Dealing with risks in patient care
Quality management
Daniel Kreidl
Qualitätsmanagementbeauftragter
Brüderstraße 65
42853 Remscheid
Phone:
02191
-797-775
Mail:
ed.anas@rkf.mq
Geschäftsführung; Ärztliche Direktion; Pflegedirektion; Qualitätsmanagement
Conference frequency: monatlich
Risk management
Geschäftsführung; Ärztliche Direktion; Pflegedirektion; Qualitätsmanagement
Conference frequency: monatlich
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available VA Fehler- und Risikomanagement (27.05.2024) |
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management Notfallplan FKR, Katastrophenschutzplan FKR, Pandemieplan (03.09.2024) |
| RM05 |
Pain management VA Perioperatives Schmerzmanagement (29.03.2023) |
| RM06 |
Fall prophylaxis PS Sturzprophylaxe (04.04.2024) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) Standard Dekubitusprohylaxe (03.07.2024) |
| RM08 |
Regulated handling of custodial measures VA Fehler- und Risikomanagement (27.05.2024) |
| RM09 |
Regulated handling of occurring malfunctions of devices VA Fehler- und Risikomanagement (27.05.2024) |
| 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 OP Sicherheitscheckliste,AA Erfassung von Komplikationen (04.09.2024) |
| RM15 |
Preoperative, complete presentation of necessary findings OP Sicherheitscheckliste, Standard Laborprofile FKR, Standard Labor Kontrollen EPZ FKR, Standard Röntgen Orthopädie (04.09.2024) |
| RM16 |
Procedure to avoid procedural and patient mix-ups OP Sicherheitscheckliste, Team Time Out, AA Patientenidentifikationsarmband (04.09.2024) |
| RM17 |
Standards for recovery and postoperative care VA Pflegerische Versorgung im Aufwachraum (24.08.2023) |
| RM18 |
Discharge management Entlassungsmanagement (16.05.2024) |
Fault reporting systems
Conference committee
Conference frequency: halbjährlich
Measures
Hygienebegehungen, aktive Fallanalysen nach Londen Protokoll, Durchführung von externen und internen Risikoaudits nach Risikopräventionskatalog, Durchführung interner Audits, u. a.
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 02.05.2024 |
| IF02 |
Internal evaluation of the received reports taken quartalsweise |
Conference committee
Conference frequency: quartalsweise
| 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) |