Risk Management / CQI

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Risk Management / CQI Nutr 564: Management Summer 2005

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Risk Management / CQI. Nutr 564: Management Summer 2005. Risk Management / CQI. Risk Management / CQI. Objectives: Review issues on patient safety Identify components of quality assurance processes Describe a ‘culture of safety’ Characterize ‘risk’ situations in health care. - PowerPoint PPT Presentation

Transcript of Risk Management / CQI

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Risk Management / CQI

Nutr 564: Management

Summer 2005

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Risk Management / CQI

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Risk Management / CQI

Objectives:Objectives: Review issues on patient safety Identify components of quality assurance processes Describe a ‘culture of safety’ Characterize ‘risk’ situations in health care

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TO ERR IS HUMAN:BUILDING A SAFER HEALTH SYSTEMHealth care in the United States is not as safe as it should be--and canbe At least 44,000 people, and perhaps as many as 98,000 people, diein hospitals each year as a result of medical errors that could havebeen prevented, according to estimates from two major studies

I N S T I T U T E O F M E D I C I N EShaping the Future for HealthNovember 1999

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Patient Safety

2005 proposed budget for patient safety is $84 million.

The Centers for Medicare & Medicaid Services (CMS) has made it clear that patient safety is indistinguishable from quality of care.

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Risk Management / CQI

What are Medical Errors?Medical errors happen when something that was planned as a part of medical care doesn't work out, or when the wrong plan was used in the first place

Where do they happen:

Medical errors can occur anywhere in the health care system:

Hospitals Clinics

Outpatient Surgery Centers Doctors' Offices

Nursing Homes Pharmacies

Patients' Homeshttp://www ahrq gov/consumer/20tips htm

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Concept Discussion

What is an SOC? Review the table on P. 5 of the “Docs Need

SOCs”. Can you add any additional activities where a health center’s quality counts?

What type of teams might best support the quality improvement process outlined in this document?

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Quality AssuranceQuality Assurance

is a dynamic, systematic process that assures the delivery of high-quality care to clients

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QA ProcessQA ProcessIdentify or define the problem Establish a method to evaluate the problem Set a timeline for data collection Collect the data Analyze the results Discuss the findings and make conclusions Suggest alternatives to rectify the problem Try a solution – evaluate Develop a system to monitor the success Implement a system to reevaluate the plan with set time criteria

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Clinical IndicatorsClinical Indicators:Measurement tool used to monitor and evaluate quality• Process indictor• Outcome indicator• Rate-based indicator

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Process Indicator - measures an activityProcess Indicator - measures an activityEasy to MeasureMay not directly impact safety

Process Indicators - ExamplesProcess Indicators - ExamplesVolume Indicators / Service TrendsScreening Patient Satisfaction

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Outcome IndicatorOutcome IndicatorMeasures what happens after an Measures what happens after an

activityactivity

Outcome IndicatorOutcome IndicatorExamples: Weight lossExamples: Weight loss InfectionInfection

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Rate-based indicator:Rate-based indicator:Assesses an event for which a Assesses an event for which a certain proportion of the events that certain proportion of the events that occur are expected occur are expected

Rate-based indicator:Rate-based indicator: Example: Proportion of patients NPO Example: Proportion of patients NPO

24 hours after surgery24 hours after surgery

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Prevention Quality Indicators:

The PQIs are a set of measures that can be used with hospital inpatient discharge data to identify "ambulatory care sensitive conditions" (ACSCs).

ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease.

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Prevention Quality Indicators:

Diabetes short-term complication AR Diabetes short-term complication AR Perforated appendix ARPerforated appendix ARDiabetes long-term complication ARDiabetes long-term complication AR Pediatric asthma ARPediatric asthma ARChronic obstructive pulmonary disease Chronic obstructive pulmonary disease Pediatric gastroenteritisPediatric gastroenteritisLow birth weight rateLow birth weight rate Hypertension ARHypertension ARCongestive heart failure ARCongestive heart failure AR Dehydration ARDehydration ARBacterial pneumonia ARBacterial pneumonia AR Urinary tract infection ARUrinary tract infection ARAngina admission without procedureAngina admission without procedure Uncontrolled diabetes AR Uncontrolled diabetes AR Adult asthma ARAdult asthma ARRate of lower-extremity amputation among patients with diabetesRate of lower-extremity amputation among patients with diabetes

AR = admission rateAR = admission rate

Prevention Quality Indicators: developed by Stanford University under a contract with the (AHRQ)

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In-Patient Quality Indicators

