Dealing with risks in patient care
Quality management
Petra Spengler
Qualitätsmanagement- Beauftragte; Qualitätsmanagement Beschwerdemanagement Risikomanagement
Suurheid 20
22559 Hamburg
Phone:
040
-8191-2903
Mail:
moc.soipelksa@relgneps.p
Geschäftsführung Ärztliches Direktorium Pflegedirektion Personalleitung Qualitätsmanagement
Conference frequency: monatlich
Risk management
Petra Spengler
Qualitätsmanagement- Beauftragte; Qualitätsmanagement Beschwerdemanagement Risikomanagement
22557 Hamburg
Phone:
040
-8191-2903
Fax: 040-8191-2001
Mail:
moc.soipelksa@relgneps.p
Geschäftsführung Ärztliches Direktorium Pflegedirektion Personalleitung Qualitätsmanagement
Conference frequency: monatlich
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available QM- Maßnahmenplan (01.11.2022) |
| RM04 |
Clinical emergency management VA Notfallmanagement (20.03.2023) |
| RM05 |
Pain management VA Akutschmerztherapie (01.04.2019) |
| RM06 |
Fall prophylaxis Sturzmanagement in der Pflege (24.08.2023) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) VA Dekubitusprophylaxe (29.09.2016) |
| RM08 |
Regulated handling of custodial measures VA Ärztliche Zwangsmaßnahmen (29.07.2020) |
| RM09 |
Regulated handling of occurring malfunctions of devices Organisationshandbuch Medizintechnik (28.04.2023) |
| 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 OP- Sicherheitscheckliste nach WHO (11.01.2022) |
| RM15 |
Preoperative, complete presentation of necessary findings FO OP- Begleitschein (27.02.2023) |
| RM16 |
Procedure to avoid procedural and patient mix-ups KGF-VA Sichere Patientenidentifikation (10.06.2022) |
| RM17 |
Standards for recovery and postoperative care VA Überwachung Aufwachraum (11.02.2021) |
| RM18 |
Discharge management KGF-VA Entlassmanagement (07.04.2021) |
Fault reporting systems
Conference committee
Conference frequency: quartalsweise
Measures
Schulungen Verfahrensanweisungen erstellt Prozesse verändert/ optimiert Veränderung der Ausstattung vorgenommen Neuanschaffungen Bauliche Maßnahmen durchgeführt Kommunikation/ Gespräch
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 11.01.2023 |
| 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 halbjährlich |
Conference committee
Conference frequency: monatlich
| No. | Explanation |
|---|---|
|
Other |
|
| EF14 |
CIRS Health Care |