Risk management in healthcare involves assessing potential risks in administration, operations, patient care, and safety. It requires evaluating risks to service providers like medication errors, surgical errors, and quality of care issues. Risks are assessed based on their consequences and likelihood of occurring, with the goal of developing policies and procedures to reduce risks. Strategies include following up on abnormal test results, reducing dosing errors, and disclosing medical errors to patients.
2. Risk Management in Healthcare Debby Cardillo Systems in Healthcare HCM631-1004A-01-PH3IP1 Colorado Technical University October 29, 2010 Instructor: Jasmin Crenshaw
3. Risk Management in Healthcare Administration Operations Patient Care Safety Policies and Procedures
4. Risks to Service Provider Medication Errors Surgical Errors Quality of Care Access
5. Percentage of Persons Without Health Insurance National Health Interview Survey, 2009
10. Conclusion Having reviewed various events relating to risk, the ability to reduce risk can be accomplished through assessment of potential outcomes and the likelihood of them occurring. We can then work cohesively to strategically create policies and procedures to proactively approach these risks with the goal of eliminating the risk.
11. References AMA Law Division. (1969). Failure to Make Diagnostic Tests. JAMA. 1969; 210(1):213-214. Retrieved October 28, 2010 from www.jama.com American Society of Hospital Pharmacists. ASHP guidelines on preventing medication errors in hospitals. Am J Hosp Pharm. 1993; 50:305–14. Arora, H. Espadas, D. Myrna M. Mani, S. Petersen, L. Singh, H. Sittig, D. Thomas, E. (2009). Timely Follow-Up of Abnormal Diagnostic Imaging Test Results in an Outpatient Setting: Are Electronic Medical Records Achieving Their Potential? National Institute of Public Health. Arch Intern Med. 2009 September 28; 169(17): 1578–1586. doi:10.1001/archinternmed.2009.263 Bain, A. and Carson, D. (2008). Professional Risk and Working With People: Decision-making in Health, Social Care and Criminal Justice. Philadelphia, PA. Jessica Kingsley Publishers. Brown, E. Levan, R. Ojeda, V. & Wyn, R. (2000). Racial and ethnic disparities in access to health insurance and health care. University of California. Retrieved October 28, 2010 from http://www.kff.org/uninsured/upload/Racial-and-Ethnic-Disparities-in-Access-to-Health-Insurance-and-Health-Care-Report.pdf
12. References Committee on Identifying and Preventing Medication Errors.(2006). National Academies. Retrieved October 28, 2010 from http://www8.nationalacademies.org/onpinews/newsitem.aspx?recordid=11623 Feld, S. (2007).What is the Definition of Quality Medical Care? Repairing the Health System. Retrieved October 28, 2010 from http://stanleyfeldmdmace.typepad.com /repairing_the_healthcare_/2007/03/what_is_the_def.html Kuhn, A.M. and Youngberg, B.J. (2002). The need for risk management to evolve to assure a culture of safety. Quality and Safety in Healthcare. Retrieved October 27, 2010 from Gale Nursing and Allied Health database. McGuigan, T., & Watson, P. (2010). Non-urgent attendance at emergency departments. Emergency Nurse, 18(6), 34-38. Retrieved from CINAHL Plus with Full Text database.
13. References University of Iowa (2006, August 3). Studies Examine Physician Disclosure Of Medical Errors ScienceDaily. Retrieved October 27, 2010, from http://www.sciencedaily.com /releases/2006/08/060803182701.htm Westcott, Rowe LLP (2010). Surgical Errors: Dangers, Prevention and Recourse. Retrieved October 28, 2010 from www.wescottrowellp.com
Editor's Notes
As a result of the numerous malpractice cases filed in the 1970s (Kuhn & Youngberg, 2002) the healthcare industry realized a more proactive approach was necessary to developing an as yet unrealized value. Even though the amount of malpractice claims has begun to lessen the ability to reduce or remove the threat clinical risks brought about an increase of insurance premiums. Management must be fully involved and committed to the promotion of patient safety and the reduction of risk. Having the information necessary to make informed decisions to balance budgetary responsibility with a reduction in medical errors with an increase in patient safety is vital. Understanding the total cost involved in the reduction of risk by a particular event, managing that risk, and acknowledging standards in order for organizations to better formulate a strategic plan. The Joint Commission on Accreditation of Healthcare Organization (JCAHO), an independent organization responsible for evaluating and accrediting healthcare organizations and healthcare programs throughout the US, began the process of relaying the safety standards of patients created in July 2001. Of primary importance concerning these standards; 1) supply leadership; 2) enhance performance by organizations; 3) patient rights, continued training and education, information management.
