Universitätsmedizin Greifswald - Tagesklinik Psychiatrie

Dealing with risks in patient care

Quality management

Geschäftsbereichsleiter Patientensicherheit und Qualität

Ingo Rollin

Phone: 03834-86-22469
Fax: 03834-86-5227
Mail: ed.dlawsfierg-inu.dem@nillor.ogni

In allen Kliniken gibt es benannte ärztliche und pflegerische Ansprechpartner für qualitätsrelevante Themen. Das Zentrale Qualitätsmanagement organisiert "QMB-Runden", zu denen die Ansprechpartner eingeladen werden. Themen sind bspw. Zertifizierungen, Befragungen, Weiterentwicklungen des QM-Systems.

Conference frequency: bei Bedarf

Risk management

Geschäftsbereichsleiter Patientensicherheit und Qualität

Ingo Rollin

Phone: 03834-86-22469
Fax: 03834-86-5227
Mail: ed.dlawsfierg-inu.dem@nillor.ogni

Risikomanagement

Conference frequency: wöchentlich

Risk management instruments and measures

No. Explanation
RM01

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

Managementhandbuch Qualitäts- und Risikomanagement (15.11.2019)

RM02

Regular further education and training measures

RM04

Clinical emergency management

Verfahrensanweisung Notfallmanagement/ Herzalarm (19.06.2019)

RM05

Pain management

Geschäftsordnung QM Akutschmerz (31.08.2021)

RM06

Fall prophylaxis

Sturzprophylaxe (24.08.2020)

RM07

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

Dekubitusprophylaxe (19.06.2019)

RM08

Regulated handling of custodial measures

Verfahrensanweisung Notwendige freiheitsentziehende Maßnahmen (09.05.2018)

RM09

Regulated handling of occurring malfunctions of devices

Managementhandbuch Qualitäts- und Risikomanagement (15.11.2019)

RM10

Structured implementation of interdisciplinary case discussions/conferences

Case review conference

  • Tumorkonferenzen
  • Mortalitäts- und Morbiditätskonferenzen
  • Pathologiebesprechungen
  • Palliativbesprechungen
  • Qualitätszirkel
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-Checkliste (07.01.2021)

RM15

Preoperative, complete presentation of necessary findings

OP-Checkliste (07.01.2021)

RM16

Procedure to avoid procedural and patient mix-ups

OP Checkliste (07.01.2021)

RM17

Standards for recovery and postoperative care

Postoperative Schmerztherapie im Aufwachraum (28.09.2021)

RM18

Discharge management

Entlassungsmanagement (02.07.2019)

Fault reporting systems

Conference committee

Conference frequency: monatlich

Measures

Patientenidentifikationsarmband; OP-Checklisten, Teilnahme am Tag der Patientensicherheit, Posteraktionen, regelmäßige interne Risikobegehungen


No. Explanation
IF01

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

As of: 11.08.2021

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 quartalsweise

Conference committee

Conference frequency: halbjährlich


No. Explanation
EF03

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