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Oct 23, 2022 •410 likes •494 views

Effective Risk Management Dr Rohini Sridhar MD FRCPA Dr. Rohini Sridhar, MD, FRCPA Chief Operating Officer, Apollo Speciality Hospital, Madurai Risk Management programme Identification of risk Strategies to avoid risk Strategies

  1. Effective Risk Management Dr Rohini Sridhar MD FRCPA Dr. Rohini Sridhar, MD, FRCPA Chief Operating Officer, Apollo Speciality Hospital, Madurai Risk Management programme � Identification of risk � Strategies to avoid risk � Strategies to limit the impact of adverse events 1

  2. Risk in hospitals Legal Risk � Clinical risk � Risk arising out of failure to comply with existing laws and regulations � Financial and business risk � PNDT, Human Organ Transplantation Act � Legal risk � Environmental risk � Legal liability under the Consumer Protection Act � Legal liability under the Consumer Protection Act � Operational Risk Environmental risk Operational Risk � Flood, Earthquakes and other natural disasters � Patient complaints –esp. unresolved � Security risk � Equipment failure � Fire and Electrical Safety events � Employee related risks � Risks employees may encounter in their jobs � Hazardous Material Spillage � Ri k � Risks employees bring to the workplace l b i t th k l � Radiation Hazard � Risks arising from inadequate nos/ skill sets Clinical Risk Management � Clinical Risk Management (CRM) is an approach to improving the quality and safe delivery of health care by: � Placing special emphasis on identifying circumstances that put patients at risk of harm, and � Acting to prevent or control those risks. � Acting to prevent or control those risks 2

  3. Near Miss Event Sentinel Event � It is a potential for harm or error which is intercepted prior to the completion of the incident/ event resulting in no harm An unexpected incident, related to system or process to the patient deficiencies, which leads to death or major and enduring loss � Most common type of error occuring in hospitals of function for a recipient of healthcare services � Provides valuable learning experience � Provides valuable learning experience Sentinel Event Sentinel Event � Sensory, motor or psychological impairment � Surgical Events � Not present at the time the service was sought or begun � Device or Product Events � Impairment unrelated to underlying condition � Patient Protection Events � Impairment lasts for a minimum period of two weeks � Environmental Events � Patient related events only � Care Management Events � Criminal Events Risk Management plan � Risk Identification and Assessment protocols � Risk Register � Risk Action plans 3

  4. Risk Assessment Protocols Risk Assessment Protocols � Clinical : � Complete Evaluation of patient at Admission and at pre- determined intervals � ASA score – Pre-operative evaluation of patients � DVT prophylaxis: to determine which patients need DVT � Identify ‘vulnerable’ Patients prophylaxis � At higher risk of adverse events eg. Falls � Braden Score : Identify patients at risk of developing bed sores. y p p g � With special needs eg Interpreter diet � With special needs eg. Interpreter, diet � Revised Trauma Score : For triage in Emergency � Vulnerable patients are followed up more closely HAZARD VULNERABILITY ANALYSIS EMERGENCY PREPAREDNESS HVA MATRIX SCORE BOARD Hazard Vulnerability Analysis � HV A is a tool used to determine the probability, risk and Risk * @ Preparedness Probability External Event (Likelihood) response preparedness of an organisation to a natural or manmade Human Business Property Preplannin Internal * Risk rating Impact impact impact g response crisis 1.External flood 2 3 3 3 54 2 2 2 1.Earthquake 2 3 3 3 54 2 2 2 � Risk Score : Probability × risk rating 1.Internal fire 3 3 2 2 36 2 2 2 � Higher the score, more the planning and focus required � Higher the score more the planning and focus required 4. Bomb blast o b b ast 3 3 2 2 2 24 1 2 2 1.Disaster 1 1 1 1 1 1 1 1 Tsunami 6. Drought 1 1 1 1 1 2 2 2 7. Road/train 3 3 1 1 9 2 2 2 accident 8. Epidemic 3 3 2 1 18 1 1 1 9. Industrial 2 2 1 1 4 1 1 2 accidents 4

