1. Patient safety and clinical risk management
Presented by,
Mrs. M.Josephin Dayana,
Tutor

2. PATIENT SAFETYANDINFORMATICS
 Patient safety is a health care discipline that emerged with the
evolving complexity in health care system
 Patient safety is fundamental to delivering quality essential
health services.
 It aims to prevent and reduce risks, errors and harms occurs to
patients during provision of health care.
 To ensure successful implementation of patient safety
strategies.

3. DEFINITION
 “SAFETY OF PATIENT DURING THE
PROVISION OF HEALTH SERVICES THAT ARE
SAFE AND OF HIGH QUALITY IS A PRE
REQUISITE FOR STRENGTHENING HEALTH
CARE SYSTEM AND MAKING PROGRESS
TOWARDS EFFECTIVE UNIVERSAL HEALTH
COVERAGE.”

4. PRINCIPLES OF PATIENT SAFETY
 Proper identification of patients and matching to their care
elements.
 Prevent of patient handover error and safety during transition.
 Assessing medical accuracy while giving care to a patient
 Performance of correct procedure at correct body side
 Take appropriate precautionary measures to avoid infection

5. Common sources of patient safety issues
 Every year, millions of patients suffer injuries or
die because of unsafe and poor quality of care.
 Many medical practices and risks associated with
health care are emerging as major challenges for
patient safety and contribute significantly to the
burden of harm due to unsafe care.

6.  Medication error
Medication error are a leading cause of injury and avoidable harm
in health care system: globally the cost associated with medication errors
has been estimated at billions annually.
 Health care associated infections
occurs in 7 and 10 out of every hospitalized patients in
high income countries and low and middle income countries
respectively.
 Unsafe injection practices
In health care settings can transmit infections,
including HIV and hepatitis B and C and pose direct
danger to patient and health care worker

7.  Diagnostic errors
occurs in about 5% of adult in outpatient care settings more
than half of which have the potential to cause severe harm.
 Unsafe transfusion practices
In health care setting expose the patient to the risk of adverse
reaction and the transmission of infection
 Radiation errors
Involves overexposure to radiation and cases of wrong patient
and wrong site identification.

8.  Sepsis
Is frequently not diagnosed early enough to save a patients
life. Because these infections are often resistant to antibiotics,
they can rapidly lead to deterorating clinical condition
 Venous thromboembolism
is one of the most common and preventable causes of
patient harm, contributing to one third of the complications
attributed to hospitalization.

9. New technologies usedto improve the patient safety
SMART PUMPS
smart pumps allows clinicians to pre-program standard
concentrations and upper and lower dose limits for a variety
of drugs

10.  AUTOMATED DISPENSING CABINET
Automated dispensing cabinet are computerized point
of use Management systems for medications and
supplies. These systems are storage devices that
electronically dispense medication and supplies at the
point of use in a controlled fashion on .

11.  BAR CODE TECHNOLOGY
Bar code technology is intended computerized
system database, the bar code contain information on the
patients name, drug, dose ,route and time of
administration. In this technology used to significant
reduction in medical administration errors.

12.  COMPUTERIZED CARE DOCUMENTATION
computerized documentation of care allows
the health care team to directly enter information
about service delivered into patient chat via
computer

13.  CLINICAL DECISION SUPPORT SYSTEM
CDDS are IT applications designed to improve clinical
decision making, increase coordination between
practitioners and promote the use of guidelines.
 COMPUTERIZED PRESCRIBER ORDER ENTRY
It is a computer based system that allows direct entry of
medical orders by a physician, nurse practitioner or healthcare
provider. Direct entering order into a computer can reduce
errors associated with hand written order

14.  ELECTRONIC HEALTH RECORDS
storing health records electronically can improve
patient safety through improving communication across
the patient journey and reducing the loss of patient
information, removing the errors associated with
translation such as poor hand writing.
 ELECTRONIC INCIDENT REPORTING
Patient safety incidents occur despite the
dedication, training and professionalism of health care
providers

15. DIFFERENT AREAS OF PATIENTSAFETY
MEDICAL SAFETY
SURGICAL SAFETY
ELECTRICAL
SAFETY
LABORATORY
SAFETY
BLOOD AND FIRE
SAFETY

16. MEDICAL SAFETY
ILLRGIBLE PRESCRIPTION
WRITTING
WRONG
MEDICATION/DOSE/PATIENT
WRONG ROUTE OF
ADMINISTRATION
PROPER HANDING OVER/
TAKING OVER

17. SURGICALSAFETY
Consent of the patient/relative in writing
 Proper identification of patient
 Pre anesthetic check up
 Ensure no foreign body left inside
 Prevention of surgical wound infection

