PATIENT SAFETY IS A KEY COMPONENT OF RISK MANAGEMENT

Dr. ADIB A YAHYA, MARS

IMMEDIATE PAST PRESIDENT ASIAN HOSPITAL FEDERATION ( AHF ) WORKSHOP KESELAMATAN PASIEN DAN MANAJEMEN RISIKO KLINIS DI RUMAH SAKIT

1. What?

3. How?

2. Why?
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What ?

DEFINISI RISIKO
RISIKO ADALAH : POTENSI TERJADINYA KERUGIAN

YANG DAPAT TIMBUL DARI PROSES KEGIATAN SAAT SEKARANG ATAU KEJADIAN DIMASA DATANG. DATANG.

ERM, Risk Management Handbook for Health Care Organization

Risiko di Rumah Sakit

RISIKO KLINIS :
SEMUA ISU YANG DAPAT BERDAMPAK TERHADAP PENCAPAIAN PELAYANAN PASIEN YANG BERMUTU TINGGI,AMAN DAN EFEKTIF.

RISIKO NONKLINIS/ Corporate Risk : NONKLINIS/

SEMUA ISSU YANG DAPAT BERDAMPAK TERHADAP TERCAPAINYA TUGAS POKOK DAN KEWAJIBAN HUKUM DARI RUMAH SAKIT SEBAGAI KORPORASI. KORPORASI.
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KATEGORI RISIKO DI RUMAH SAKIT : ( Categories of Risk ) Patient care-related risks careMedical staff-related risks staffEmployeeEmployee-related risks PropertyProperty-related risks Financial risks Other risks

Risiko yang berhubungan dengan perawatan pasien (Patient care related risks) risks)

Direct association with patient care Consequences of inappropriate or incorrectly performed medical treatments Confidentiality and appropriate release of information Protection from abuse, neglect and assault abuse, Was patient informed of risks? risks? Nondiscriminatory treatment Appropriate triage and transfer of patients from ER Patient participation in research studies and use of experimental drugs - was consent obtained? Was patient discharged appropriately?

Risiko yang berhubungan dengan tenaga medis (Medical staff - related risks) risks)

- Credential terhadap staf medis ? - Tindakan medis sesuai kompetensi dan prosedur baku ?

- Was patient properly managed ?

- Do we have adequately trained staff ?

Risiko yang berhubungan dengan karyawan (Employee related risks)

- Risiko keselamatan dan kecelakaan kerja - Maintaining a safe environment - Employee Health Policy : . reducing risk of occupational illness and injury . providing for the treatment and compensation of workers for work-related illnesses or injuries work-

Risiko yang berhubungan dengan property (Property related risks) risks)

Protect assets from losses due to fires, floods, etc fires, floods, Paper and/or electronic records - patient, business and financial - protected from damage or destruction Procedures for handling cash and safeguarding valuables Bonding and insurance to protect facility from losses
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Risiko keuangan (Financial risks) risks)

Bad Debt Meningkatnya suku bunga Global Financial tsunami

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Risiko lain (Other risks) risks)

- Hazardous material management :

chemical, radioactive, infectious biological waste management

- Legal & regulatory risks - Reputational Risk

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WHY ?

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HOSPITAL
System made up of thousands of interinter-linked processes.. processes.. things can go wrong

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Errors are inevitable

.but most are preventable

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HOW ?

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DIDALAM SISTEM KITA YANG SANGAT KOMPEKS INI .. BAGAIMANA KITA AKAN MENDARAT DENGAN SELAMAT ? BAHAYA / HAZARD / RISIKO YANG MANA YANG HARUS KITA TANGANI TERLEBIH DAHULU ?

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MANJEMEN RISIKO . . . ADALAH PENDEKATAN PROAKTIF

UNTUK MENGIDENTIFIKASI,MENILAI DAN MENYUSUN PRIORITAS RISIKO, DENGAN TUJUAN UNTUK MENGHILANGKAN ATAU MEMINIMALKAN DAMPAKNYA.

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RISK MANAGEMENT PROCESS

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PROSES MANAJEMEN RISIKO

TEGAKKAN KONTEKS

KOMUNIKASI DAN KONSULTASI

ANALISA RISIKO ASESMEN RISIKO EVALUASI RISIKO

KELOLA RISIKO RISK REGISTER

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MONITOR DAN REVIEW

IDENTIFIKASI RISIKO

RISK MANAGEMENT TECHNIQUES/TREATMENTS RISK CONTROL :

- EXPOSURE AVOIDANCE - LOSS PREVENTION - LOSS REDUCTION - SEGREGATION (SEPARATION OR DUPLICATION) - CONTRACTUAL TRANSFER FOR RISK CONTROL

RISK FINANCING :
- RISK RETENTION - RISK TRANSFER
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IMPLEMENTASI MANAJEMEN RISIKO KLINIK DI RUMAH SAKIT

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PRIMUM, NON NOCERE FIRST, DO NO HARM

HIPPOCRATESS TENET (460(460-335 BC)

Risiko SELALU MELEKAT dengan proses pengobatan kepada pasien itu sendiri

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RISIKO MENYATU DENGAN SEMUA ASPEK PELAYANAN KESEHATAN,TERMASUK :

pengobatan dan perawatan kepada pasien; menentukan prioritas pelayanan ; pengembangan proyek dan pelayanan ; pembelian obat dan produk kesehatan lain; instruksi dan follow up kepada pasien.

