Hospitals
carry a natural amount of risk in their operations: both clinical, and
non-clinical risk. While there exist the apparent clinical risks such as infections, wrong medication, wrong surgery
etc, there also exist non- clinical
risks such as fire, chemical spillage, electrical hazards etc.
Risk management is an important part of Quality Management
and Patient Safety activities in hospitals. The US National Library of
Medicine’s controlled vocabulary thesaurus, MeSH,
defines Risk Management as “ the
process of minimizing risk to an
organization by developing systems to identify
and analyze potential hazards to prevent accidents, injuries, and other
adverse occurrences, and by attempting to handle
events and incidents which do occur in such a manner that their effect and
cost are minimized. Effective risk management has its greatest benefits in
application to insurance in order to avert or minimize financial liability.”
The
management of risks require a proactive
approach consisting of Risk
identification, Risk assessment, Risk mitigation, Problem Prioritization, Risk
reporting , Risk management, Investigation of adverse events and Establishment of a safe organizational
culture.
An incident reporting
policy is required. An important part of risk management is the reporting
system for incidents such as adverse events , sentinel events and near
misses. Sentinel events, which are events not related to the primary
illness, resulting in patient death/ permanent loss of function, may include serious
injury such as loss of limb or function.
The number of sentinel events are to be monitored on a monthly basis and reported to
the Quality Steering Committee. Patients are assessed at admission for risk of
adverse episodes such as falls, and proactive measures are taken accordingly. It
is recommended that the incidents are analysed and analysis is done , including Root Cause Analysis for Sentinel events.
This analysis is used to redesign /modify processes or carry out corrective/
preventive steps.
“Safety First” programme is implemented
in many hospitals for vulnerable patients
(patients<16 yrs/ >60 yrs, women in labour, critical
care patients, patients unable to perform ADL). In addition, the following
patients/ processes are high risk and departmental level precautions are to be
taken: Patients undergoing surgery, sedation, blood transfusion, chemotherapy,
dialysis.
For long-staying patients, medical board is to be held and communication is to be carried out
with the patient’s relatives.
Failure
Mode and Effects Analysis (FMEA) is a technique used for proactive risk reduction. It
consists of the computation of a RPN ( Risk Probability Number) , which is
arrived at by multiplying Severity (S), Occurrence (O) and Detection ( D), i.e.
S X O X D. It can be used for a
variety of problems such as Medication Errors (MEs), Needle Stick Injuries (
NSIs) etc.
According to Hippocrates, the father of modern medicine, the
basic principle of medicine should be “
Primum non nociere” , i.e. “ First do no harm.” Keeping this in mind, Risk
management is an activity that should be proactively carried out by hospitals.
