Risk Management

Prepared by: Dr. Alber Paules, CPHQ

Introduction
In October 1999, the Institute of Medicine (IOM) released "To Err Is Human: Building a Safer Healthcare System", a report that put the issues of patient safety and medical errors in front of the American public and on the agendas of healthcare institutions, consumer groups, the US Administration and the Congress. This report revealed that up to 98,000 people die in hospitals each year as a result of medical errors and countless more are seriously harmed.

Introduction
NB: Institute Of Medicine (IOM)
An institute formed by the National Academy of Sciences in 1970. It is a non-profit organization which provides evidencebased and independent guidance to the nation's policy makers, professionals, and leaders in the health care sector. The IOM's mission is to serve as an adviser to the nation to improve health. Studies at the IOM are funded by both the governmental and the private sectors.

Medical Errors
The IOM report defines medical error as "the failure of a planned action to be completed as intended (i.e. error of execution), or the use of a wrong plan to achieve an aim (i.e. error of planning)." It also includes failure of an unplanned action that should have been completed (omission). Medical errors may or may not result in adverse events.

An adverse event can be described as "an injury caused by medical management rather than by the underlying disease or condition of the patient."

N.B.
If an adverse event is preventable, then it should be considered to be the result of a medical error (e.g.) administration of an antibiotic to a patient whose medical record shows a prior allergic reaction to this type of antibiotic. If the adverse event is non-preventable, then it should not be considered to be the result of a medical error (e.g.) administration of an antibiotic to a patient who denied any history of allergy towards drugs.

Common Sources of Medical Errors

Drug-related errors, such as those resulting from prescribing the wrong medication or dosage, misinterpreting the correct prescription or prescribing instructions, and using incorrect routes of administration. Diagnostic error, such as misdiagnosis leading to an incorrect choice of therapy, and misinterpretations of diagnostic test results with subsequent wrongful act. Equipment failure, such as defibrillators with dead batteries or intravenous pumps whose valves are easily dislodged, causing increased dosage of medication over a short period of time. Blood-transfusion-related injuries, such as giving a patient blood of an incorrect type. Misinterpretation of medical orders, such as failing to give a patient a salt-free meal as ordered by a physician.

Risk Management
Joint Commission defines Quality as "the optimal achievement of therapeutic benefit and avoidance of risk and minimization of harm." Definition of (Risk Management): "an organized effort to identify, assess, and reduce risk to patient, visitors, staff, and organizational assets."

Risk Management
Risk management is a formal attempt to control liability, prevent financial loss, and protect the financial assets of the organization. Risk management is the reduction or elimination of financial loss due to damage, theft, misplacement of property, or patient injury.

Risks in Healthcare
Professional liability suits and claims. Non-professional liability suits and claims. Destruction of or damage to health organization property, and inability to continue operations due to such destruction or damage.

Goal of Risk Management

The main goal of HC risk management is to create and maintain a safe and effective health care environment for patients, visitors and employees, thereby preventing or reducing financial losses to the organization incurred by the occurrence of any of the pre-mentioned risks. It is the role of the (Risk Manager) to accomplish this goal.