Risk Management / CQI Nutr 564: Management Summer 2002.
-
Upload
keila-brownlow -
Category
Documents
-
view
217 -
download
1
Transcript of Risk Management / CQI Nutr 564: Management Summer 2002.
Risk Management / CQIRisk Management / CQI
Nutr 564: Management
Summer 2002
Risk Management / CQIRisk Management / CQI
Risk Management / CQIRisk Management / CQI
Objectives:Objectives: Acquaint students with CQI terminology Review issues on patient safety Identify components of quality assurance processes Characterize ‘risk’ situations in health care
Risk Management / CQIRisk Management / CQI
TerminologyTerminology
CQI = Continuous Quality Improvement
QA = Quality Assurance
Risk Management / CQIRisk Management / CQI
Objectives:Objectives: Acquaint students with CQI terminology Review issues on patient safety Identify components of quality assurance processes Characterize ‘risk’ situations in health care
Risk Management / CQIRisk Management / CQIWhat 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. Medical errors can occur anywhere in the health care system:
Hospitals. Clinics.
Outpatient Surgery Centers. Doctors' Offices.
Nursing Homes. Pharmacies.
Patients' Homes. http://www.ahrq.gov/consumer/20tips.htm
Risk Management / CQIRisk Management / CQI
Errors can involve: Medicines.
Surgery.
Diagnosis.
Equipment.
Lab reports.
http://www.ahrq.gov/consumer/20tips.htm
Risk Management / CQIRisk Management / CQI
“Strategies for Leadership: An Organizational Approach to Patient Safety”
American Hospital Association
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
Risk Management / CQIRisk Management / CQI
Objectives:Objectives: Acquaint students with CQI terminology Review issues on patient safety Identify components of quality assurance processes Characterize ‘risk’ situations in health care
Risk Management / CQIRisk Management / CQI
Quality AssuranceQuality Assurance
is a dynamic, systematic process that assures the delivery of high-quality care to clients
Risk Management / CQIRisk Management / CQI
Clinical IndicatorsClinical Indicators:
Measurement tool used to monitor and evaluate the quality of important • Process indictor
• Outcome indicator
• Rate-based indicator
Risk Management / CQIRisk Management / CQI
Clinical Indicators:
Measurement tool used to monitor and evaluate the quality of important • Process indictor
• Outcome indicator
• Rate-based indicator
Risk Management / CQIRisk Management / CQI
Process Indicator - measures an activityProcess Indicator - measures an activity
Easy to Measure
May not directly impact safety
Risk Management / CQIRisk Management / CQI
Process Indicators - ExamplesProcess Indicators - ExamplesVolume Indicators / Service Trends
Screening
Patient Satisfaction
Risk Management / CQIRisk Management / CQI
Clinical Indicators:
Measurement tool used to monitor and evaluate the quality of important • Process indictor
• Outcome indicator
• Rate-based indicator
Risk Management / CQIRisk Management / CQI
Outcome IndicatorOutcome Indicator
Measures what happens after an activityMeasures what happens after an activity
Risk Management / CQIRisk Management / CQI
Outcome IndicatorOutcome Indicator
Examples: Weight lossExamples: Weight loss
InfectionInfection
Risk Management / CQIRisk Management / CQI
Clinical Indicators:
Measurement tool used to monitor and evaluate the quality of important • Process indictor
• Outcome indicator
• Rate-based indicator
Prevention Quality Indicators:Prevention Quality Indicators:
Bacterial pneumonia. Bacterial pneumonia. Dehydration. Dehydration.
Pediatric gastroenteritis. Pediatric gastroenteritis. Urinary infections. Urinary infections.
Perforated appendicitis. Perforated appendicitis. Low birth weight. Low birth weight.
Angina without an inhospital procedure. Angina without an inhospital procedure. Congestive heart failure. Congestive heart failure.
Hypertension. Hypertension. Adult asthma. Adult asthma.
Pediatric asthma. Pediatric asthma. Chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease.
