Dealing with risks in patient care
Quality management
Dr. Andreas Hellwig
Geschäftsbereichsleiter Medizinmanagement
Gudrunstraße 56
44791 Bochum
Phone:
0234
-509-8899
Mail:
ed.oblkk@mq
Alle klinischen und betrieblichen Fachabteilungen.
Conference frequency: halbjährlich
Risk management
Andreas Hellwig
Geschäftsbereichsleiter Medizinmanagement
Gudrunstraße 56
44791 Bochum
Phone:
0234
-509-8899
Mail:
ed.oblkk@mq
Bereichsleiter Medizinmanagement (Risikomanagementhauptverantwortlicher, Qualitätsmanager und Leiter QM/RM), Risikomanager (klinisch und betrieblich), Informationssicherheitsrisikomanagerin, Mitarbeiterin zentrales QM/RM
Conference frequency: quartalsweise
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available Managementhandbuch (31.05.2022) |
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management Managementhandbuch (31.07.2018) |
| RM05 |
Pain management Managementhandbuch (28.01.2022) |
| RM06 |
Fall prophylaxis Managementhandbuch (14.04.2020) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) Managementhandbuch (30.04.2021) |
| RM08 |
Regulated handling of custodial measures Managementhandbuch (21.03.2016) |
| RM09 |
Regulated handling of occurring malfunctions of devices Managementhandbuch (31.01.2020) |
| 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 Managementhandbuch (31.08.2022) |
| RM15 |
Preoperative, complete presentation of necessary findings Managementhandbuch (31.08.2022) |
| RM16 |
Procedure to avoid procedural and patient mix-ups Managementhandbuch (21.12.2020) |
| RM17 |
Standards for recovery and postoperative care Vitalcheck-Pflege (29.10.2020) |
| RM18 |
Discharge management Managementhandbuch (31.08.2022) |
Fault reporting systems
Conference committee
Conference frequency: monatlich
Measures
CIRS-Gremium, Gremium Sicherheit im KKB, Einführung neuer Checklisten, kontinuierliche Weiterentwicklung von Standards, Konzepten (z. B. zentrales Schadenmanagement), Verfahrensanweisungen etc.
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 06.03.2020 |
| 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 halbjährlich |
Conference committee
Conference frequency: quartalsweise
| No. | Explanation |
|---|---|
| EF06 |
CIRS NRW (North Rhine and Westphalia-Lippe Medical Chambers, North Rhine Westphalia Hospital Association, North Rhine and Westphalia-Lippe Association of Statutory Health Insurance Doctors, German Medical Association, National Association of Statutory Hea |