A key strategy to support your learning about patient safety is to reflect on basic concepts and how you can apply these concepts in your daily practice. This article is the eighth in a series highlighting a key patient safety topic.
What are the Major Concepts Related to Managing Risks to Patients in Healthcare Environments?
Managing risks to patients in the healthcare environment requires an understanding that things can and will go wrong. It also requires a view that supports the goal to “create safety” through learning, responding and improving from not only past harm, but also from real time operations, future operations and reliability of systems. This extends beyond learning from critical incidents to include learning from near misses, insights, situations that go well, concerns and hazards.
Actions to improve patient safety include areas previously covered in blog articles one through seven:
- designing work systems to reinforce any potential vulnerabilities, e.g., standardize processes (article two, human and environmental factors)
- situational awareness, e.g., observe the environment and think ahead (article two)
- developing a culture that draws attention to potential hazards or actual failures with the aim to learn and improve (article three, culture of safety)
- commitment to engage patients and families in solutions (article four, engaging with patients and families; article seven, patient family communication)
- developing effective multidisciplinary healthcare teams that anticipate and effectively manage situations that place patients at risk (articles five and six, teamwork)
- organization to create a systematic approach to proactively identify and manage risks in the environment
- individual to competently perform in this system
Safety Practices for Individuals and Organization to Manage Risks
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Organization |
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Integrate key safety practices that reduce the risk of patient safety incidents into everyday practices. For example: * infection control, including aseptic technique, hand hygiene, screening, and surveillance * proper handling and maintenance of equipment * injury prevention, including safe patient transport, handling and transfers, and the removal of physical hazards * the safe administration of medication, including independent double checks, recognition of sound-alike and look-alike medications, use of only approved abbreviations, consistent reconciliation of medication across the continuum and reliable patient identification and alerts * use of checklists and other cognitive aids that are designed to reduce the potential of harm to patients * become knowledgeable about the organization’s policies and processes. |
Integrate proactive learning and improvement into organizational culture. For example: * establish processes to report concerns about patient safety and patient incidents, and learn from near misses and situations involving patient harm (including the lessons of others) * establish consistent, organization-wide, standard approaches and processes to guide practice, e.g., evidence-informed practice guidelines and checklists[1] * ensure that patient safety and risk management data are integrated for analysis, including patient incidents, staff safety data, hazards, complaints, litigation, financial and environmental risks[2] * implement a consistent process to analyze clinical, financial, and operational risks to identify opportunities for improvement * communicate lessons learned from all risk-related information to healthcare providers and staff |
There are many references and websites available on managing risks in healthcare. For more information, see www.mips.ca, Resources, Tips & Research or call 1-866-927-6477.
Learn to be Safe!![1] Canadian Patient Safety Institute. Domain 4: manage safety risks. Patient safety competencies Available at: http://www.patientsafetyinstitute.ca/en/toolsresources/safetycompetencies/pages/default.aspx
[2] NHS Seven Steps to Patient Safety. Available at: http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety/
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