risk management / cqi nutr 564: management summer 2002

Risk Management / CQIRisk Management / CQI

Nutr 564: Management

Summer 2002

Risk Management / CQIRisk Management / CQI

Risk Management / CQIRisk Management / CQI

Objectives:Objectives: Acquaint students with CQI terminology Review issues on patient safety Identify components of quality assurance processes Characterize ‘risk’ situations in health care

Risk Management / CQIRisk Management / CQI

TerminologyTerminology

CQI = Continuous Quality Improvement

QA = Quality Assurance

Risk Management / CQIRisk Management / CQI

Objectives:Objectives: Acquaint students with CQI terminology Review issues on patient safety Identify components of quality assurance processes Characterize ‘risk’ situations in health care

Risk Management / CQIRisk Management / CQIWhat are Medical

Errors?

Medical errors happen when something that was planned as a part of medical care doesn't work out, or when the wrong plan was used in the first place. Medical errors can occur anywhere in the health care system:

Hospitals. Clinics.

Outpatient Surgery Centers. Doctors' Offices.

Nursing Homes. Pharmacies.

Patients' Homes. http://www.ahrq.gov/consumer/20tips.htm

Risk Management / CQIRisk Management / CQI

Errors can involve: Medicines.

Surgery.

Diagnosis.

Equipment.

Lab reports.

http://www.ahrq.gov/consumer/20tips.htm

Risk Management / CQIRisk Management / CQI

“Strategies for Leadership: An Organizational Approach to Patient Safety”

American Hospital Association

TO ERR IS HUMAN:BUILDING A SAFER HEALTH SYSTEMHealth care in the United States is not as safe as it should be--and canbe. At least 44,000 people, and perhaps as many as 98,000 people, diein hospitals each year as a result of medical errors that could havebeen prevented, according to estimates from two major studies.

I N S T I T U T E O F M E D I C I N EShaping the Future for HealthNovember 1999

Risk Management / CQIRisk Management / CQI

Objectives:Objectives: Acquaint students with CQI terminology Review issues on patient safety Identify components of quality assurance processes Characterize ‘risk’ situations in health care

Risk Management / CQIRisk Management / CQI

Quality AssuranceQuality Assurance

is a dynamic, systematic process that assures the delivery of high-quality care to clients

Risk Management / CQIRisk Management / CQI

Clinical IndicatorsClinical Indicators:

Measurement tool used to monitor and evaluate the quality of important • Process indictor

• Outcome indicator

• Rate-based indicator

Risk Management / CQIRisk Management / CQI

Clinical Indicators:

Measurement tool used to monitor and evaluate the quality of important • Process indictor

• Outcome indicator

• Rate-based indicator

Risk Management / CQIRisk Management / CQI

Process Indicator - measures an activityProcess Indicator - measures an activity

Easy to Measure

May not directly impact safety

Risk Management / CQIRisk Management / CQI

Process Indicators - ExamplesProcess Indicators - ExamplesVolume Indicators / Service Trends

Screening

Patient Satisfaction

Risk Management / CQIRisk Management / CQI

Clinical Indicators:

Measurement tool used to monitor and evaluate the quality of important • Process indictor

• Outcome indicator

• Rate-based indicator

Risk Management / CQIRisk Management / CQI

Outcome IndicatorOutcome Indicator

Measures what happens after an activityMeasures what happens after an activity

Risk Management / CQIRisk Management / CQI

Outcome IndicatorOutcome Indicator

Examples: Weight lossExamples: Weight loss

InfectionInfection

Risk Management / CQIRisk Management / CQI

Clinical Indicators:

Measurement tool used to monitor and evaluate the quality of important • Process indictor

• Outcome indicator

• Rate-based indicator

Prevention Quality Indicators:Prevention Quality Indicators:

Bacterial pneumonia. Bacterial pneumonia. Dehydration. Dehydration.

Pediatric gastroenteritis. Pediatric gastroenteritis. Urinary infections. Urinary infections.

Perforated appendicitis. Perforated appendicitis. Low birth weight. Low birth weight.

Angina without an inhospital procedure. Angina without an inhospital procedure. Congestive heart failure. Congestive heart failure.

Hypertension. Hypertension. Adult asthma. Adult asthma.

Pediatric asthma. Pediatric asthma. Chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease.

Uncontrolled diabetes.Uncontrolled diabetes. DM, short-term complications. DM, short-term complications.

