11h - frank r. painter
TRANSCRIPT
CU
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Risk Management in HealthcareRisk Management in Healthcare
Frank R. Painter, MS, CCEFrank R. Painter, MS, CCEClinical Engineering Internship Clinical Engineering Internship Program DirectorProgram DirectorUniversity of ConnecticutUniversity of ConnecticutHealthcare Technology ConsultantHealthcare Technology Consultant
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ACCEACCE
American College of Clinical American College of Clinical EngineeringEngineeringProfessional society of Clinical Professional society of Clinical EngineersEngineers
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Risk Versus SafetyRisk Versus Safety
Safety & Risk; opposite sides of the Safety & Risk; opposite sides of the same coinsame coin
If risk goes up, safety goes downIf risk goes up, safety goes down
If risk goes down, safety goes upIf risk goes down, safety goes up
Everyone likes safety; no one likes Everyone likes safety; no one likes riskrisk
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Risk Versus SafetyRisk Versus Safety
Risk management identifies risks, Risk management identifies risks, analyzes risk data and mitigates riskanalyzes risk data and mitigates riskSafety programs manage that risk Safety programs manage that risk through education, maintenance, through education, maintenance, design, and personal protective design, and personal protective equipmentequipment
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Understanding SafetyUnderstanding Safety
Safety = The level of risk you are Safety = The level of risk you are willing to acceptwilling to accept
SafetySafety is freedom from danger, is freedom from danger, risk or injuryrisk or injury
Safety is subjectiveSafety is subjective
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Understanding RiskUnderstanding Risk
RiskRisk is the possibility of suffering is the possibility of suffering harm or lossharm or loss
Probability of an eventProbability of an event
Severity of an eventSeverity of an event
Risk = Probability x SeverityRisk = Probability x Severity
Risk is measured in numbersRisk is measured in numbers
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Risk AcceptanceRisk Acceptance
Acceptableconsideringthe benefit
Probability
Severity
Generallyunacceptable
Generallyacceptable
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Managing RiskManaging Risk
Reduce the probabilityReduce the probability
Reduce the severityReduce the severity
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Healthcare RisksHealthcare Risks
Medication ErrorsMedication ErrorsWrong Site SurgeryWrong Site SurgeryHospital Acquired InfectionsHospital Acquired InfectionsManaging Multiple AlarmsManaging Multiple AlarmsPatient RestraintsPatient RestraintsElectromagnetic InterferenceElectromagnetic InterferencePatient FallsPatient FallsSurgical & ICU FiresSurgical & ICU FiresElectrosurgical BurnsElectrosurgical Burns
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Managing RiskManaging Risk
CONTROLtake actions toavoid/minimize
risks
EVALUATEcompute risk exposures anddetermine which risks posethe greatest threat, and how
they might be averted
ANALYZEestimate the likelihood
and loss of eachoutcome, under all
alternative choices ordecisions
PLAN ACTIONavoid/minimize risks
MONITORmonitor risk preventionactivities and modify as
needed
ASSESSRISK
identify, name andcategorize risks
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Unusual Conditions in Unusual Conditions in Hospitals Increase RiskHospitals Increase Risk–– Functions 24 x 7Functions 24 x 7–– Multiple functions; patient care, cafeteria, clinical Multiple functions; patient care, cafeteria, clinical
lab, laundry, etclab, laundry, etc–– Hospital equipment varied and complex Hospital equipment varied and complex –– Hazards affect healthy staff as well as severely ill Hazards affect healthy staff as well as severely ill
& immobile patients& immobile patients–– ““HazardsHazards”” mean fires, infections, security issues, mean fires, infections, security issues,
chemicals and the likechemicals and the like–– Hazards vary with equipment and applicationsHazards vary with equipment and applications–– Hazards constantly changingHazards constantly changing
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Integrated Safety Integrated Safety Program Program (Tobey Clark)(Tobey Clark)
Environmental Safety
Employee Safety
Risk Management
Patient Safety
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Hospital Risk Management Hospital Risk Management ProgramsPrograms
One component of an overall quality One component of an overall quality control programcontrol programHistorically, treated as separate processHistorically, treated as separate processRecently integrated into quality Recently integrated into quality assurance and patient safety activitiesassurance and patient safety activitiesRisk managers, safety officers, quality Risk managers, safety officers, quality assurance, & patient safetyassurance, & patient safetyAll integrated at some levelAll integrated at some level
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Hospital Risk ManagementHospital Risk Management(continued)(continued)
Risk is an exposure to the chance of Risk is an exposure to the chance of injury or financial lossinjury or financial lossRisk Managers reduce liability & costs Risk Managers reduce liability & costs by managing risksby managing risksAccident data analysisAccident data analysisConstant systems improvements to Constant systems improvements to reduce riskreduce risk
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Risk ManagementRisk Management
Insurance policiesInsurance policies–– MalpracticeMalpractice–– LiabilityLiability–– Errors & OmissionsErrors & Omissions
Claims managementClaims managementRisk reduction strategiesRisk reduction strategiesIncident investigationIncident investigation
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Risk Management ToolsRisk Management Tools
Administrative supportAdministrative supportHazard identificationHazard identificationHazard evaluationHazard evaluationTrainingTrainingControlsControlsCommunicationsCommunicationsRecord keeping Record keeping Program review & improvementProgram review & improvementTotal involvementTotal involvement
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JCAHOJCAHO
Environment of Care StandardsEnvironment of Care Standards–– Safety ManagementSafety Management–– Security ManagementSecurity Management–– Hazardous Materials & Waste ManagementHazardous Materials & Waste Management–– Emergency ManagementEmergency Management–– Life Safety (Fire Safety) ManagementLife Safety (Fire Safety) Management–– Medical Equipment ManagementMedical Equipment Management–– Utility Systems ManagementUtility Systems Management–– Safety Committee & Safety OfficerSafety Committee & Safety Officer
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JCAHOJCAHO
Patient Safety StandardsPatient Safety Standards
–– Annual FMEA (Failure Mode Annual FMEA (Failure Mode and Effect Analysis)and Effect Analysis)
–– Sentinel Events Sentinel Events –– RCA (RootRCA (RootCause Analysis)Cause Analysis)
–– National Patient Safety GoalsNational Patient Safety Goals
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Clinical Engineers as Risk Clinical Engineers as Risk ManagersManagers
By definition, clinical engineers By definition, clinical engineers ““apply apply engineering and managerial skills to engineering and managerial skills to the advancement of health care.the advancement of health care.””