18. ELECTRICALSAFETY
USE
GENERATOR
PROPER
PLUGGED
AND FIXED
AVOID SHORT
CIRCUIT

19. FIRE SAFETY
HAVE FIRE
EXTINGUISHERS
FIRE PROOF
MATERIAL FOR
CONSTRUCTION
TRAINNED
EXECUTIVE IN
FIRE
MANAGEMENT

20. BLOODSAFETY
PROPER GROUPING/ CROSS MATCHING
CONTROL OF MISMATCHING REACTION
PROPER LABELLING OF GROUP,NAME
OF THE PATIENT
STANTARD OPERATION PROCEDURE
INFORM ADVERSE REACTIONS TO
BLOOD BANK

21. LABORATORY SAFETY
AVOID
NEEDLE STICK
INJURY
RADIOLOGY
SAFETY
MEASURES

22. CARE OF
HANDLING
ACIDS
BIO MEDICAL
WASTE
SEGREGATION
MANAGEMENT

23. GENERALMEASURES TOIMPROVE PATIENT SAFETY
ENCOURAGE
STAFF
INCIDENT
REPORTING
IN DEPTH
INCIDENT
ANALYSIS
ALL INCIDENTS
REPORTED
REDUCE THE
ADMINISTRATIVE
BURDEN

24.  IMPLEMENTING AND MONITORING
IMPROVEMENT

25. SOLICIT AND USE PATIENT OUTPUT
IMPROVE THE QUALITY
AND SAFE CARE
ACTIVE PATIENT
PARTICIPATION
ACTIVELY LISTENING THE
PATIENT EXPERIENCES

26. INCREASE THE SAFETY OF HEALTH CARE
PROFESSIONALS
PROVIDE MEDICAL SUPPORT PROVIDE PSYCHOLOGICAL SUPPORT

27. IMPACTSON PATIENT SAFETY ANDCARE
 Easier access to information
 Adoption of digital medical records
 Reduction of drug related errors
 Improved public health
 Clinical decision support

28. Clinical risk
 Clinical risk can be caused by many factors in
systems; the environment and the individual
interplay in processes related to care provision.
 patient safety requires the application of risk
management
 Risk management in hospitals is an important
everyday issues because of more complex
treatment and procedures.

29. Risk management
o Risk management is a systematic approach to
identifying, analysing and responding to risks
maximizing the probability and consequences of positive
event.
o Working together as a team will improve patient
outcomes and mitigate risks.
o The interpersonal approach leads to enhanced patient
care and a reduction in potential risk

30. Risk management definition
According to McGowan et al;
Risk management requires each
provider to be aware of the inherent risk and benefits
of care of the patient and a goal among all providers
to “ first do no harm”.

31. Goal of risk management
ON PATIENT
TO ELIMINATE OR
DECREASE RISK
INCIDENCE
ON MEDICAL
STAFF HEALTH AS
WELL AS
ON TOTAL
MEDICAL
INSTITUTION

32. OBJECTIVES OF THE RISK MANAGEMENT
 Ensure compliance with applicable rules and
regulations.
 Assurance that the activities comply with
PACED
 Support decision making with appropriate
risk based information

33. Steps in risk management
 Identify the risk – distinguishing the possible risk
Assess the risk – analysing the probable impact of the
identified risks
Control the risk – managing or mitigating the risks
depending on the risk nature
Review the process- evaluating the process of risk
management to the requirement

34. Principles of risk management
 The main principle of risk management is that it reduces the
volatility or uncertainty of outcomes thus achieving the best
possible results
P - Propotionate to the level of risk
A - Aligned with other related activities
C - Comprehensive , systematic and structured
E - Embedded within healthcare processes
D – Dynamic, iterative and responsive to cange

35. Principles of risk management
 Risk management is a systematic approach to identifying ,
analyzing ,and responding to risks, maximizing the
probability and consequences of positive events
,minimizing the probability and consequences of adverse
events.

36. RISK MANAGEMENT STRATEGY
 Create an environment that fosters success
 Be realistic
 Educate
 Listen to needs and concerns
 Set strategic
 Communicate frequently, honestly , and succinctly using
appropriate methods.

37. CLINICAL RISK MANAGEMENT
According to WHO, clinical risk management specifically
is concerned with improving the quality and safety of health –
care services by identifying the circumstances and
opportunities that put patients at risk of harm and acting to
prevent or control those risks.
Yasser K. Alotaibi and frank Federico recommend
a comprehensive framework for organizations looking to
improve patient safety outcomes when using health
information technology which includes the following :

38. Health information governance :
Organization must establish a health information oversight
mechanism that includes leadership and relevant stakeholders.
Safety risk identification :
Organizations need to identify areas that health information
technology might aid in improving patient safety namely ,
medication safety , guideline adherence and so forth

39. 3. stake- holder involvement :
Stakeholders need to be involved in all phases of health
information projects from planning and implementation until
continuous improvement.
4. informed decision :
Organizations need to review the cost effectiveness of
suggested technologies , which includes conducting an evidence
based decision and an evaluation of the current information
technology infrastructure including software and hardware.
5. Sufficient training :
Organizations need to ensure that all relevant line staff
receive sufficient training on the use of the proposed health
information technology.

