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Klinikum Chemnitz gGmbH

Flemmingstraße 2
09116 Chemnitz

Phone: 0371-33332470
Fax: 0371-333-33202
Mail: ed.cks@tkatnok

http://www.klinikumchemnitz.de

Basic information

Number of beds: 1.384
Number of specialist departments: 20

Number of inpatient cases: 49.486
Number of partial inpatient cases: 4.888
Number of outpatient cases: 73.991

Hospital owners: Stadt Chemnitz
Type of provider: öffentlich

Specialist departments

Services

Quality

External comparative quality assurance

Further information

External quality assurance according to state law
No participation

External quality assurance according to the DMP

Koronare Herzkrankheit (KHK)

seit 2004

Implementation of the minimum quantity agreement

Treatment area

Care of premature and newborn babies (with a birth weight of less than 1250g) at a hospital with proven level 1

Quantity performed	39
Exception?	No exception

Knee joint total endoprostheses

Quantity performed	72
Exception?	No exception

Complex operations on the esophageal organ system

Quantity performed	25
Exception?	No exception

Complex operations on the pancreatic organ system

Quantity performed	89
Exception?	No exception

Stem cell transplant

Quantity performed	59
Exception?	No exception

Minimum quantities forecast

Care of premature and newborn babies (with a birth weight of less than 1250g) at a hospital with proven level 1

Overall result forecast presentation:	yes
Quantity performed reporting year:	39
Quantity forecast year:	25
Examination by state associations?	yes
Exemption?	no
Result of the examination by the federal state authorities?	no
Transitional arrangement?	no

Complex operations on the pancreatic organ system

Overall result forecast presentation:	yes
Quantity performed reporting year:	89
Quantity forecast year:	92
Examination by state associations?	yes
Exemption?	no
Result of the examination by the federal state authorities?	no
Transitional arrangement?	no

Stem cell transplant

Overall result forecast presentation:	yes
Quantity performed reporting year:	59
Quantity forecast year:	51
Examination by state associations?	yes
Exemption?	no
Result of the examination by the federal state authorities?	no
Transitional arrangement?	no

Knee joint total endoprostheses

Overall result forecast presentation:	yes
Quantity performed reporting year:	72
Quantity forecast year:	56
Examination by state associations?	yes
Exemption?	no
Result of the examination by the federal state authorities?	no
Transitional arrangement?	no

Complex operations on the esophageal organ system

Overall result forecast presentation:	yes
Quantity performed reporting year:	25
Quantity forecast year:	24
Examination by state associations?	yes
Exemption?	no
Result of the examination by the federal state authorities?	no
Transitional arrangement?	no

Implementation of resolutions of the Federal Joint Committee on quality assurance (G-BA)

No.	Explanation
CQ01	Quality assurance measures for inpatient care with the indication abdominal aortic aneurysm
CQ02	Quality assurance measures for the inpatient care of children and adolescents with haemato-oncological diseases
CQ05	Measures for quality assurance in the care of pre-term and full-term neonates – Perinatal Centre LEVEL 1
CQ03	Quality assurance measures for the implementation of positron emission tomography (PET) in hospitals for the indications non-small-cell lung cancer (NSCLC) and solid pulmonary nodules
CQ19	Quality assurance measures for proton therapy in patients with inoperable non-small cell lung cancer (NSCLC) of UICC stages I-III
CQ18	Measures for quality assurance of positron emission tomography in patients with Hodgkin lymphoma and aggressive non-Hodgkin lymphoma for interim staging after chemotherapy to decide on the continuation of therapy

Compliance with staffing requirements

Clarifying chat completed: no
Clarifying chat not completed: no
No participation in clarifying chat: no
Notification of non-fulfilment of nursing care not made: yes