The disclosure of medical errors is a demanding issue as there are a variety of reasons both pro and con influencing a physician’s decision to report the error (University of Iowa, 2006). Generally an error is not the result of an individual but system based. Disclosing the error is the decision of the individual as most errors may only be evident to an individual becoming their responsibility to report. Acknowledging a medical error relates to three goals of quality care; informing the patient results are not occurring as anticipated, organizations must be informed to prevent them from recurring and increasing patient safety, and other medical personnel can learn from mistakes made. In a news release published 2006 by the Committee on Identifying and Preventing Medication Errors states medication errors are the average mistake made affecting 1.5 million yearly as reported by the Institute of Medicine of the National Academies. The cost of treatment to rectify the mistakes made costs upwards of $3.5 million which does not include the supplemental costs in healthcare, loss of payroll or the decline in productivity. Drugs with similar names are attributed for 25 per cent of the mistakes made in errors reported to the Medication Error Reporting Program operated collaborativelywith the U.S. Pharmacopeia (USP) and the Institute for Safe Medication Practices (ISMP). Labeling and packing concerns were also cited as the basis of 33 per cent in errors with 30 per cent of them resulting in deaths. The standardization of drug naming terms to include all pharmaceutical companies being mandated to adhere to these standards will go far in the reduction or elimination of these errors. A practice of providing free drug samples should also be investigated as the process and documentation of these samples is lacking or nonexistent. In a 2000 publication by the Institute of Medicine (IOM) studies of New York, Colorado and Utah data was estimated from 1997 in the area of hospital admissions denotes between 44,000 and as high as 98,000 patients deaths can be connected to medical errors. Various reasons can be attributed to these deaths from defective equipment to equipment not been sterilized sufficiently. Other errors sited are incorrect locations, unnecessary surgery, anesthesia errors, death during surgery, and instruments being left during the operation among others. Ways in which to prevent and reduce surgical errors is through involvement of the patient in their healthcare and treatment, reports the Agency for Healthcare Research and Quality. Patients being as proactive in their care from treatment plans, medication prescription to the selection of hospitals. Informing the physician of all medication, herbs and vitamins taken will go a long way in the reduction of drug interaction to the verification of directions. The selection of hospitals for surgical procedures should be performed at one with a history in carrying out the procedure being scheduled. Insistence all hospital personnel wash hands prior to examinations is not out of line in the prevention of infection. Patients should be confident in the team’s knowledge, skills and abilities in completing the operation successfully. Avoid scheduling surgical procedures during summer months as this is when new surgical residents begin with senior residents promoted. It is also recommend avoiding scheduling surgical procedures at the end of the work week. Improving quality of care requires the identification of the specific elements comprising quality care first (Feld 2007), . Accomplishing the tasks in the delivery of quality care should follow these steps; recognize potential patients who are at risk; make an applicable assessment; apply a diagnosis; begin correct treatment; arrange follow up; follow the proper compliance and/or treatment.Disparities in health care can be contributed to several factors, uninsured and limited access to services. Lack of health insurance and obstacles to receiving health care are conducive to the reduction of ethnic and racial minorities receiving preventative care thereby enhancing the likelihood of increased disease or poor health. There are a variety of factors which can be attributed to differences in health, with access to health being of prime importance. Cardiovascular disease has a high mortality rate; African Americans and Latinos are more apt not to be treated for this ailment and are prone not to receive coronary revascularization or cardiac catheterization. In addition, African American are generally not diagnosed with breast cancer until late stages attributing to a 14 per cent difference in survival rates. Generally there are five reasons people seek medical treatment (McGuigan and Watson, 2010); family member becomes ill; reduced ability to perform normal activities; interruption in public interactions; insistence of family members; symptoms have reached their duration. The reason a person presents at the emergency room is due to an inability to obtain an appointment with their primary care physician (PCP) or their perception immediate medical attention is needed. Patients who present at an emergency room for non-emergency issues take the focus away from those requiring emergency care in some instances overloading staff. This can be offset by routing patients presenting at emergency department increased availability to primary care services thereby freeing emergency staff to treat emergent cases. Evidence suggests, writes McGuigan and Watson (2010), those utilizing emergency rooms also visit other types of physicians frequently. Upon triaging non-urgent cases with a referral to primary care physicians still takes time from more urgent cases only creating a temporary fix.
NOTES: A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or military plan at the time of interview.
Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, by region: United States, January-March 2010
Physicians may be held negligent in the event normal diagnostic testing is not ordered in the diagnosis of a patient. Either he or his staff can and has been held responsible and negligent for the consequences if; 1) the procedures are considered standard in the delivery of medical services under similar cases; 2) the physician neglected to order the standardized testing thereby misdiagnosing and treating the patient correctly; 3) resulting in the patient being cheated from a chance of a full recovery or suffering additional injury. Timely follow up of abnormal test results still poses a challenge even with the added technology of an electronic medical record system (Arora, et.al., 2009). It was assumed with this tool to aid in the notification simplifying the process the problem would be drastically reduced. Studies indicate abnormal test results which do not have follow up within a four week timeframe can have a detrimental clinical outcome. Medication, a form a drug therapy, is utilized as a means to improve the quality of life for a patient while minimizing risk. Taking of any medication as its inherent risks both known and unknown whether it is prescribed or not. Medication errors include the dispensing of medication, prescribing, administration, and patient compliance. Medication errors when detected should be documented in order to prevent them from recurring. Discovery of potential errors will assist in determining deficiencies in the system.
Assessing risk involves the collection of information; we must also know the reliability of the information relating to the range of risk as opposed to the basics. Indecision regarding whether the risk is worthwhile may require the collection of more specific information. Risk assessment requires the analysis of both the outcome and its likelihood. From a legal, ethical or professional point of view the assessment of risk only has to cover reasonable outcomes. The inclusion of unreasonable outcomes can become counterproductive and thereby quickly become lacking sufficient practice. The goal of a risk assessment is the incorporation of as much information as possible, with as many options as necessary while keeping the decisions simple. Limiting the range of outcomes in the inclusion of risk assessment can be rationalized by the causation rule. Those responsible for decision making should consider risks only in the realm of them possibly occurring for the event or period of time they are contemplating. Assessing the risk should indicate the specific period of time.
