Risk Management
NUR/492
Risk Management
The process of error prevention in order to protect both patients and healthcare workers is
called Risk Management. The mere word prevention means it needs to be caught before it
happens. The effectiveness relies on the assigned interdisciplinary group that the hospital
will organize to manage it. “Recognition, identification, analysis and treatment of possible
dangers in a hospital is what risk management is all about” (Mostafa, 2009).
In the place where I used to work in, this process is a bit tricky. Since it is prevention; that
means no act has been committed yet and it is based solely on the integrity of the members
of the staff to religiously report cases of “almost errors”. The focal point of the risk
management team was with the nurses since they believed that it is where everything
starts and thus could be prevented. There was a policy that involves filling out a form in
these “almost errors” cases. The aim was to put in processes that could possibly prevent
the errors.
A very good example of a situation for risk management was what happened in our unit.
There was a process called double checking which means that for certain medications, a
nurse had to have someone with the same qualifications make a double check on the
medication before administering it. A drug called versed which is used for post operative
patients is usually kept in a pyxis. The neonates are given miniscule doses of this drug and
so the orders are only for such amount. The strength in the vials used is 2 ml/ 2mg which
equals a 1 ml/ 1 mg concentration. There was an instance when a nurse had to administer
this medication and had another nurse do the double checking. The second nurse observed
that the amount of medicine in the vial read 1 ml/ 5mg. This means the dose is much higher
than what is supposed to be drawn by the first nurse. The double check method prevented
a serious and potentially fatal error from happening. The process of filling out the form was
followed and it was submitted for review of the risk management team.
The result of that incident was a determination of the risk management team that since
there is never a need for a high dose of the medication versed that would exceed 2 ml/ 2
mg vial; there is no need to have a stock of large concentrations. It was noticed that there
were small concentration vials as well as larger concentrations in stock. The risk
management team recommended that all large concentration vials be removed and no
longer place in stock for that unit.
The risk management team was able to successfully implement a process that not only save
lives but also prevented possible severe medications errors. The patients in the
neonatology unit are very sensitive babies who require extra careful handling especially
with medication. A small amount of difference may have fatal results compared to adult
patients. These are considerations that the risk management team is very much aware of
and always keeping in mind when dealing with neonates. The implementation process was
very quick. The team kept in mind the urgency and importance of making the change and
ensuring that such a mistake will never happen again. It is not only for the safety of the
babies in the neonatology unit but also the protection of the nurses.
At the time, risk management was a very new concept and not all of the nurses are familiar
with it or receptive to it. The risk management team addressed it by assuring the nurses
that they will not be penalized for reporting an almost error. The focus was more in making
sure that it is caught early on and will not happen to anyone else. Communication played a
very big part in the implementation of this new process. The team was very encouraging
and even commended staff members who reported an incident. There was uneasiness at
first since most nurses don’t want to report a mistake due to fear of reprimand or
humiliation. But the risk management team soon put their fears to rest. They exerted extra
effort to connect with the nurses and make them feel comfortable which made all the
difference.
Buerhaus had a research which shows that 4% of patients that are in a hospital will at one
time or another go through an incident that is off putting. Almost 66% of these could have
been prevented (Lin, 2006). While Buehaus was doing this, he stumbled upon a tool that he
thought helped managers in identifying possible dangers in the hospital. It was a table that
listed the different tasks being done in the workplace and the potential hazards that can
happen together with it. There was also a list of the seriousness and the likelihood of
something dangerous happening. Along the table were the ways that these incidents can be
prevented and the effectiveness of each method (Lin, 2006).
There was a comparison made by Buerhaus of a study of risk management in the United
States compared to that of Taiwan. The process is a bit different in that the unit manager is
the head of the team in the latter country. The hierarchy is staff nurse to unit manager then
to nursing director. Resolutions and the implementation of different processes are the unit
manager’s responsibility (Lin, 2006).
There are negative and positive aspects to this method. Unit managers get an added task
which needs time and concentration on top of their current duties. The good side is that
staff nurses are at ease with their unit managers and are more likely to report an issue or
mistake to them than to the risk management team who they barely know.
The VA Medical Center in Lexington, KY has a policy about honesty in risk management. It
has helped them tremendously in the financial risks involved. This policy was based on the
risk management policy implemented by the Department of Veteran Affairs in 1995 which
states that should any accident occur, the patient and the family should be informed
immediately. The reason for this change was because of a study that showed patients and
their families are more likely not to file a lawsuit if there is an acknowledgment of a
mistake done (Kraman, 2004).
This honesty policy has helped the VA Medical Center in Lexington by showing the patients
and their families that the medical center is actually taking responsibility for whatever
happens. The issues are dealt with and corrective actions are done. The medical facility
management will speak to the patients’ family, acknowledge the problem and apologize.
They are assured that the person that caused what happened will also be held liable. There
were more instances of out of court settlements rather than lawsuits. This of course means
that the hospital was able to save hundreds of thousands of dollars.
Conclusion
Prevention is always better than cure. The short term cost of establishing a risk
management team may be great but the benefits far outweigh the costs. An
interdisciplinary team of healthcare professionals that has established good
communication with the staff nurses and gained their trust is the best way to manage risks
in hospitals.
References
Kraman, S.S. (2004). Risk management: extreme honesty may be the best policy. Retrieved
from http://annals.ba0.biz/content/131/12/963.full
Lin, L. (2006). Comparison of risk management in Taiwan and the USA. Journal Of Nursing
Management, 14(3), 222-226.
Mostafa, G. (2009). Enhancing nurses' knowledge and awareness about risk management:
system design. Eastern Mediterranean Health Journal = La Revue De Santé De La
Méditerranée Orientale = Al-Majallah Al-Ṣiḥḥīyah Li-Sharq Al-Mutawassiṭ, 15(5),
1135- 1144.