Dealing with risks in patient care
Quality management
Kathy Mehler
Stabsstelle Qualitätsmanagement
Große Allee 50
34454 Bad Arolsen
Phone:
05691
-800-77323
Mail:
ten.hng@relhem.yhtak
Vorstand/Geschäftsführung, QMB
Conference frequency: halbjährlich
Risk management
Günter Roth
Stabsstelle Qualitätsmanagement GNH
Große Allee 50
34454 Bad Arolsen
Phone:
0561
-980-4961
Mail:
ten.hng@htor.retneug
Geschäftsführung, Stabsstelle Qualitätsmanagement und Organisation, Qualitätsmanagementbeauftragte
Conference frequency: halbjährlich
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available Rahmenkonzept Risikomanagement GNH; (26.09.2024) |
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management Es existiert eine einheitliche hausinterne Notfallnummer. Darüber hinaus existieren hausinterne Regelungen zu den konkreten Abläufen sowie Checklisten für den Notfallrucksack und -wagen. (01.08.2024) |
| RM05 |
Pain management Therapiestandard zur postoperativen Schmerztherapie (17.02.2023) |
| RM06 |
Fall prophylaxis Arbeitsanweisung Sturzprophylaxe in der Pflege (12.04.2020) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) Richtlinie Dekubitusprophylaxe in der GNH (06.09.2021) |
| RM08 |
Regulated handling of custodial measures Besondere Sicherungsmaßnahme Fixierung; Vorgaben zur Meldung an das Amtsgericht; Vorgaben zur Dokumentation von Maßnahmen (09.06.2022) |
| RM09 |
Regulated handling of occurring malfunctions of devices Organisationshandbuch Medizintechnik für Anwender (24.08.2022) |
| 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 SOP Patientensicherheit im OP-Ablauf sowie diverse Checklisten (17.05.2023) |
| RM15 |
Preoperative, complete presentation of necessary findings SOP Patientensicherheit im OP-Ablauf (17.05.2023) |
| RM16 |
Procedure to avoid procedural and patient mix-ups Verfahrensbeschreibung zur Prävention von Eingriffsverwechslungen (29.03.2023) |
| RM18 |
Discharge management Verfahrensregel zum Entlassungsmanagement (08.03.2022) |
Fault reporting systems
Conference committee
Conference frequency: halbjährlich
Measures
Ausweitung OP-Checkliste, Regelmäßige Schulung der Teams
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 05.04.2023 |
| IF02 |
Internal evaluation of the received reports taken halbjährlich |
| IF03 |
Training of employees in handling the error reporting system and in implementing the findings from the error reporting system taken bei Bedarf |
Conference committee
Conference frequency: halbjährlich
| No. | Explanation |
|---|---|
| EF03 |
KH-CIRS (German Hospital Association, German Nursing Council, German Medical Association) |
| EF13 |
DokuPIK (Documentation of Pharmaceutical Interventions in Hospitals at the Federal Association of German Hospital Pharmacists (ADKA) |