Engineering educationEngineering education–– Scientific method (cause and effect)Scientific method (cause and effect)–– Analysis of systems and processes Analysis of systems and processes
(identify root causes)(identify root causes)
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Clinical Engineers as Risk Clinical Engineers as Risk ManagersManagers
Knowledge:Knowledge:–– How technology worksHow technology works–– How hospitals workHow hospitals work–– How the human body worksHow the human body works–– How the human mind worksHow the human mind works–– How to investigate an accidentHow to investigate an accident–– How to work with peopleHow to work with people–– How to write technical reportsHow to write technical reports
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Engineering & Risk Engineering & Risk ReductionReduction
Contributions to risk reduction and Contributions to risk reduction and patient safety:patient safety:–– Medical equipment planningMedical equipment planning
–– Medical equipment inspectionMedical equipment inspection
–– Medical equipment maintenanceMedical equipment maintenance
–– Training medical equipment usersTraining medical equipment users
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Engineering & Risk Engineering & Risk ReductionReduction
Management of recalls & hazard alertsManagement of recalls & hazard alerts
Analysis of maintenance recordsAnalysis of maintenance records
Review of Review of ““near missnear miss”” eventsevents
Incident investigationIncident investigation
User TrainingUser Training
Quality ImprovementQuality Improvement
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Systems Approach to Systems Approach to Reducing Medical Device RiskReducing Medical Device Risk
Assure safety of systems & processesAssure safety of systems & processesModify systems & processes as Modify systems & processes as recommended by the teamrecommended by the teamInvestigate failuresInvestigate failures–– Identify root causesIdentify root causes–– Modify the Modify the systemssystems to prevent future to prevent future
failures failures –– Benefit from past failuresBenefit from past failures
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ManufacturersManufacturers
Know their devicesKnow their devicesUse FMEA in designUse FMEA in designUse human factors Use human factors engineering and usability engineering and usability testing in designtesting in designKeep a complaint fileKeep a complaint fileListen to feedback and Listen to feedback and improve the design improve the design
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Healthcare WorkersHealthcare Workers
Device trainingDevice training–– How it worksHow it works–– What can go wrongWhat can go wrong–– What happens when it goes wrongWhat happens when it goes wrong
Report problems without fear of Report problems without fear of punishment or ridicule.punishment or ridicule.Competency assessmentCompetency assessment
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Patients and FamilyPatients and Family
Device TrainingDevice Training
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Clinical EngineersClinical Engineers
Device TrainingDevice TrainingService and inspectionService and inspectionInvestigate problemsInvestigate problemsProvide feedback to healthcare Provide feedback to healthcare workersworkersAdvise administrationAdvise administration
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AdministrationAdministration
Know devices in generalKnow devices in general–– Costs, risks, supplies, maintenanceCosts, risks, supplies, maintenance……Support training and improvementSupport training and improvementSupport nonSupport non--punitive problem punitive problem reportingreportingProvide record keepingProvide record keepingShare informationShare informationHave a planHave a plan
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GovernmentGovernment
Regulate medical device qualityRegulate medical device qualityCreate systems to share informationCreate systems to share informationFacilitate open communicationsFacilitate open communicationsPublicize trendsPublicize trendsEncourage quality healthcare systemsEncourage quality healthcare systemsAcknowledge good performanceAcknowledge good performance
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Risk Management Risk Management SummarySummary
Safety must begin at the topSafety must begin at the top------Ministry Ministry of Health, Local Health Authoritiesof Health, Local Health Authorities , , and hospital administratorsand hospital administrators------but must but must be implemented by motivated staff be implemented by motivated staff membersmembers
Risk management must be fully Risk management must be fully integrated into our health care culture, integrated into our health care culture, systems and processessystems and processes
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Risk Management Risk Management Summary Summary (continued)(continued)
Investigation of accidents, incidents and Investigation of accidents, incidents and ““near hitsnear hits”” can provide information that will can provide information that will allow improvements in systems and allow improvements in systems and processesprocesses
Clinical Engineers are valuable team Clinical Engineers are valuable team members members –– Educated, trained and experienced in accident Educated, trained and experienced in accident
investigation, they can provide the identification investigation, they can provide the identification of the root causes of failed systemsof the root causes of failed systems