Complications of AnesthesiaComplications of Anesthesia Death in Low-Mortality DRGsDeath in Low-Mortality DRGsDecubitus UlcerDecubitus Ulcer Failure to RescueFailure to RescueForeign Body Left During ProcedureForeign Body Left During Procedure Iatrogenic PneumothoraxIatrogenic PneumothoraxSelected Infections due to Medical CareSelected Infections due to Medical Care Postoperative Hip FracturePostoperative Hip FracturePostoperative Respiratory FailurePostoperative Respiratory Failure Birth Trauma – Injury to NeonateBirth Trauma – Injury to NeonatePostoperative SepsisPostoperative Sepsis Postoperative Wound DehiscencePostoperative Wound DehiscenceAccidental Puncture or LacerationAccidental Puncture or Laceration Transfusion ReactionTransfusion ReactionPostoperative Physiologic and Metabolic DerangementsPostoperative Physiologic and Metabolic DerangementsPostoperative Pulmonary Embolism or Deep Vein ThrombosisPostoperative Pulmonary Embolism or Deep Vein ThrombosisPostoperative Hemorrhage or HematomaPostoperative Hemorrhage or HematomaObstetric Trauma with or without 3Obstetric Trauma with or without 3rdrd Degree Lacerations– Degree Lacerations– Vaginal withVaginal with

Instrument; Vaginal without Instrument;Instrument; Vaginal without Instrument; Cesarean Delivery Cesarean Delivery

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Elements of successful CQI projectsElements of successful CQI projects

Team effort in design

Employee involvement at all levels

Quality is part of job description

Safety in participation

Continuous effort

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Culture of Safety

IdealIdeal People would report errorPeople would report error System would assess errorSystem would assess error Take corrective actionTake corrective action Monitor for additional sources of error Monitor for additional sources of error

without fear of punishmentwithout fear of punishment

Liang BA, MD, PhD, JD

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Concept Discussion:

Review the questionnaire “Hospital Survey on Patient Safety Culture”. What is your reaction to this questionnaire?

How do you envision using such a questionnaire in a facility?

Does the document ‘Docs Need SOCs” convey a culture of safety?

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Culture of Safety

A safety culture can be defined as: a set of values, beliefs, and norms about

– what's important, – how to behave, and – what attitudes are appropriate when it comes to patient safety in a

workgroup. The safety culture is the product of

– individual and group values, – attitudes, – perceptions, – competencies, and– patterns of behavior that determine the commitment to, and the

style and proficiency of, an organization's health and safety management.

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Culture of Safety

A safety culture A positive safety culture is characterized by

– communications founded on mutual trust,– by shared perceptions of the importance of safety, and – by confidence in the efficacy of preventive measures.

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Culture of Safety

The ten dimensions of patient safety cultureThe ten dimensions of patient safety culture

1. Supervisor/manager expectations and actions promoting patient safety

2. Organizational learning—Continuous improvement3. Teamwork within units4. Communication openness5. Feedback and communication about error6. Nonpunitive response to error (no shame and blame)7. Staffing8. Hospital management support for patient safety9. Teamwork across hospital units10. Hospital handoffs and transitions

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Culture of Safety

Dr. David Hunt (CMS)

1. Intent: An organization must intentionally look for adverse events and the systems that may need attention. The intention is for improvement of systems, not malpractice avoidance.

2. Relevance: “What” is being looked at is important. There are several relevant topics from which to choose.

3. Transparency: If the problem is hidden under shame and blame, it will not be transparent; only by bringing it out in the sunlight can problems be addressed.

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Concept Discussion:

Does the document ‘Docs Need SOCs” convey a culture of safety?

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Risk ManagementRisk Management

Clinical and administrative activities Clinical and administrative activities undertaken to identify, evaluate, and reduce the risk undertaken to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors and the risk of of injury to patients, staff, and visitors and the risk of loss to the organization itselfloss to the organization itself

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Risk Management / CQI

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Concept Discussion:

Seattle Times article Picture this same scenario 20 years ago.

Describe what you envision would be a traditional management approach to such an event? Do you agree with the approach described in this article?

What factors might influence a family’s decision to take legal action?

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Concept Discussion:

Other safety issues in a health care facility.

What are high risk areas in food service?

How can a culture of a safety be applied to staff training

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Clinical Nutrition and Food Service Systems

High risk areas*

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*

*

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Clinical Nutrition and Food Service Systems

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Clinical Nutrition and Food Service Systems

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Clinical Nutrition and Food Service SystemsHigh risk areas

* Equipment - knives / blades* Wet floors

* Cleaning solutions

* High turnover in personnel