Dealing with risks in patient care
Quality management
Dirk Tedeschi
Leitung Qualitätsmanagement
Stadtring Kattenstroth 130
33332 Gütersloh
Phone:
0521
-589-9010
Mail:
ed.dlefeleib-ohk@ihcsedet.krid
Ärzte, Pflege, IT, Apotheke, QM, Labor, MAV, Physiotherapie, Personalleiter, Hygiene
Conference frequency: bei Bedarf
Risk management
Dirk Tedeschi
Leitung Qualitätsmanagement
Kiskerstraße 26
33615 Bielefeld
Phone:
0521
-589-9010
Fax: 0521-589-9004
Mail:
ed.dlefeleib-ohk@ihcsedet.krid
Klinik für Allgemein-, Viszeral-, Thorax- und Minimalinvasive Chirurgie, Klinik für Unfallchirurgie, Pflege, Technik, Qualitätsmanagement, Hygiene, MAV
Conference frequency: monatlich
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available Handbuch im Intranet (12.06.2023) |
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management D6667 Verfahrensanweisung zum innerklinischen Notfallmanagement (18.12.2022) |
| RM05 |
Pain management D1184 Schmerztherapie-Algorithmus (12.06.2023) |
| RM06 |
Fall prophylaxis D8855 Verfahrensanweisung Sturzprophylaxe (02.01.2023) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) D12024 Verfahrensanweisung zum Umgang mit dem Expertenstandard "Dekubitusprophylaxe in der Pflege" (28.12.2022) |
| RM08 |
Regulated handling of custodial measures D2138 Standard Freiheitsentziehende Maßnahmen (02.01.2023) |
| RM09 |
Regulated handling of occurring malfunctions of devices D6976 VA zum Umgang mit auftretenden Fehlfunktionen von Geräten (22.03.2023) |
| RM10 |
Structured implementation of interdisciplinary case discussions/conferences Case review conference
|
| RM12 |
Use of standardised information sheets |
| RM13 |
Application of standardised surgical check lists |
| RM18 |
Discharge management D10471 Entlassungsplan (13.05.2023) |
Fault reporting systems
Conference committee
Conference frequency: monatlich
Measures
Interdisziplinäre Risikoaudits
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 23.09.2023 |
| IF02 |
Internal evaluation of the received reports taken monatlich |
| IF03 |
Training of employees in handling the error reporting system and in implementing the findings from the error reporting system taken monatlich |
Conference committee
Conference frequency: monatlich
| No. | Explanation |
|---|---|
| EF06 |
CIRS NRW (North Rhine and Westphalia-Lippe Medical Associations, North Rhine-Westphalia Hospital Association, North Rhine and Westphalia-Lippe Associations of Statutory Health Insurance Physicians, German Medical Association) |