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CRITICAL POINTS IN CLINICAL RISK MANAGEMENT

PROVIDING CARE IN THE EMERGENCY ROOM MAKING A DIAGNOSIS ORDERING INVESTIGATIONS AND INTERPRETING THE RESULTS UNDERTAKING INVASIVE PROCEDURES DRUG TREATMENT WARD MANAGEMENT

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RISK MANAGEMENT IN ER
POTENTIAL ERRORS Assessment of emergencies by insufficiently experienced junior staff Inadequate use of specialist opinion Inadequate reading of simple radiographs Poor management of standard situation Inadequate assessment before discharge REDUCING/MINIMISING RISKS Experienced clinicians available fullfull-time Involvement of specialist in the training of staff Training of staff on call radiologist Use protocols with sensitivity Senior staff to take responsibility for discharges
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REDUCING DIAGNOSTIC ERROR POTENTIAL ERRORS Failure to take a well-focused wellcase history Failure to assess the evidence & make a DD Inappropriate use of tests
REDUCING/MINIMISING RISKS

Concentrate on key elements Better training Write down conclusions before making a plan

Define spesific quuestios to be answered by chosen tests

Leaving the problem unexplained

Get a second opinion

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REDUCING THE RISKS OF INVESTIGATION

POTENTIAL ERRORS Clinician misreads visual evidence e.g. x ray; ECG Clinician not aware of lab results Clinician not aware of ward observation Clinician fails to understand test result REDUCING/MINIMISING RISKS Fully trained staff to interpret and report on tests Clinically important results to be relayed to clinician urgently Ward tests to be supervised and results discussed with clinicians Aware of the limits of their competence Senior staff to check repeatedly Careful supervision

Inappropriate use of tests

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Reducing the risks of invasive procedures

Consider The risk : benefit ratio Discuss the procedure with the patient Carrying out the procedure including coping with potential difficulties Ensure that the equipment is in good working order and that back up equipment is available If the procedure is not going well obtain help / be prepared to give up Ensure that the operator has sufficient skill

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Reducing the risks of invasive procedures

Consider The risk : benefit ratio Discuss the procedure with the patient Carrying out the procedure including coping with potential difficulties Ensure that the equipment is in good working order and that back up equipment is available If the procedure is not going well obtain help / be prepared to give up Ensure that the operator has sufficient skill

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COMMON SPECIFIC FACTORS ASSOCIATED WITH DRUG ADVERSE EVENTS FAILURE TO TAKE ACCOUNT OF DECLINING RENAL / HEPATIC FUNCTION FAILURE TO CHECK FOR POSSIBLE ALLERGIC RESPONSES USING THE WRONG DRUG NAME OR MEANS OF ADMINISTRATION MISCALCULATION OF DOSAGE
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REDUCING THE RISKS OF ONGOING WARD CARE

POTENTIAL ERRORS Failure to monitor clinical progress Failure to recognise that a patient is not making satisfactory progress Failure to provide appropriate treatment REDUCING.MINIMISING RISKS Joint education regarding appropriate monitoring Regular supervision

Use spesialist staff clinician from appropriate unit, nurse spesialist, physiotherapist Briefing & de-briefing deSBAR
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Shift working

PATIENT SAFETY,QUALITY OF CARE AND RISK MANAGEMENT

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The basic principles for safety and quality of care The basic principles for patient safety are the principles for quality of care: care: - to do the right thing for the right patient using the right method and at the right time, and time, - to communicate well with the patient and the rest of the clinical team
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Its easy gettin good players. The hard part is gettin them to play with each other
(Casey Stengel)
(Casey

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Communicating Team ???

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Quality in Healthcare
. begins with ensuring patient safety

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Key reasons
Patients are more at risk than non-patients nonMedical interventions are, by their nature, highhigh-risk procedures - small error margins Medicine remains an inexact, hands-on inexact, handsendeavour

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Patient safety in context

Patient safety is an important component of risk management, clinical governance, and management, governance, quality improvement. improvement.

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Australian Patient Safety Foundation 41

CONCLUSIONS
I.

improving the quality of care.

Risk management is not primarily about avoiding or mitigating claims; rather, it is a tool for

II. Incident reporting is only one aspect of the identification of risk. Incident reporting is on the reactive side of risk management. More emphasis needs to be placed on

the proactive side.

III. Risk management is actually

the business of all stakeholders

organisation, clinicians and nonclinicians.

in the

IV. The primary focus of risk management should now be

clinical governance and patient safety.

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FINAL WORD

Safe care is not an option. It is the right of every patient who entrusts their care to our Healthcare systems
Sir Liam Donaldson, Chair, WHO World Alliance for Patient Safety, Forward Programme, 20062007
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TERIMAKASIH

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