1. Risk Management / CQI Nutr 564: Management Summer 2002

2. Risk Management / CQI

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

4. Risk Management / CQI Terminology CQI = Continuous Quality Improvement QA = Quality Assurance

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

6. Risk Management / CQI What 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

7. Risk Management / CQI Errors can involve:  Medicines.  Surgery.  Diagnosis.  Equipment.  Lab reports. http://www.ahrq.gov/consumer/20tips.htm

8. Risk Management / CQI “Strategies for Leadership: An Organizational Approach to Patient Safety” American Hospital Association

9. TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM Health care in the United States is not as safe as it should be--and can be. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been 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 E Shaping the Future for Health November 1999

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

12. Risk Management / CQI Quality Assurance is a dynamic, systematic process that assures the delivery of high-quality care to clients

13. Risk Management / CQI Clinical Indicators Clinical Indicators: Measurement tool used to monitor and evaluate the quality of important Process indictor Outcome indicator Rate-based indicator

14. Risk Management / CQI Clinical Indicators: Measurement tool used to monitor and evaluate the quality of important Process indictor Outcome indicator Rate-based indicator

15. Risk Management / CQI Process Indicator - measures an activity Easy to Measure May not directly impact safety

16. Risk Management / CQI Process Indicators - Examples Volume Indicators / Service Trends Screening Patient Satisfaction

17. Risk Management / CQI Clinical Indicators: Measurement tool used to monitor and evaluate the quality of important Process indictor Outcome indicator Rate-based indicator

18. Risk Management / CQI Outcome Indicator Measures what happens after an activity

19. Risk Management / CQI Outcome Indicator Examples: Weight loss Infection Infection

20. Risk Management / CQI Clinical Indicators: Measurement tool used to monitor and evaluate the quality of important Process indictor Outcome indicator Rate-based indicator

21. Prevention Quality Indicators: Bacterial pneumonia. Dehydration. Pediatric gastroenteritis. Urinary infections. Perforated appendicitis. Low birth weight. Angina without an inhospital procedure. Congestive heart failure. Hypertension. Adult asthma. Pediatric asthma. Chronic obstructive pulmonary disease. Uncontrolled diabetes.DM, short-term complications. Diabetes, long-term complications. Lower extremity amputations among patients with diabetes. Prevention Quality Indicators: developed by Stanford University under a contract with the (AHRQ).

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

23. Risk Management / CQI Rate-based indicator: Examples: Examples: Proportion of patients NPO 24 hours after surgery

24. Risk Management / CQI QA Process Identify or define the problem Establish a method to evaluate the problem Set a timeline for data collection Collect the data

25. Risk Management / CQI QA Process (Cont.) Analyze the results Discuss the findings and make conclusions Suggest alternatives to rectify the problem Try a solution - evaluate

26. Risk Management / CQI 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

27. Risk Management / CQI

28. Health Care QA System wide indicators Department indicators Interdisciplinary indicators

29. Risk Management / CQI Health Care QA Quarterly projects standard

30. Risk Management / CQI JCAHO Standards Early response to medical error Root- cause analysis Sentinel event database Continuous review

31. Risk Management / CQI Ideal People would report error System would assess error System would assess error Take corrective action Take corrective action Monitor for additional sources of error Monitor for additional sources of error without fear of punishment Liang BA, MD, PhD, JD

32. Risk Management / CQI Elements of successful CQI projects Team effort in design Employee involvement at all levels Quality is part of job description Safety in participation Continuous effort

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

34. Risk Management / CQI Risk Management Clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury to patients, staff, and visitors and the risk of loss to the organization itself

35. Risk Management / CQI

36. Procedures Equipment Facilities

37. Risk Management / CQI Clinical Nutrition and Food Service Systems High risk areas *

38. Risk Management / CQI Clinical Nutrition and Food Service Systems

39. Risk Management / CQI Clinical Nutrition and Food Service Systems

40. Risk Management / CQI Clinical Nutrition and Food Service Systems High risk areas * Equipment - knives / blades * Wet floors * Cleaning solutions * High turnover in personnel

41. Risk Management / CQI Risk Management:

42. Risk Management / CQI The Perception of Risk Not always about money Encourage discourse between legal and medical professions

43. Risk Management / CQI Bursztajn HJ and Brodsky A “A New Resource for Managing Malpractice Risks in Managed Care” Arch Intern Med 156:2057-63, 1996.

44. Risk Management / CQI Seven Basic Quality Control Tools Process Flow Charts Process Flow Charts Checksheets Checksheets Run Charts Run Charts Scatter Diagrams Scatter Diagrams Cause-and-Effect Diagrams Cause-and-Effect Diagrams Histograms and Bar Charts Histograms and Bar Charts Pareto Charts Pareto Charts © The McGraw-Hill Companies, Inc., 1999