Diabetes, long-term complications. Diabetes, long-term complications. Lower extremity amputations among Lower extremity amputations among patients with diabetes.patients with diabetes.

Prevention Quality Indicators: developed by Stanford University under a contract with the (AHRQ).

Risk Management / CQIRisk Management / CQI

Rate-based indicator:Rate-based indicator:Assesses an event for which a certain Assesses an event for which a certain proportion of the events that occur are proportion of the events that occur are expected.expected.

Risk Management / CQIRisk Management / CQI

Rate-based indicator:Rate-based indicator:

Examples:Examples:Proportion of patients NPO 24 hours after Proportion of patients NPO 24 hours after surgerysurgery

Risk Management / CQIRisk Management / CQI

QA ProcessQA Process

Identify or define the problem

Establish a method to evaluate the problem

Set a timeline for data collection

Collect the data

Risk Management / CQIRisk Management / CQI

QA Process (Cont.)QA Process (Cont.)

Analyze the results

Discuss the findings and make conclusions

Suggest alternatives to rectify the problem

Try a solution - evaluate

Risk Management / CQIRisk Management / CQI

QA Process (Cont.)QA Process (Cont.)

Develop a system to monitor the success of the proposed solution

Implement a system to reevaluate the plan with set time criteria

Risk Management / CQIRisk Management / CQI

Risk Management / CQIRisk Management / CQI

Health Care QAHealth Care QA

System wide indicatorsSystem wide indicators

Department indicatorsDepartment indicators

Interdisciplinary indicatorsInterdisciplinary indicators

Risk Management / CQIRisk Management / CQI

Health Care QA

Quarterly projects standard

Risk Management / CQIRisk Management / CQI

JCAHO StandardsJCAHO Standards

Early response to medical error

Root- cause analysis

Sentinel event database

Continuous review

Risk Management / CQIRisk Management / CQI

IdealIdeal People would report errorPeople would report error System would assess errorSystem would assess error Take corrective actionTake corrective action Monitor for additional sources of error Monitor for additional sources of error

without fear of punishmentwithout fear of punishment Liang BA, MD, PhD, JD

Risk Management / CQIRisk Management / CQI

Elements of successful CQI projectsElements of successful CQI projects

Team effort in design

Employee involvement at all levels

Quality is part of job description

Safety in participation

Continuous effort

Risk Management / CQIRisk Management / CQI

Objectives:Objectives: Acquaint students with CQI terminology Review issues on patient safety Identify components of quality assurance processes Characterize ‘risk’ situations in health care

Risk Management / CQIRisk Management / CQI

Risk ManagementRisk Management

Clinical and administrative activities Clinical and administrative activities undertaken to identify, evaluate, and reduce the risk undertaken to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors and the risk of injury to patients, staff, and visitors and the risk

of loss to the organization itselfof loss to the organization itself

Risk Management / CQIRisk Management / CQI

Risk Management / CQIRisk Management / CQI

Procedures

Equipment

Facilities

Risk Management / CQIRisk Management / CQI

Clinical Nutrition and Food Service Systems

High risk areas*

*

*

*

Risk Management / CQIRisk Management / CQI

Clinical Nutrition and Food Service Systems

Risk Management / CQIRisk Management / CQI

Clinical Nutrition and Food Service Systems

Risk Management / CQIRisk Management / CQI

Clinical Nutrition and Food Service Systems

High risk areas* Equipment - knives / blades

* Wet floors

* Cleaning solutions

* High turnover in personnel

Risk Management / CQIRisk Management / CQI

Risk Management:

Risk Management / CQIRisk Management / CQI

The Perception of Risk

Not always about money

Encourage discourse between legal and medical professions

Risk Management / CQIRisk Management / CQI

Bursztajn HJ and Brodsky A

“A New Resource for Managing Malpractice Risks in Managed Care” Arch Intern Med

156:2057-63, 1996.

Risk Management / CQIRisk Management / CQI

Seven Basic Quality Control ToolsSeven Basic Quality Control Tools• Process Flow ChartsProcess Flow Charts

• ChecksheetsChecksheets

• Run ChartsRun Charts

• Scatter DiagramsScatter Diagrams

• Cause-and-Effect DiagramsCause-and-Effect Diagrams

• Histograms and Bar ChartsHistograms and Bar Charts

• Pareto ChartsPareto Charts© The McGraw-Hill Companies, Inc., 1999