40. 6. Gradual implementation:
Rolling out the technology in a gradual stepped approach is crucial to
avoid disruption of current processes and systems.
7. Continuous evaluation and monitoring of patient safety
outcomes : Organizations need to measure patient safety
outcomes on a continuous basis especially during the initial
implementation to ensure that the new technology achieves its
intended outcome.

41. 8. Technology optimization :
Organizations need to modify and fine tune the implemented
technology based on user feedback and patient safety
outcomes.
9. Regular technology updates :
Organizations must ensure that health information
technologies are continuously updated to comply with recent
best clinical practices , regulatory standards, and technical
stability.

42. FUNCTIONS OF RISK MANAGEMENT PROCESS
 Provide an agreed trust wide structure for assessing
clinical risk
 Ensure that staff are aware of their responsibilities in
relation to risk management
 Ensure that patients/ service users and their
responsibilities in relation to risk management

43.  Outline a clear process for risk management including
timescales.
 Ensure the tools that are authorized for use in clinical
risk assessment are evidenced based
 Promote the importance of accurate and clear
recording of identified risks and associated
management

44. A process model for risk assessment and management
 Initial clinical risk assessment/ screening
Initial risks management plan
Comprehensive risk assessment
Comprehensive risk management plan
Positive risk management and positive risk
taking
Risk management review

45. INITial clinical risk assessment/ screening
 This screening assessment provides a record of the information
and available at the time of the assessment .
 In some circumstances the initial screening assessment and
the initial risk management plan may be completed by a single
practitioner.
 This information would support the development of the initial
risk management plan as indicated
 The trust may benefit from the development of local SOPS (
Standard Operation Procedures)

46. Initial risk management plan
 The aims of this plan is to ensure the safety of
the individual and others during the initial episode
of care

47. Comprehensive risk assessment
 In most circumstances the comprehensive risk assessment
and management plan would be led by a named
professional who will ensure that there is a coordinated
plan .
 They will be supported by the MDD and the patient / service
user and or family.

48. Comprehensive risk management plAN
 The management plan would reflect all of the risk indicators
identified through the assessment processes.
 It would include short and long term risk management
options short term options should include crisis and reactive
strategies.
 It would ensure that the persons wishes are considers as
far ‘as they are able to’ in the context of a capacity
assessment

49. Positive risk management and positive risk taking
 working with the service user to identify what is likely to work-
and what is not
 paying attention to the views of carers and others around the
service user when finally deciding a plan of action
 Weighing up the potential costs and benefits of choosing one
action over another
 Being willing to take a decision that involves an element of
risk because the potential positive benefits

50. Risk management review
 At regular intervals for individuals as determined by their
management plan
 At regular intervals as defined by the service (e.g.weekly
ward round for in patient)
 At significant point in care pathway
 When transferring from one service / team / worker to
another
 When being discharge from a service.

51.  Summary
Today we are discussed about the patient safety and clinical risk
definition, aims, goals, objectives and strategies involve in patient safety .
 Conclusion
At the end we can say that patient safety plays an important role
in the professional as well as personal development of nurse. Patient safety
and clinical risk management should be developed by the nurses and
conducted within the nursing or in general educational system in cooperation
with the nurses. Hope you might understand the introduction, definition,
goals, aims, objectives, and the strategies involve in patient safety and
clinical risk.

52. Evaluation
 Essay (1x15=15)
1.Explain in detail about the risk management process.
 Short notes: (2x5=10)
1.Impacts of health informatics in patient safety and care
2.Health risk management plan
 Short answers (2x2=4)
1. Principles of patient safety
2. Action measures to ensure the fire safety

53. Bibliography
 A.Ian clement and s.p. subashini, HEALTH/NURSING
INFORMATICS AND TECHNOLOGY, published by frontline
publication, 1st edition, page preferred 109-126.
 Neelam kumary and poonam verma, HEALTH/NURSING
INFORMATICS AND TECHNOLOGY, published by s.vikas
and company, 2022edition, page preffered 146-155.
 https://www.slideshare.net/kavanti23/patient-safety-and-risk-
management-in-hospitals
 https://www.slideshare.net/NcDas/patient-safety-12021837