Risk Managements

NRS 559 – Leadership In Nursing

Lecturer : DR. SITI KHUZAIMAH BINTI

AHMAD SHARONI
Presentor :
 NUR AMYLIA BINTI MOHD NORSABRI
(2017807272)
 NUR AZIEMAH BINTI MOHD ZAMRI (2017415056)
 Learning Outcomes

At the end of this chapter, you will be able to:

● Define risk management.

● Describe nursing’s role in risk management.
● Explain how the incident reports are done.
● Describe the examples of risk.
● Explain role of the nurse manager.
 Definition

Risk management:

• a component of quality management, but its purpose is to

identify, analyze, and evaluate risks and then to develop a
plan for reducing the frequency and severity of accidents
and injuries.
• A continuous daily program of detection, education and
intervention.
Risk Management Program

● Involves all department of the organization.

● Must be an organization-wide program, with the board
of directors’ approval and input from all departments.
● Must have high level commitment, including that of the
chief executive officer and the chief nurse.
Risk Management Program

1. Identifies potential risks for accidents, injury or financial loss. Formal and informal communication with all
organizational departments and inspections of facilities are essential to identifying problem areas.

2. Reviews current organization-wide monitoring systems (incident reports, audits, committee minutes, oral
complaints, patient questionnaires), evaluates completeness and determine additional systems needed to
provide the factual data essential for risk management control.

3. Analyzes the frequency, severity and causes of general categories and specific types of incidents causing
injury or adverse outcomes to patients. To plan risk intervention strategies, it is necessary to estimate the
outcomes associated with the various types of incidents.

4. Review and appraises safety and risk aspects of patient care procedures and new programs.
5. Monitor laws and codes related to patient safety, consent and care.

6. Eliminates or reduces risks as much as possible.

7. Reviews the work of other committees to determine potential liability and recommend prevention or
corrective action. Examples of such committees are infection, medical audit, safety/security, pharmacy,
nursing audit and productivity.

8. Identifies needs for patient, family and personnel education suggested by all of the foregoing and
implements the appropriate educational program.

9. Evaluates the results of a risk management program.

10. Provide periodic reports to administration, medical staff and the board of directors.
Nursing’s role in Risk Management
● Nursing is the one department involved in patient care 24-hours a day; nursing
personnel are therefore critical to the success of a risk management program
● The chief administrator must be committed to the program. His or her attitude
will influence the staff and their participation.

High-risk areas in health care fall into five categories:

1. Medication errors
2. Complications from diagnostic or treatment procedures
3. Falls
4. Patient or family dissatisfactions with care
5. Refusal or treatment or refusal to sign consent for treatment
Cont..

● Medical records and incidence reports serve to document

organizational, nurse and physician accountability.
● If records are faulty, inadequate or omitted, the
organization is more likely to be sued and more likely to
lose.
● Incident reports are used to analyze the severity, frequency
and causes of occurrences within the five risk categories.
Steps in reporting incidents
2. Notification
1. Discovery 3. Investigation
The risk manager receives the
Nurses, physicians, The risk manager or
completed incident form
patients, families or any representative
within 24-hours after the
employees or volunteer investigate the incident
incident. A telephone call may
may report actual or immediately.
be made earlier to hasten
potential risk. follow-up in the event of a
major incident.

6. Recording 5. Action 4. Consultation

The risk manager should The risk manager should clarify any The risk manager
be sure that all records misinformation to the patient or consults with the
including incident family, explaining exactly what referring physician, risk
reports, follow-up and happened. The patient should be management
actions taken, if any, are referred to the appropriate source for committee member, or
filed in a central help and if needed, be assured that both to obtain
depository. care for any necessary service will be additional information
provided free of charge. and guidance.
 Example of risk

Medication Errors Diagnostic Procedure

Medical–Legal Patient or Family

Incident Dissatisfaction with Care
Medication Errors

A reportable incident occurs when a medication or fluid is

omitted, the wrong medication or fluid is administered, or
a medication is given to the wrong patient, at the wrong
.time, in the wrong dosage, or by the wrong route

Example : Weight was transcribed incorrectly from emergency room

sheet. Medication dose was calculated on incorrect weight;
therefore, patient was given double the dose required. Error
discovered after first dose and corrected. Second dose omitted per
physician’s order.
 Diagnostic Procedure

Any incident occurring before, during, or after such

procedures as blood sample stick, biopsy, X-ray
examination, lumbar puncture, or other invasive
procedure is categorized as a diagnostic procedure
incident.

Example : Patient found on the floor after lumbar puncture.

Right side rail down. Examined by a physician, BP 120/80, T
98.6, P 72, R 18. No injury noted on exam. Patient returned to
bed, side rail placed up. Will continue to monitor patient
condition.
 Medical–Legal Incident

If a patient or family refuses treatment as ordered and

prescribed or refuses to sign consent forms, the situation
is categorized as a medical-legal incident.