Uncontrolled diabetes.Uncontrolled diabetes. DM, short-term complications. DM, short-term complications.
Diabetes, long-term complications. Diabetes, long-term complications. Lower extremity amputations among Lower extremity amputations among patients with diabetes.patients with diabetes.
Prevention Quality Indicators: developed by Stanford University under a contract with the (AHRQ).
Risk Management / CQIRisk Management / CQI
Rate-based indicator:Rate-based indicator:Assesses an event for which a certain Assesses an event for which a certain proportion of the events that occur are proportion of the events that occur are expected.expected.
Risk Management / CQIRisk Management / CQI
Rate-based indicator:Rate-based indicator:
Examples:Examples:Proportion of patients NPO 24 hours after Proportion of patients NPO 24 hours after surgerysurgery
Risk Management / CQIRisk Management / CQI
QA ProcessQA Process
Identify or define the problem
Establish a method to evaluate the problem
Set a timeline for data collection
Collect the data
Risk Management / CQIRisk Management / CQI
QA Process (Cont.)QA Process (Cont.)
Analyze the results
Discuss the findings and make conclusions
Suggest alternatives to rectify the problem
Try a solution - evaluate
Risk Management / CQIRisk Management / CQI
QA Process (Cont.)QA Process (Cont.)
Develop a system to monitor the success of the proposed solution
Implement a system to reevaluate the plan with set time criteria
Risk Management / CQIRisk Management / CQI
Risk Management / CQIRisk Management / CQI
Health Care QAHealth Care QA
System wide indicatorsSystem wide indicators
Department indicatorsDepartment indicators
Interdisciplinary indicatorsInterdisciplinary indicators
Risk Management / CQIRisk Management / CQI
Health Care QA
Quarterly projects standard
Risk Management / CQIRisk Management / CQI
JCAHO StandardsJCAHO Standards
Early response to medical error
Root- cause analysis
Sentinel event database
Continuous review
Risk Management / CQIRisk Management / CQI
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
Risk Management / CQIRisk Management / CQI
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
Risk Management / CQIRisk Management / CQI
Objectives:Objectives: Acquaint students with CQI terminology Review issues on patient safety Identify components of quality assurance processes Characterize ‘risk’ situations in health care
Risk Management / CQIRisk Management / CQI
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 injury to patients, staff, and visitors and the risk
of loss to the organization itselfof loss to the organization itself
Risk Management / CQIRisk Management / CQI
Risk Management / CQIRisk Management / CQI
Procedures
Equipment
Facilities
Risk Management / CQIRisk Management / CQI
Clinical Nutrition and Food Service Systems
High risk areas*
*
*
*
Risk Management / CQIRisk Management / CQI
Clinical Nutrition and Food Service Systems
Risk Management / CQIRisk Management / CQI
Clinical Nutrition and Food Service Systems
Risk Management / CQIRisk Management / CQI
Clinical Nutrition and Food Service Systems
High risk areas* Equipment - knives / blades
* Wet floors
* Cleaning solutions
* High turnover in personnel
Risk Management / CQIRisk Management / CQI
Risk Management:
Risk Management / CQIRisk Management / CQI
The Perception of Risk
Not always about money
Encourage discourse between legal and medical professions
Risk Management / CQIRisk Management / CQI
Bursztajn HJ and Brodsky A
“A New Resource for Managing Malpractice Risks in Managed Care” Arch Intern Med
156:2057-63, 1996.
Risk Management / CQIRisk Management / CQI
Seven Basic Quality Control ToolsSeven Basic Quality Control Tools• Process Flow ChartsProcess Flow Charts
• ChecksheetsChecksheets
• Run ChartsRun Charts
• Scatter DiagramsScatter Diagrams
• Cause-and-Effect DiagramsCause-and-Effect Diagrams
• Histograms and Bar ChartsHistograms and Bar Charts
• Pareto ChartsPareto Charts© The McGraw-Hill Companies, Inc., 1999