Dealing with risks in patient care

Quality management

Michael Müller

Leiter GB Unternehmensentwicklung

Nikolai-Rumjanzew-Str 100
04129 Leipzig

Phone: 0341 -909-3100
Mail: ed.groegtknas@relleum.leahcim

Abteilung Qualitätsmanagement

Conference frequency: wöchentlich

Risk management

Michael Müller

Leiter GB Unternehmensentwicklung

Phone: 0341 -909-3100
Fax: 0341-909-1474
Mail: ed.groegtknas@relleum.leahcim

Qualitätsmanagement, Ärztlicher Deinst, Pflegedienst, Krankenhaushygiene

Conference frequency: monatlich

Risk management instruments and measures

No. Explanation
RM01

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

Qualitätsmanagementhandbücher, z.B. Lungenkrebszentrum (11.08.2019)

RM02

Regular further education and training measures

RM04

Clinical emergency management

VA Notfallmanagement (08.01.2014)

RM05

Pain management

Qualitätsmanagementhandbücher, z.B. Lungenkrebszentrum (11.08.2019)

RM06

Fall prophylaxis

Pflegestandard Sturzprophylaxe (18.09.2017)

RM07

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

Pflegestandard: Dekubitusprophylaxe (15.04.2014)

RM08

Regulated handling of custodial measures

Medizinische Richtlinie: Anwendung freiheitsentziehender Maßnahmen (09.01.2020)

RM09

Regulated handling of occurring malfunctions of devices

VA Patientensicherheit im OP (06.01.2018)

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

VA Patientensicherheit im OP (06.01.2018)

RM15

Preoperative, complete presentation of necessary findings

VA Patientensicherheit im OP (06.01.2018)

RM16

Procedure to avoid procedural and patient mix-ups

VA Markierung des Operationsfeldes-Vermeidung von Eingriffsverwechslungen (08.01.2014)

RM17

Standards for recovery and postoperative care

VA Patientensicherheit im OP (06.01.2018)

Fault reporting systems

Conference committee

Conference frequency: monatlich

Measures

Verfahrensanweisungen für das Klinikum: Notfallmanagement, Patientenidentifikation, Vermeidung Eingriffsverwechslungen, Patientensicherheit im OP, Einführung einer OP- Checkliste (WHO), externe Überprüfung durch Gesellschaft für Risikoberatung und BBVL GmbH

No. Explanation
IF01

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

As of: 10.01.2015

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: halbjährlich

No. Explanation
EF13

DokuPIK (Documentation of Pharmaceutical Interventions in Hospitals at the Federal Association of German Hospital Pharmacists (ADKA)