Procedure to avoid procedural and patient mix-ups VA Patientenidentifikation und OP-Checkliste (07.08.2019) |
| RM17 |
Standards for recovery and postoperative care Übergabe Aufwachraum an Normalstation und an Intensivstation; OP-Saalkarte (11.10.2023) |
| RM18 |
Discharge management Entlassungsmanagement (07.09.2023) |
Fault reporting systems
Conference committee
Conference frequency: andere Frequenz
Measures
Anpassung / Neuerstellung von Verfahrensanweisungen, Schulung von Mitarbeitern, Sensibilisierung durch Veröffentlichung von CIRS-Fällen im Intranet
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 04.12.2023 |
| 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 bei Bedarf |
Conference committee
Conference frequency: monatlich
| No. | Explanation |
|---|---|
| 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) |