  5. SAFETY / FIRE SAFETY PREPAREDNESS HVA MATRIX SCORE BOARD HAZMAT PREPAREDNESS HVA MATRIX SCORE BOARD External Risk * @ Preparedness resp Probability onse Event (Likelihood) Human Property Internal * Business Preplannin Imp impa Risk rating resp impact g External act ct onse resp Risk * @ Preparedness Probability 1. Engineering onse 3 3 2 2 36 2 2 2 Activities Event (Likelihood) Human Property Internal * Business Preplannin 2. Employee Imp impa Risk rating resp 3 2 2 2 24 2 2 2 impact g Safety act ct onse 3. Contractor 3. Contractor 1 Major hazmat 1. Major hazmat 3 3 3 3 2 2 1 1 18 18 2 2 2 2 2 2 2 2 3 2 24 1 1 2 Safety spill. 4 Fire Safety 3 3 3 2 54 2 2 1 2. Radiology 2 2 2 1 8 1 1 1 exposure 5. Fire Equipment 2 3 3 2 36 1 2 1 Failure 3. Lab chemical 2 2 3 3 36 1 1 1 storage 6 CGSS Fire 2 3 3 2 36 1 2 2 4. Small / 7. Power Plant 2 3 3 3 54 1 1 1 medium 3 2 1 1 6 1 1 1 Fire internal spill 8. Operation Theatre 2 2 3 3 36 1 2 2 Fire 9. Hazmat Fire 2 2 2 2 16 1 2 2 SECURITY PREPAREDNESS HVA MATRIX SCORE BOARD BIOMEDICAL ENGINEERING HVA MATRIX SCORE BOARD External Risk * @ Preparedness resp Risk * @ Preparedness Probability Probability External onse Event (Likelihood) Event (Likelihood resp Human Business Property Internal Human Property Internal Preplannin * ) * onse Business Preplannin Imp impac impa Risk rating resp Imp impa Risk rating resp g impact g act t ct onse act ct onse 1. Theatre Light 1. Theft / 1 3 2 1 6 1 1 2 3 1 3 1 9 2 1 2 Failure Pilferages 2. Theatre Table 2. Abduction 2 3 1 2 12 1 1 2 1 2 1 2 4 1 1 3 Failure 3. Missing 2 2 2 2 NA NA 2 2 8 8 1 1 1 1 2 2 3 Blood Gas 3. Blood Gas Patient Machine 2 2 2 2 16 1 2 2 Failure 4. Security 2 2 2 2 16 2 2 2 Threat 4. Ventilator Failure Or 2 2 2 2 16 1 1 1 5. VIPs Protocol 2 1 1 2 4 2 1 1 Shortages 5. ETO 6. Bomb Threat 3 3 3 3 81 2 1 1 Equipment 2 2 3 1 12 1 1 1 Mal 7. Terrorist 2 3 2 3 36 2 1 1 Function Attack 6. MRI Mal 8. Crowd Control 2 1 2 1 4 1 2 2 3 1 2 2 12 1 3 1 Function 9. Traffic Control 1 2 2 1 4 2 1 1 7. CT Scanner Mal 3 1 2 2 12 1 3 1 Function Patient Education Strategies to Prevent Risk � Patient and Employee education � Brochures and booklets � Good Clinical Practice and protocols � Pictorial displays and charts � Good facility Maintenance � Counselling about specific risks: � Facility Audits � Food-drug interactions, � Activities of Daily Living � A ti iti f D il Li i � Clinical Audits � Hand washing and Hygiene 5

  6. Clinical practice APOLLO SPECIALITY HOSPITALS CENTRAL LINE BUNDLE COMPLIANCE CHECKLIST � Implemenation of care bundles in ICU � V entilator bundle � Central line bundle DATE NAME AGE/ UHID WARD CONS SITE DAYS HAND MAX CLORHEX DAILY REMARKS SEX HYGIENE BARRIER SKIN REVIEW � Presurgical Checklists ASEPSIS � Clinical Pathways � Cli i l P th Example 2 Appendix A VENTILATOR BUNDLE CHECKLIST Example 1 (Individual Patient) Patient: VENTILATOR BUNDLE CHECKLIST Admit Date: Sedaton Vaction & Assessment of HOB 30 ° Date Bed/Pt initials PUD Prophylaxis DVT Prophylaxis ICU Day 1 2 3 4 5 6 7 8 9 10 Readiness to Extubate 1. Head Of The Bed 30° 2. Daily Sedation Vacation and Daily Assessment of readness to extubate 3. PUD Prophylaxis 4.DVT Prophylaxis 6

  7. HOSPIT HOSPIT AL RISK RISK REGIS REGISTRY Department: Departmen Description of the risk Risk assessment Person Actions Preventive Signature & t Code, Type Risk involved taken actions name of the Risk No & rating identified Reporting Date Employee Department: • Department code to suffix, if Housekeeping – then it will be HK/01/5 th J an ‘ 07 • Risk Assessment : All risks, whether resulting from accident, incident, errors or risk assessment can be evaluated and graded. This includes near misses too. TYPE LIKELIHOOD CONSEQUENCE RISK RATING Frequent Catastrophic Very High A Probable Significant High B Unlikely Moderate Medium C Remote Negligible Low D Risk Action plan � ‘Blame free’ and prompt reporting � Provide education to all staff of Clinical Risk � Root cause Analysis Management principles � Remedial Measures to minimize the consequence of adverse � Promote a cultural change in the organisation by event encouraging clinical and non clinical staff to proactively � Preventive measures to reduce recurrence of similar risk P i d f i il i k identify potential risks and facilitate process redesign to id tif t ti l i k d f ilit t d i t � Review of effectiveness reduce risk � Further encourage a 'just' culture where the emphasis is on process and system redesign to improve safety Employee level Strategic level � Education about risk identification � Risk Management Committees – eg. Safety, Medication, Radiation Safety, Transfusion � Standard Operating Procedures � Review the risk register and the effectiveness of action to � Employee safety Measures reduce and prevent risk � Risk reporting formats � Develop and recommend policies to reduce and prevent risk � Develop and recommend policies to reduce and prevent risk 7

  8. Risk Management Education Corrective Identification Action Root Cause Reporting Analysis 8

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