Dealing with risks in patient care
Quality management
Frau Elke von der Groeben
Leitung Qualitätsmanagement
Steinhäuserstraße 18
76135 Karlsruhe
Phone:
0721
-8108-2133
Mail:
ed.ak-suitnecniv@nebeorgrednov.ekle
Frau Bernadette Schäfer
Leitung Qualitäts- und Projektmanagement
Steinhäuserstraße 18
76135 Karlsruhe
Phone:
0721
-8108-8008
Mail:
ed.ak-suitnecniv@refeahcs.ettedanreb
Conference frequency:
Risk management
Maik Beltrame
Prokurist / Leitung Allgemeine Verwaltung
Steinhäuserstraße 18
76042 Karlsruhe
Phone:
0721
-889-2396
Fax: 0721-889-3902
Mail:
ed.ak-kaid@emartleb.m
Conference frequency:
Risk management instruments and measures
| No. | Explanation |
|---|---|
| RM01 |
Comprehensive quality and/or risk management documentation (QM/RM documentation) is available Qualitätsmanagement, Risikomanagement (30.09.2019) |
| RM02 |
Regular further education and training measures |
| RM03 |
Employee surveys |
| RM04 |
Clinical emergency management Vorgehen bei Notfällen (04.05.2018) |
| RM05 |
Pain management Schmerzmanagement Pflege (13.06.2023) |
| RM06 |
Fall prophylaxis Sturzprophylaxe (19.01.2021) |
| RM07 |
Use of a standardised concept for pressure ulcer prophylaxis (e.g. “Expert Standard for Pressure Ulcer Prophylaxis in Nursing”) Dekubitusprophylaxe (05.09.2022) |
| RM08 |
Regulated handling of custodial measures Name:Freiheitsentziehende Maßnahmen (17.10.2018) |
| RM09 |
Regulated handling of occurring malfunctions of devices Organisationshandbuch Medizintechnik (01.01.2019) |
| 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 Checkliste (02.10.2019) |
| RM15 |
Preoperative, complete presentation of necessary findings fachabteilungsspezifische Indikationsbesprechung (zum Beispiel EPZ) (09.08.2017) |
| RM16 |
Procedure to avoid procedural and patient mix-ups Checkliste Time-Out: Chirurgische Klinik (02.12.2020) |
| RM17 |
Standards for recovery and postoperative care postoperative Schmerztherapie auf Station (14.05.2017) |
| RM18 |
Discharge management Entlassmanagement (02.10.2019) |
Fault reporting systems
Conference committee
Conference frequency: bei Bedarf
Measures
CIRS ist ein anonymes Berichtsystem zur Meldung, Erfassung und Auswertung von kritischen Ereignissen. Ziel ist die Ableitung und Umsetzung von praxisbezogenen und risikopräventiven Maßnahmen. Analyse von kritischen Zwischenmeldungen zur Verbesserung der Patientensicherheit und Fehler- und Schadensvermeidung. Antibiotic-Stewardship. Ethik-Komitee. CIRS u.v.m
| No. | Explanation |
|---|---|
| IF01 |
Documentation and procedural instructions for handling the error reporting system are available As of: 16.03.2021 |
| IF02 |
Internal evaluation of the received reports taken quartalsweise |
| 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: bei Bedarf
| No. | Explanation |
|---|---|
| EF15 |
PaSIS (Patient Safety and Information System of the University Hospital Tübingen) |