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SPANISH EXPERIENCE IN CLINICAL RISK MANAGEMENT

EUROPEAN WORKSHOP ON HEALTHCARE RISK MANAGEMENT Roma, June 13th 2005. SPANISH EXPERIENCE IN CLINICAL RISK MANAGEMENT. AEGRIS (Spanish Society of Clinical Risk Management) Department of General and Digestive Surgery Clinical Risk Management Unit

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SPANISH EXPERIENCE IN CLINICAL RISK MANAGEMENT

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  1. EUROPEAN WORKSHOP ON HEALTHCARE RISK MANAGEMENT Roma, June 13th 2005 SPANISH EXPERIENCE IN CLINICAL RISK MANAGEMENT AEGRIS (Spanish Society of Clinical Risk Management) Department of General and Digestive Surgery Clinical Risk Management Unit Complejo Hospitalario de Ciudad Real. Spain

  2. THE SPANISH EXPERIENCE IN RISK MANAGEMENT….. FROM A NATIONAL AND REGIONAL POINT OF VIEW… TO THE PRACTICAL REALITY IN A TERTIARY HOSPITAL

  3. Ciudad Real 17 REGIONS + 2 CITIES 18 HEALTH AUTHORITIES

  4. Spanish Legal System • Criminal Court • Administrative Court. In a public Health System all the compensation claims are against the institution, not the individual (Laws: 30/1992, 4/1999, 19/2003)

  5. Since there are 18 different Health Authorities it is nearly impossible to obtain global data on the number and economical impact of claims. All public data available are those from the INSALUD between 1995 and 2000

  6. INSALUD: 13 million population • 1995-1998: 6,000,000 € • 1998 – 2000: 9,000,000 € • 2000 – 2002: 18,000,000 € • 2003 – 2004: 26,500,000 € • 63 million € in 2003 for all the NHS. • Number of claims from 1995 to 2000: 2.700 with an increase of 15% every year

  7. ACCIDENT/ 100 BEDS: 2,1 • COST/BED: 310 € • COST/ACCIDENT: 15.000 €

  8. NATIONAL INITIATIVES • GOVERNMENT… • NHS Quality Agency. Four step policy: • Prioritize • Improve reporting systems • Improve professional competence • Improve common strategies in all the different organizations

  9. NATIONAL INITIATIVES • GOVERNMENT… • NHS Quality Agency. Four step policy: 1.- PRIORITIZE Patient Safety Meeting (Feb 8th, 2005) Experts Workshop Technical Group involving all regions Proposals to the National Health Authorities

  10. NATIONAL INITIATIVES • GOVERNMENT… • NHS Quality Agency. Four step policy: 2.- REPORTING SYSTEMS Still doubts to be resolved…… • Confidentiality • Independence from Insurance companies and Justice • Not punitive…

  11. NATIONAL INITIATIVES • GOVERNMENT… • NHS Quality Agency. Four step policy: 4.- IMPROVE COMMON STRATEGIES • With Professional associations • With patient’s associations • With judges • Create a safety policy….

  12. NATIONAL INITIATIVES • GOVERNMENT… • NHS Quality Agency. Four step policy: SAFETY POLICY 6,000,000 € BUDGET. 4 objectives • Study the incidence of adverse events • Training for medical and non medical staff • Identification systems for in- patients • Improvement of Nosocomial infection rate

  13. NATIONAL INITIATIVES • GOVERNMENT… • NHS Quality Agency. Four step policy: SAFETY POLICY 6,000,000 € BUDGET • Allocated to the Regional Health Authorities to complete the four objectives

  14. NON GOVERNMENTAL INITIATIVES • AEGRIS • Training in Clinical Risk Management. • Publications. • Courses. • Annual Congress dedicated to CRM • Patient Safety Centre (Avedis Donavedian Foundation)

  15. SCIENTIFIC RESEARCH • IDEA project. San Juan University. Prof Aranaz. • Medication errors, ISMP Spain. Universities of Salamanca, Barcelona, Madrid, Pais Vasco • Adverse events incidence. Cataluña hospitals. MAPFRE foundation • And so on…….

  16. REGIONAL INITIATIVES REGIONAL HEALTH AUTHORITY MURCIA

  17. REGIONAL INITIATIVES MURCIA HEALTH AUTHORITY • 1.- Creation of a Central Patient Safety Regional Unit • Run by experienced professionals in Clinical Risk Management • All the background and information from previous claims • Support for Risk Management Programmes • Drive Adverse Events studies • Create an Incident Reporting System • Analyse Incidents reported centrally and propose corrective • measures in collaboration with the Local CRM Units • Training of medical and non medical staff in CRM • Appoint Clinical Risk Managers • 2.- Creation of Local Clinical Risk Management Units In one years time

  18. LOCAL INITIATIVES CASTILLA LA MANCHA HEALTH AUTHORITY (SESCAM) CREATION OF A CLINICAL RISK MANAGEMENT UNIT IN CIUDAD REAL. SEPTEMBER 2004

