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Universitätsklinikum Frankfurt

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069-6301-0
Fax: 069-6301-7474
Mail: ed.mffku@QISAP

  • Number of beds: 1.112
  • Number of specialist departments: 32
  • Number of inpatient cases: 47.059
  • Number of partial inpatient cases: 1.788
  • Number of outpatient cases: 532.669
  • Hospital owners: Land Hessen
  • Type of provider: öffentlich
  • University Hospital
  • Academic teaching hospital
External comparative quality assurance
Further information
Bezeichnung
Teilnahme externe Qualitätssicherung yes
Bezeichnung
Teilnahme externe Qualitätssicherung does not apply
Bezeichnung
Teilnahme externe Qualitätssicherung yes
Quantity performed 122
Exception? No exception
Quantity performed 16
Exception? No exception
Quantity performed 59
Exception? No exception
Quantity performed 25
Exception? No exception
Quantity performed 29
Exception? No exception
Quantity performed 200
Exception? No exception
Overall result forecast presentation: yes
Quantity performed reporting year: 122
Quantity forecast year: 99
Examination by state associations? yes
Exemption? yes
Result of the examination by the federal state authorities? yes
Transitional arrangement? no
Overall result forecast presentation: Pending lawsuit
Quantity performed reporting year: 16
Quantity forecast year: 17
Examination by state associations? Pending lawsuit
Exemption? yes
Result of the examination by the federal state authorities? no
Transitional arrangement? no
Overall result forecast presentation: yes
Quantity performed reporting year: 59
Quantity forecast year: 61
Examination by state associations? yes
Exemption? yes
Result of the examination by the federal state authorities? yes
Transitional arrangement? no
Overall result forecast presentation: yes
Quantity performed reporting year: 25
Quantity forecast year: 23
Examination by state associations? yes
Exemption? yes
Result of the examination by the federal state authorities? yes
Transitional arrangement? no
Overall result forecast presentation: yes
Quantity performed reporting year: 29
Quantity forecast year: 42
Examination by state associations? yes
Exemption? yes
Result of the examination by the federal state authorities? yes
Transitional arrangement? no
Overall result forecast presentation: yes
Quantity performed reporting year: 200
Quantity forecast year: 214
Examination by state associations? yes
Exemption? yes
Result of the examination by the federal state authorities? yes
Transitional arrangement? no
Overall result forecast presentation: yes
Quantity performed reporting year: 60
Quantity forecast year: 50
Examination by state associations? yes
Exemption? yes
Result of the examination by the federal state authorities? yes
Transitional arrangement? no
Overall result forecast presentation: yes
Quantity performed reporting year: 278
Quantity forecast year: 256
Examination by state associations? yes
Exemption? yes
Result of the examination by the federal state authorities? yes
Transitional arrangement? no
Overall result forecast presentation: yes
Quantity performed reporting year: 86
Quantity forecast year: 80
Examination by state associations? yes
Exemption? yes
Result of the examination by the federal state authorities? yes
Transitional arrangement? no
No. Explanation
CQ05 Measures for quality assurance in the care of pre-term and full-term neonates – Perinatal Centre LEVEL 1
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
CQ25 Measures for quality assurance in the performance of minimally invasive heart valve interventions pursuant to Article 136, para. 1, sentence 1, number 2 for hospitals licensed in accordance with Article 108 of the SGB V
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
CQ24 Quality assurance measures for allogeneic stem cell transplantation for multiple myeloma (valid until 30 June 2022)
CQ26 Decision on measures for quality assurance of targeted lung denervation by catheter ablation in chronic obstructive pulmonary disease
CQ27 Guideline on quality assurance measures for inpatient care with bronchoscopic lung volume reduction procedures for severe emphysema (QS Guideline bronchoscopic LVR /QS-RL BLVR)
  • 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
Number Group
555 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*
45 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
45 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”

According to Section 4 (2) of the Quality Management Guideline, facilities must provide for the prevention of and intervention in cases of violence and abuse as part of their internal quality management. The aim is to prevent, recognise and respond appropriately to abuse and violence, particularly against vulnerable patient groups such as children and adolescents or people in need of help, and also to prevent it within the facility. The respective procedure is aligned with the size of the facility, the range of services and the patients in order to define customised solutions for sensitising the teams as well as other suitable preventative and interventional measures. These may include information materials, contact addresses, training/education, codes of conduct, recommendations for action/intervention plans or comprehensive protection concepts.

  • Is a protection concept in place? Yes
  • Last review of the measure: 01.06.2022 17:56:44
Gemäß § 4 Absatz 2 in Verbindung mit Teil B Abschnitt I § 1 der Qualitätsmanagement-Richtlinie haben sich Einrichtungen, die Kinder und Jugendliche versorgen, gezielt mit der Prävention von und Intervention bei (sexueller) Gewalt und Missbrauch bei Kindern und Jugendlichen zu befassen (Risiko- und Gefährdungsanalyse) und – der Größe und Organisationsform der Einrichtung entsprechend – konkrete Schritte und Maßnahmen abzuleiten (Schutzkonzept). In diesem Abschnitt geben Krankenhäuser, die Kinder und Jugendliche versorgen, an, ob sie gemäß § 4 Absatz 2 in Verbindung mit Teil B Abschnitt I § 1 der Qualitätsmanagement-Richtlinie ein Schutzkonzept gegen (sexuelle) Gewalt bei Kindern und Jugendlichen aufweisen.
  • Name of the working group: Arbeitsgruppe AMTS