Example : Patient refused to sign consent for bone marrow biopsy. States
side effects not understood. Doctor reviewed reasons for test and side
effects three different times. Doctor informed the patient that without
consent he could not perform the test. Offered to call in another physician
for second opinion. Patient agreed. After doctor left, patient signed consent
form.
Patient or Family Dissatisfaction with Care
When a patient or family indicates general dissatisfaction with
care and the situation cannot be or has not been resolved,
then an incident report is filed.

Examples : Mother complained that she had found child saturated with
urine every morning (she arrived around 0800). Explained to mother that
diapers and linen are changed at 0600 when 0600 feedings and meds are
given. Patient’s back, buttocks, and perineal areas are free of skin
breakdown. Parents continue to be distressed. Discussed with primary
nurse.
Root Cause Analysis
A method to work backwards through an event to examine every
action that led to the error or event that occurred and it is a
complicated process.

A simplified method to conduct an event analysis follows:

 Patient—what patient factors contributed to the event?

 Personnel—what personnel actions contributed to the event?

 Policies—are there policies for this type of event?

 Procedures—are there standard procedures for this type of event?

 Place—did the workplace environment contribute to the event?

 Politics—did institutional or outside politics play a role in the

event?
 Role of the Nurse Manager
The nurse manager plays a key role in the success of any risk management program.

Nurse managers can reduce risk by helping their staff view health and illness from the patient’s
perspective. Usually, the staff’s understanding of quality differs from the patient’s expectations and
perceptions.

Many claims are filed because of a breakdown in communication between the health care provider and the
patient. In many instances, after an incident or bad outcome, a quick visit or call from an organization’s
representative to the patient or family can soothe tempers and clarify misinformation.

Once an incident has occurred, the important factors in successful risk management are:
● Recognition of the incident.
● Quick follow-up and action.
● Personal contact.
● Immediate restitution (where appropriate).
 Handling Complaints
● The first step is to listen to the person to hear concerns and to
help defuse the situation. Arguing or interrupting only
increases the person’s anger or emotion.
● After the patient or family member has had his or her say, the
nurse manager can then attempt to solve the problem by
asking what is expected in the form of a solution.
● The nurse manager should ensure that immediate patient
care and safety needs are met, collect all facts relevant to the
incident, and if possible, comply with the patient or family
member’s suggested resolution.
● If the patient and/or family member’s requested resolution
exceeds the nurse manager’s authority, the nurse manager
should seek the assistance of a nurse administrator or
hospital legal counsel.
● All incidents must be properly documented. Information on the incident form
should be detailed and include all the factors relating to the incident, as
demonstrated in the previous examples. The documentation in the chart, however,
should be only a statement of the facts and of the patient’s physical response; no
reference to the incident report should be made, nor should words such as error or
inappropriate be used.
● The chart must never be used as a tool for disciplinary comments, action, or
expressions of anger.
● Handling a complaint without punishing a staff member is a delicate situation. The
manager must determine what happened in order to prevent another occurrence,
but using an incident report for discipline might result in fewer or erroneous
incident reports in the future.
 A Caring Attitude

● With employees, the nurse manager sets the tone that contributes
to a safe and low-risk environment.
● One of the most important ways to reduce risk is to instill a sense of
confidence in both patients and families by emphasizing and
recognizing that they will receive personalized attention and that
their needs will be attended to with competence. This confidence is
created environmentally and professionally.
● The nurse manager needs to foster the attitude that any mistake
that does occur is perceived as an opportunity to improve a system
or a process rather than to punish an individual. If the nurse
manager has developed a patient-focused atmosphere in which
patients believe their best interests are a priority, the potential for
risk will be reduced.
 Creating a Blame-Free Environment

The health care environment is known to be a blame culture that

“is a major source of medical errors and poor quality of
patient care”. Such a culture inhibits reporting of inadequate
practice, underreporting of adverse events, and inattention to
possible safety problems.

A just culture, in contrast, allows for reporting of errors without

fear of undue retribution suggest that transitioning to a just
culture does more than improve reporting mechanisms or
initiate training programs.

A just culture provides an environment in which employees can

question policies and practices, express concerns, and admit
mistakes without fear of retribution.
Errors can be categorized as:
● Human errors, such as unintentional behaviors that may cause an adverse consequence
● At-risk behaviors, such as unsafe habits, negligence, carelessness
● Reckless behaviors, such as conscious disregard for standards A just culture is prepared to handle
incidents involving human error.

At-risk or reckless behaviors, however, are not tolerated. Managing and improving quality requires
ongoing attention to system-wide processes and individual action. The nurse manager is in a key
position to identify problems and encourage a culture of safety and quality.
References
Sullivan, E. J. (2012). Effective Leadership and Management in Nursing. (8th ed.). Pearson.
Thank You 