  19. HOW TO IDENTIFY RISKS IN A PRACTICAL WAY? • CREATION OF A CLINICAL RISK MANAGEMENT UNIT IN CIUDAD REAL GENERAL HOSPITAL 2004 • SUPPORT FROM THE CHIEF EXECUTIVE OF THE SESCAM • SUPPORT FROM THE HOSPITAL MANAGER • SUPPORT FROM THE HEAD OF DPTS • STAFF (MEDICAL, NURSES, AUXILIARY NURSES, ADMINISTRATIVE, PORTERS….)WHO WANTED TO VOLUNTARILY COLLABORATE IN THE PROJECT ……remunerated with days

  20. CLINICAL RISK MANAGEMENT UNIT • Mainly by clinicians • 3 area supervisors (surgical, medical and central sevices) and 2 nurses from A&E • 3 surgeons • Medical staff, nurses, auxiliary nurses who want to participate from: • GENERAL SURGERY • A&E • THEATRES • NUCLEAR MEDICINE • GYNAE AND OBST • NEPHROLOGY • ENT…

  21. CLINICAL RISK MANAGEMENT UNIT • All work full time in their clinical work and help in the Unit as volunteers the time they can • Unit situated on the 7th floor, 24 m2 ….…far from the Executive Management of the Hospital

  22. OBJECTIVES • Risk Assessment of the Units • Implementing an incident reporting system • Analysis of incidents • Identification, common proposals for changes in close collaboration with the Head of Dpt, follow up of actions taken • Cooperation in how to develope and produce reportsreports after receiving a claim

  23. OBJECTIVES • Advise in high risk situations • RM Continuous Education for staff • Help in the design of RM Programmes for the Dpts that want to collaborate • Establish a“zero tolerance” policy related to agression against staff

  24. ACTIONS PERFORMED • 73 actions….. • Presentation of the CRM Unit at the General Session of the Hospital • Presentation of the Law 41 at the General Session of the Hospital • All Informed Consent forms from the Dpt of General and Digestive surgery were adapted to comply with the new Law 41 • Creation of an Informed Consent processfor sedation in terminal patients

  25. ACTIONS PERFORMED • Confidentiality in the Pathology results circuit • Assessment of high risk situations when asked by nurses or physicians involved • Confidentiality for admitted patients • New circuit for pathology specimens obtained in theatre

  26. ACTIONS PERFORMED • Claim reports (11 cases) • Intervention in risk situations when the family or relatives are not happy with medical care given (internal medicine, urology, A&E) • Reports about capability of medical and non medical staff….that can affect patient safety….can this resident, doctor, nurse take care of the patient?? • First step after physical and non physical violence against staff

  27. ACTIONS PERFORMED • Modification of the diagnostic imaging contrast medium injection protocol at the Nuclear Medicine Department (double cheking) • Assessment of Medication errors on the wards • Creation of a “Patient Safety Comission” with the participation of all the directors of the hospital and Health and Safety • Clinical Risk Management 50 hours course ready to start

  28. NEW RESEARCH PROJECTS • Adverse Incident Review of Medical records. Clinical application of the research project. In collaboration with the Patient Safety Unit at St Mary’s Hospital, Imperial College, London directed by Professor Charles Vincent • Effect of Distractions in theatre related to Patient Safety. In collaboration with the Patient Safety Unit at St Mary’s Hospital, Imperial College, London directed by Professor Charles Vincent

  29. NURSES ACTIONS PERFORMED • Creation of an information leaflet for auxiliary nurses who are new starters to theatre explaining Pathology specimen circuit…and what to do with them • Design of Induction Programmes for nurses working in A&E, Surgical Area and ICU • Identification band for patients admitted to A&E • New counting system for swabs in theatre • Pilot project for a new medication system (Surgical Department) • Collaboration with Haematology in the design of the transfusion process/policy circuit • Organizational changes in A&E aiming to improve Patient Safety

  30. MAJOR PROBLEMS FOR THE UNIT

  31. LACK OF TIME..........

  32. SCEPTISCISM.........

  33. IT IS NOT A PRIORITY NOW…..

  34. I DO NOT COLLABORATE WITH THE MEDICAL DIRECTORS……

  35. IF IT IS RUN BY SURGEONS I DON’T WANT TO KNOW ANYTHING ABOUT IT........

  36. THE FUTURE IS NOT EASY, BUT NOBODY SAID IT WAS GOING TO BE AND A FINAL CONCLUSION…

  37. THE SUCCESS OF CLINICAL RISK MANAGEMENT DEPENDS DIRECTLY ON THE INVOLVEMENT OF ALL MEDICAL AND NON MEDICAL STAFF WORKING IN A HOSPITAL….

  38. ….IT DOES NOT DEPEND ONLY UPON THE POLITICAL DESIRE….. “DO IT…….IT WILL WORK”

  39. PATIENT SAFETY POLICIES WE ALL DREAM OF.........

  40. DON QUIJOTE RULES….

  41. If you follow these rules , Sancho, . Your days will be long, . Your fame eternal, . You will receive many gifts, . Your happiness will be impossible to describe, . Your children will marry as you desire . You will live in peace with your people . And you will improve patient safety….

  42. “2005. IV CENTENARY” EL INGENIOSO HIDALGO DON QUIJOTE DE LA MANCHA PART II CHAPTER XLI

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