Hausweites Dokumentenlenkungsprogramm

05.10.2023

  • Bereitstellung einer geeigneten Infrastruktur zur Sicherstellung einer fehlerfreien Zubereitung
  • Zubereitung durch pharmazeutisches Personal
  • Anwendung von gebrauchsfertigen Arzneimitteln bzw. Zubereitungen
  • Vorhandensein von elektronischen Systemen zur Entscheidungsunterstützung (z.B. Meona®, Rpdoc®, AIDKlinik®, ID Medics® bzw. ID Diacos® Pharma)
  • 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)
  • 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
The instruments and measures to promote drug therapy safety are presented with a focus on the typical procedures of the medication process in inpatient patient care. A special feature of the medication process in the inpatient environment is the transition management during admission and discharge. The instruments and measures listed below address structural elements, e.g. special IT equipment and work materials, as well as process aspects, such as work descriptions for particularly risky process steps or concepts for securing typical risk situations . In addition, proven measures to avoid or learn from medication errors can be specified. The hospital presents here which aspects it has already dealt with and which measures it has specifically implemented. The following aspects can be presented, if necessary using free text fields:
- Admission to hospital, including anamnesis
; Instruments and measures are presented for determining the old medication (drug history), the subsequent clinical assessment and the switch to the medication available in the hospital (house list), as well as for documenting both the patient's original medication and that for hospital treatment adapted medication.
- Medication process in the hospital
In this context, the following sub-processes are assumed as examples: drug history - prescription - patient information - drug delivery - drug use - documentation - therapy monitoring - result assessment. Instruments and measures for safe medication prescription can be presented, e.g. B. in terms of readability, clarity and completeness of the documentation, but also in terms of area of ​​application, effectiveness, benefit-risk ratio, tolerability (including potential contraindications, interactions, etc.) and resource considerations. Information can also be provided to support reliable medication ordering, delivery and use or administration.
- Discharge
In particular, the measures taken by hospitals can be presented to ensure that information on drug therapy is structured and passed on to doctors and physicians providing further treatment, as well as the appropriate provision of patients with drug information, medication plans and medications. Drug prescriptions are made.
AMTS is the totality of measures to ensure an optimal medication process with the aim of reducing medication errors and thus avoidable risks for patients during drug therapy. A prerequisite for the successful implementation of these measures is that AMTS is practised as an integral part of daily routine in an interdisciplinary and multi-professional approach.
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Training in other healing professions
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Berufsständische Ausbildung ist ab dem 4. Quartal 2021 ersetzt duch das Studium der Hebammenwissenschaften, angesiedelt bei der medizinischen Fakultät der Geothe-Universität-Frankfurt. In 2022 absolvierten 19 Beschäftigte des Uniklinikums den Studiengang.

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Christa Hottenrott

Patientenfürsprecherin

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-5457
Mail: ed.ugk@rehcerpsreufnetneitap

Rita Handwerk-Sieker

Patientenfürsprecherin

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-5457
Mail: ed.ugk@rehcerpsreufnetneitap

Ingrid Iwanowsky

Patientenfürsprecherin

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-5457
Mail: ed.ugk@rehcerpsreufnetneitap

Dipl.-Betriebsw. (FH) Thomas Schramke

Stabsstelle Patientensicherheit und Qualität, Beschwerdemanagement

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-7145
Mail: ed.ugk@tnemeganamedrewhcseb-bew

Leon Kesy

Stabsstelle Patientensicherheit u. Qualität, Beschwerdemanagement

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-80087
Mail: ed.ugk@tnemeganamedrewhcseb-bew

Dr. med. Kyra Schneider

Leitung Stabsstelle Patientensicherheit & Qualität, Patientensicherheitsbeauftragte

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-83095
Mail: ed.ugk@redienhcS.aryK

Prof. Dr. med. Jürgen Graf

Vorstandsvorsitzender und Ärztlicher Direktor

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-80100
Mail: ed.ugk@FKU-VV

Prof. Dr. med. Sebastian Harder

Klinischer Pharmakologe

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-6423
Mail: ed.ugk@redraH.naitsabeS

Irene Kolic

Vertrauensperson der Schwerbehinderten und Gleichgestellten

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-81550
Mail: ed.ugk@ciloK.enerI

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069-6301-0
Fax: 069-6301-7474
Mail: ed.mffku@QISAP

Birgit Roelfsema

Vorstandsmitglied und Pflegedirektorin

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-89500
Mail: ed.ugk@fku-dp

Markus Jones

Vorstandsmitglied und Kaufmännischer Direktor

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-6800
Mail: ed.ugk@fku-dk

Prof. Dr. med. Jürgen Graf

Ärztlicher Direktor und Vorstandsvorsitzender

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-80100
Mail: ed.ugk@FKU-VV

Prof. Dr. med. Jürgen Graf

Ärztlicher Direktor und Vorstandsvorsitzender

Theodor-Stern-Kai 7
60590 Frankfurt am Main

Phone: 069 -6301-80100
Mail: ed.ugk@FKU-VV

IK: 260612124

Location number: 772858000

Old location number: 772858000