Dealing with risks in patient care
Quality management
Janna Worms
Leitung Medizinisches Qualitäts- und Risikomanagement
Flemmingstraße 2
09116 Chemnitz
Phone:
49
-371-33332476
Mail:
ed.cks@smrow.annaj
Ärztlicher Dienst, Pflegedienst, Krankenhausapotheke, Krankenhaushygiene, Zentrales Qualitäts- und Risikomanagement, Qualitätsmanagementbeauftragte der Kliniken und Abteilungen
Conference frequency: quartalsweise
Risk management
Janna Worms
Leitung Medizinisches Qualitäts- und Risikomanagement
Phone:
49
-371-33332476
Fax: 49-371-33332492
Mail:
ed.cks@smrow.annaj
Klinische Risikomanager/in, Ärztlicher Dienst, Pflegedienst, Beschwerdemanagement, Versicherungswesen, Zentrales Qualitäts- und Risikomanagement, Krankenhaushygiene, Krankenhausapotheke, Logistik
Conference frequency: monatlich
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available KC-RM-VA-00005 (07.08.2020) |
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management KC-RM-VA-00005 (07.08.2020) |
| RM05 |
Pain management KC-RM-VA-00005 (07.08.2020) |
| RM06 |
Fall prophylaxis KC-RM-VA-00005 (07.08.2020) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) KC-RM-VA-00005 (07.08.2020) |
| RM08 |
Regulated handling of custodial measures KC-RM-VA-00005 (07.08.2020) |
| RM09 |
Regulated handling of occurring malfunctions of devices KC-RM-VA-00005 (07.08.2020) |
| 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 KC-RM-VA-00005 (07.08.2020) |
| RM15 |
Preoperative, complete presentation of necessary findings KC-RM-VA-00005 (07.08.2020) |
| RM16 |
Procedure to avoid procedural and patient mix-ups KC-RM-VA-00005 (07.08.2020) |
| RM17 |
Standards for recovery and postoperative care KC-RM-VA-00005 (07.08.2020) |
| RM18 |
Discharge management KC-RM-VA-00005 (07.08.2020) |
Fault reporting systems
Conference committee
Conference frequency: monatlich
Measures
Anschaffung von Schutzanzügen zum Schutz vor chemisch kontaminierten Patienten, erneute Schulung der OP-Teams zum Ablauf des Team-Time-Outs, Erstellung einer SOP zur Regelung der Betreuung von frisch operierten Patientinnen im Aufwachraum des Geburtensaals
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 08.04.2022 |
| 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 bei Bedarf |
Conference committee
Conference frequency: monatlich
| No. | Explanation |
|---|---|
| EF03 |
KH-CIRS (German Hospital Association, German Nursing Council, German Medical Association) |