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Dr Rohini Sridhar MD FRCPA
Effective Risk Management
- Dr. Rohini Sridhar, MD, FRCPA
1 Risk in hospitals Legal Risk Clinical risk Risk arising out of - - PDF document
1 Risk in hospitals Legal Risk Clinical risk Risk arising out of - - PDF document
Effective Risk Management Dr Rohini Sridhar MD FRCPA Dr. Rohini Sridhar, MD, FRCPA Chief Operating Officer, Apollo Speciality Hospital, Madurai Risk Management programme Identification of risk Strategies to avoid risk Strategies
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Near Miss Event
It is a potential for harm or error which is intercepted prior to the completion of the incident/ event resulting in no harm to the patient Most common type of error occuring in hospitals Provides valuable learning experience Provides valuable learning experience
Sentinel Event
An unexpected incident, related to system or process deficiencies, which leads to death or major and enduring loss
- f function for a recipient of healthcare services
Sentinel Event
Sensory, motor or psychological impairment Not present at the time the service was sought or begun Impairment unrelated to underlying condition Impairment lasts for a minimum period of two weeks Patient related events only
Sentinel Event
Surgical Events Device or Product Events Patient Protection Events Environmental Events Care Management Events Criminal Events
Risk Management plan
Risk Identification and Assessment protocols Risk Register Risk Action plans
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Risk Assessment Protocols
Clinical :
ASA score – Pre-operative evaluation of patients DVT prophylaxis: to determine which patients need DVT prophylaxis Braden Score : Identify patients at risk of developing bed sores. y p p g Revised Trauma Score : For triage in Emergency
Risk Assessment Protocols
Complete Evaluation of patient at Admission and at pre- determined intervals Identify ‘vulnerable’ Patients
At higher risk of adverse events eg. Falls With special needs eg Interpreter diet With special needs eg. Interpreter, diet
Vulnerable patients are followed up more closely
Hazard Vulnerability Analysis
HV A is a tool used to determine the probability, risk and preparedness of an organisation to a natural or manmade crisis Risk Score : Probability × risk rating Higher the score more the planning and focus required Higher the score, more the planning and focus required
Event Probability (Likelihood) * Risk * @ Preparedness External response Human Impact Business impact Property impact Risk rating Preplannin g Internal response 1.External flood 2 3 3 3 54 2 2 2 1.Earthquake 2 3 3 3 54 2 2 2 1.Internal fire 3 3 2 2 36 2 2 2
- 4. Bomb blast
3 2 2 2 24 1 2 2
EMERGENCY PREPAREDNESS HVA MATRIX SCORE BOARD HAZARD VULNERABILITY ANALYSIS
- b b ast
3 1.Disaster Tsunami 1 1 1 1 1 1 1 1
- 6. Drought
1 1 1 1 1 2 2 2
- 7. Road/train
accident 3 3 1 1 9 2 2 2
- 8. Epidemic
3 3 2 1 18 1 1 1
- 9. Industrial
accidents 2 2 1 1 4 1 1 2
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Event Probability (Likelihood) * Risk * @ Preparedness External resp
- nse
Human Imp act Business impact Property impa ct Risk rating Preplannin g Internal resp
- nse
- 1. Engineering
Activities 3 3 2 2 36 2 2 2
- 2. Employee
Safety 3 2 2 2 24 2 2 2
- 3. Contractor
3 3 2 1 18 2 2 2
SAFETY / FIRE SAFETY PREPAREDNESS HVA MATRIX SCORE BOARD
- 3. Contractor
Safety 3 3 2 1 18 2 2 2 4 Fire Safety 3 3 3 2 54 2 2 1
- 5. Fire
Equipment Failure 2 3 3 2 36 1 2 1 6 CGSS Fire 2 3 3 2 36 1 2 2
- 7. Power Plant
Fire 2 3 3 3 54 1 1 1
- 8. Operation
Theatre Fire 2 2 3 3 36 1 2 2
- 9. Hazmat Fire
2 2 2 2 16 1 2 2 Event Probability (Likelihood) * Risk * @ Preparedness External resp
- nse
Human Imp act Business impact Property impa ct Risk rating Preplannin g Internal resp
- nse
1 Major hazmat
HAZMAT PREPAREDNESS HVA MATRIX SCORE BOARD
- 1. Major hazmat
spill. 2 2 3 2 24 1 1 2
- 2. Radiology
exposure 2 2 2 1 8 1 1 1
- 3. Lab chemical
storage 2 2 3 3 36 1 1 1
- 4. Small /
medium internal spill 3 2 1 1 6 1 1 1 Event Probability (Likelihood) * Risk * @ Preparedness External resp
