Dealing with risks in patient care
Quality management
Jens Wagenknecht
Qualitätsmanagementbeauftragter/ Qualitätsmanagement & Organisationsentwicklung, Risikomanagement, Zertifizierung und Zentrenbildung, Zufriedenheitserhebungen
Dr.-Ottmar-Kohler-Straße 2
55743 Idar-Oberstein
Phone:
06781
-66-1963
Mail:
ed.nekinilk-ghs.oi@tnemeganamsteatilauq
Direktorium, Betriebsrat, Qualitätsmanagement
Conference frequency: quartalsweise
Risk management
Jens Wagenknecht
Qualitätsmanagementbeauftragter/ Qualitätsmanagement & Organisationsentwicklung, Risikomanagement, Zertifizierung und Zentrenbildung, Zufriedenheitserhebungen
Phone:
06781
-66-1963
Fax: 06781-66-1789
Mail:
ed.nekinilk-ghs.oi@tnemeganamsteatilauq
Direktorium, Betriebsrat, Qualitätsmanagement
Conference frequency: quartalsweise
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available Qualitätsmanagement Handbuch (Nexus Curator) (15.11.2023) |
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management Qualitätsmanagement Handbuch (Nexus Curator) (15.11.2023) |
| RM05 |
Pain management Qualitätsmanagement Handbuch (Nexus Curator) (15.11.2023) |
| RM06 |
Fall prophylaxis Pflegestandard 9.9 Sturzprophylaxe (01.12.2016) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) Pflegestandard 1.2 Dekubitusprophylaxe (09.02.2022) |
| RM08 |
Regulated handling of custodial measures Standard Ärztlicher Dienst (Psychiatrie) (25.07.2023) |
| RM09 |
Regulated handling of occurring malfunctions of devices Organisationshandbuch Medizintechnik (25.04.2018) |
| RM10 |
Structured implementation of interdisciplinary case discussions/conferences Case review conference
|
| 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 KIS-Formular zur OP-Anmeldung (01.07.2017) |
| RM15 |
Preoperative, complete presentation of necessary findings Dienstanweisung zur Dokumentation (30.03.2021) |
| RM16 |
Procedure to avoid procedural and patient mix-ups Verfahrensanweisung mit OP-Checkliste (11.06.2017) |
| RM17 |
Standards for recovery and postoperative care SOP Überwachung AWE (18.09.2023) |
| RM18 |
Discharge management 9.12 Pflegestandard auf Basis des Nationalen Expertenstandards Entlassmanagement (01.05.2018) |
Fault reporting systems
Conference committee
Conference frequency: monatlich
Measures
Sukzessiver Ausbau der elektronischen Patientenakte. Risikoaudits und -screenings mit externen Experten. Einrichtung einer neuen CIRS-Software und Ausbau der softwaregestützen Risikomanagments.
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 01.08.2022 |
| IF02 |
Internal evaluation of the received reports taken jährlich |
| 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: monatlich
| 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) |