Further training
pursuant to Article 136b, para. 1, sentence 1, no. 1 of the SGB

Number	Group
364	Medical specialists (m/f) , psychological psychotherapists (m/f) and child and adolescent psychotherapists (m/f) who are subject to the obligation to undergo further training*
290	Number of medical specialists (m/f) from no. 1 who have completed a five-year period of further training and are therefore subject to the obligation to provide evidence
249	Number of those persons from no. 2 who have provided proof of further training according to Article 3 of the G-BA regulations

* according to the “Provisions of the Joint Federal Committee for the Further Training of Medical Specialists (m/f), Psychological Psychotherapists (m/f) and Child and Adolescent Psychotherapists (m/f) in Hospitals”

General information

Drug therapy safety

Steering committee

Drug commission

Training of employees on AMTS related topics

Use of standardised forms for drug medical history

VA Umgang mit Arzneimitteln (KC-PATV-VA-00001) Formular Arzneimittelanamnese (KC-APO-FB-00001)

06.12.2020

Electronic support for the admission and anamnesis process (e.g. import of patient master data or medication plans, use of a drug knowledge database, input screen for drugs or anamnesis information)

Process description for an optimal medication process (e.g. drug anamnesis – prescription – patient information – drug delivery – drug application – documentation – therapy monitoring – result evaluation)

VA Umgang mit Arzneimitteln (KC-PATV-VA-00001)

06.12.2020

SOP on good prescription practices

VA Umgang mit Arzneimitteln (KC-PATV-VA-00001), AA Entlassmanagement (KC-PV-AA-00009)

06.12.2020

Provision of one or more electronic drug information systems (e.g. Lauer-Taxe®, ifap klinikCenter®, Gelbe Liste®, Fachinfo-Service®)

Concepts for ensuring the error-free preparation of medications

Bereitstellung einer geeigneten Infrastruktur zur Sicherstellung einer fehlerfreien Zubereitung
Zubereitung durch pharmazeutisches Personal
Anwendung von gebrauchsfertigen Arzneimitteln bzw. Zubereitungen
patientenindividuelle parenterale Ernährungslösungen für intensivpflichtige Patienten und Frühgeborenene; parenterale Schmerzlösungen für die Anästhesie

Electronic support for the supply of patients with drugs

Versorgung der Patientinnen und Patienten mit patientenindividuell abgepackten Arzneimitteln durch die Krankenhausapotheke (z.B. Unit-Dose-System)
Bestellung über WebMUSE; gesamte individuelle Herstellung, Abgabe erfolgt über ein Warenwirtschaftssystem und Herstellungsprogramme; Einführung Arztmodul zur elektr. Anforderung von onkologischen Zubereitungen in der Frauenklinik und Inneren Medizin

Measures to minimise medication errors

Fallbesprechungen
Maßnahmen zur Vermeidung von Arzneimittelverwechslung
Spezielle AMTS-Visiten (z. B. pharmazeutische Visiten, antibiotic stewardship, Ernährung)
Teilnahme an einem einrichtungsübergreifenden Fehlermeldesystem (siehe Kapitel 12.2.3.2)
Meldung von beinahe- und stattgefunden Medikationsfehlern, detaillierte Analyse der Medikationsfehler, um ggf. Schwerpunkte festzustellen und Maßnahmen daraus abzuleiten; bei Arzneimittelumstellung Nutzung einer Checkliste (z.B. Look-Alike; Sound-Alike, ...)

Measures to ensure seamless drug therapy after discharge

Aushändigung von arzneimittelbezogenen Informationen für die Weiterbehandlung und Anschlussversorgung der Patientin oder des Patienten im Rahmen eines (ggf. vorläufigen) Entlassbriefs
Aushändigung von Patienteninformationen zur Umsetzung von Therapieempfehlungen
Aushändigung des Medikationsplans
bei Bedarf Arzneimittel-Mitgabe oder Ausstellung von Entlassrezepten
Projekt: Entlassgespräch zur Arzneimitteltherapie durch pharmazeutisches Personal in der Geriatrie