- nse
Human Imp act Business impact Property impa ct Risk rating Preplannin g Internal resp
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- 1. Theft /
Pilferages 3 1 3 1 9 2 1 2
- 2. Abduction
2 3 1 2 12 1 1 2
- 3. Missing
2 2 NA 2 8 1 1 2
SECURITY PREPAREDNESS HVA MATRIX SCORE BOARD
Patient 2 2 NA 2 8 1 1 2
- 4. Security
Threat 2 2 2 2 16 2 2 2
- 5. VIPs Protocol
2 1 1 2 4 2 1 1
- 6. Bomb Threat
3 3 3 3 81 2 1 1
- 7. Terrorist
Attack 2 3 2 3 36 2 1 1
- 8. Crowd Control
2 1 2 1 4 1 2 2
- 9. Traffic Control
1 2 2 1 4 2 1 1 Event Probability (Likelihood ) * Risk * @ Preparedness External resp
- nse
Human Imp act Business impac t Property impa ct Risk rating Preplannin g Internal resp
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- 1. Theatre Light
Failure 1 3 2 1 6 1 1 2
- 2. Theatre Table
Failure 1 2 1 2 4 1 1 3 3 Blood Gas
BIOMEDICAL ENGINEERING HVA MATRIX SCORE BOARD
- 3. Blood Gas
Machine Failure 2 2 2 2 16 1 2 2
- 4. Ventilator
Failure Or Shortages 2 2 2 2 16 1 1 1
- 5. ETO
Equipment Mal Function 2 2 3 1 12 1 1 1
- 6. MRI Mal
Function 3 1 2 2 12 1 3 1
- 7. CT Scanner
Mal Function 3 1 2 2 12 1 3 1
Strategies to Prevent Risk
Patient and Employee education Good Clinical Practice and protocols Good facility Maintenance Facility Audits Clinical Audits
Patient Education
Brochures and booklets Pictorial displays and charts Counselling about specific risks:
Food-drug interactions, A ti iti f D il Li i Activities of Daily Living Hand washing and Hygiene
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Clinical practice
Implemenation of care bundles in ICU
V entilator bundle Central line bundle
Presurgical Checklists Cli i l P th Clinical Pathways
DATE NAME AGE/ SEX UHID WARD CONS SITE DAYS HAND HYGIENE MAX BARRIER CLORHEX SKIN ASEPSIS DAILY REVIEW REMARKS
APOLLO SPECIALITY HOSPITALS CENTRAL LINE BUNDLE COMPLIANCE CHECKLIST
Appendix A Example 1 VENTILATOR BUNDLE CHECKLIST Date Bed/Pt initials HOB 30 ° Sedaton Vaction & Assessment of Readiness to Extubate PUD Prophylaxis DVT Prophylaxis Example 2 VENTILATOR BUNDLE CHECKLIST (Individual Patient) Patient: Admit Date: ICU Day 1 2 3 4 5 6 7 8 9 10
- 1. Head Of The Bed 30°
- 2. Daily Sedation Vacation and
Daily Assessment of readness to extubate
- 3. PUD Prophylaxis
4.DVT Prophylaxis
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HOSPIT HOSPIT AL RISK RISK REGIS REGISTRY
Departmen t Code, Risk No & Date Description of the risk Risk assessment Person involved Actions taken Preventive actions identified Signature & name of the Reporting Employee Type Risk rating
Department:
TYPE LIKELIHOOD CONSEQUENCE RISK RATING A Frequent Catastrophic Very High B Probable Significant High C Unlikely Moderate Medium D Remote Negligible Low
Department:
- Department code to suffix, if Housekeeping – then it will be HK/01/5th J
an ‘07
- Risk Assessment : All risks, whether resulting from accident, incident, errors or risk assessment can be evaluated
and graded. This includes near misses too.
Risk Action plan
‘Blame free’ and prompt reporting Root cause Analysis Remedial Measures to minimize the consequence of adverse event P i d f i il i k Preventive measures to reduce recurrence of similar risk Review of effectiveness
Provide education to all staff of Clinical Risk Management principles Promote a cultural change in the organisation by encouraging clinical and non clinical staff to proactively id tif t ti l i k d f ilit t d i t identify potential risks and facilitate process redesign to reduce risk Further encourage a 'just' culture where the emphasis is
- n process and system redesign to improve safety
Employee level
Education about risk identification Standard Operating Procedures Employee safety Measures Risk reporting formats
Strategic level
Risk Management Committees – eg. Safety, Medication, Radiation Safety, Transfusion Review the risk register and the effectiveness of action to reduce and prevent risk Develop and recommend policies to reduce and prevent risk Develop and recommend policies to reduce and prevent risk
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