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Abstract
Vascular catheter-related infections have become common cases today, leading to loss of lives. This is a hospital acquired condition, which is expensive for hospitals to deal with, once it happens. It is therefore, necessary that all health facilities exposed to the risk of vascular catheter-related infections adopt a proactive risk management assessment, in order to prevent this condition, which is detrimental to both the patient, and hospital. The risk management process comprises various steps, which must be performed appropriately to ensure great outcome. The process also requires strong leadership and the involvement of the hospital staff, health professionals, patients, and their families. This will help prevent this risk, which undermines patients’ safety and the nursing practice.
Introduction
Risk management in health organizations is essential as it enhances the safety of patients in health facilities. Therefore, managers have the responsibility of overseeing the processes involved in both proactive risk management and patient safety in their health facilities. There are different risks, which patients in hospitals are exposed to, and fortunately, all of them can be managed beforehand. An example is the risk concerning the hospital acquired conditions by patients. There are various conditions patients might catch in the course of their nursing care, as a result of the nurses’ error, among other reasons. This is always costly to the health facility, and therefore, it is better if such risks are managed proactively, to save the health facility costs.
It is estimated that close to 100,000 cases of vascular catheter-related infections occur every year, causing an estimated 28,000 deaths. The treatment of each case costs about $45,000. This makes vascular catheter-related infections a big and costly problem for any health care organization. This is a hospital caused condition, which results when bacteria follow along after the insertion of a catheter. These bacteria could have come from the catheter itself due to contamination, poor aseptic methods, or natural skin flora, among others. Solutions to this incident include using proper aseptic technique, changing catheters at a fixed interval and using catheters made of materials more resistant to adherence by pathogens can reduce the number of bloodstream infections at a facility. For many years, it was considered that the hospital acquired conditions are inevitable and nothing could be done about it. However, different studies later showed that more than a half of all HAIs were preventable, if evidence-based strategies are used, in addition to the culture of safety in health organizations. This paper focuses on the proactive risk management of catheter-related infections in a health facility, and why it is important to manage such a risk proactively (O’Grady & Pittet, 2004).
Proactive Risk Management Assessment
Risk management is essential in all industries. This addresses liabilities in a proactive and a reactive manner. In the health care sector, risk management puts into consideration the safety of patients, the rights of patients, as well as quality assurance. It is important to proactively manage risk in health care, as this might happen in different health care aspects, such as errors in the electronic record keeping, and medical errors. In this case, the risk of vascular catheter-related infections occurs because of medical errors (Kavaler & Spiegel, 2003).
This situation therefore, requires to be risk managed, as vascular catheter-related infections result in the great loss by health organization, since treatment of this is expensive. Proactive risk management assessment will be instrumental in preventing the occurrence of the catheter-related infections. In this risk management programme, the first step will be to form a team of professions, which will identify and review any activities that may lead to this condition in the health organization. After reviewing the risks, the team will quantify the risk. This is by reviewing the impact the risk might have on the health facility, and the probability of its occurrence. This will be by the use of a scale of 1-4, one being low, and four being high. Finally, the team will set up the mitigation plans for the risk, which in this case will involve both individuals and groups of people in the health facility (Kavaler & Spiegel, 2003).
The nurses and other staff members will be exposed to occasional trainings on the vascular catheter-related infections, how these occur, and their prevention. This will make them adjust their practice and work in ways that will reduce the risk of vascular catheter-related infections. Using an evidence-based insertion bundle by the nurses, will also be recommended, as a preventive strategy of the risk. In addition, emphasis on observing hand hygiene during the insertion process, as well as use of sterile gloves and other maximum barrier precautions during the process. Likewise, staff will be encouraged to promptly remove devices, when they are no longer needed (Sharpe, 1999).
Monitoring Risk
The risk management team will perform monitoring and updating of the risk. The mitigation plans identified will also be updated in this step. The team will meet regularly for the purpose of reviewing and updating the gathered risk information. Monitoring of this risk will be performed by different products and tools, which are capable of reporting potential risks.
Monitoring will involve the use of checklists to record adherence by the nurses to the recommended safety practices. During the training, nurses will have been trained on various preventive strategies and safety measures to practice in order to prevent vascular catheter-related infections. These will be monitored as they work, to prove if they adhere to the recommended practices. Such process measures are multiplied by 100 to get a percentage, the highest being 100 per cent, which is also the target measure. The staff should be able to adhere to the elements of insertion they were trained on, as well as other preventive and safety measures during the process, including hand hygiene, cleaning and disinfecting of equipment, and use of sterilized equipment in the process, among others. Monitoring will also involve the assessment of the nurses’ insertion practices in individual units and facilities. Finally, from the monitoring process, gaps will be identified in the recommended processes, which help in the improvement of the strategies for prevention of vascular catheter-related infections in the health organization (Kavaler & Spiegel, 2003).
Improvement Recommendations
In order to achieve effective proactive risk management assessment, managers should consider re-establishing their management team. On a regular basis, the managers should select new members and add them to the team, while eliminating the old team members. This is because; having the same individuals in a risk management team is not advisable, as these may not come up with the desired outcome (“The Joint Commission,” 2012).
Managers should also consider hiring members of the risk management team from other companies other than the risk management companies. This is because an outsider might be in a position to identify a risk, which an insider might not take note of. Risk management must also involve the members of staff. Therefore, through a continuous communication with staff members, the manager should ensure that these are updated on the progress of the plan. Involving the staff is serves a function in the risk management process, as these will be able to adjust their work practices, in relation to the risk identified (“The Joint Commission,” 2012).
Leadership of the health facility will play a big role in the improvement of the risk. The proactive risk management assessment introduces a form of culture change in the health organization, therefore, the CEO and other leaders must show commitment to the process. These must communicate the goal of the program to the staff, provide the financial resources required for the program, and collaborate with staff to overcome potential obstacles to the program (Youngberg, 2011).
A culture of safety is another recommendation for improvement. The whole organization must exhibit their commitment to the safety of their patients through observing safety in their practice. The environment in the health organization should be blame-free and allow for staff members to freely report in case of any medical error. In this organizational culture, there must be a high level of collaboration among the staff members to ensure that all problems relating to patient safety are solved collectively. Staff members should also be cultured to generously provide any essential resources needed for patient safety (Youngberg, 2011).
Empowerment of staff is essential as an improvement recommendation. When staff members are empowered, they will be able to speak out fearlessly and without intimidation, when they witness unacceptable behaviour and actions, which could jeopardize patient safety. Managers must also ensure there are sufficient resources needed for the efforts aimed at preventing the risk. These include training equipment, training and competency assessment resources, trained professionals as trainers, and maintenance of an appropriate level of staff (Kavaler & Spiegel, 2003).
The management should also ensure the availability of written policies and procedures, with the guidelines for the evidence-based practices. This should be made available to all staff members, as a reminder and guide in their practices. It is also necessary to update them, review them, and monitor their effects on the practice of the staff. Finally, it is advisable to involve patients and their families in the risk assessment process. These will be brought on board to receive education and training on the preventive steps they can take to ensure that the risk of vascular catheter-related infections is reduced (“The Joint Commission,” 2012).
Conclusion
Proactive risk management is a crucial process for any health organization, and it is advisable that all health facilities identify, analyze, and manage their risks. Risks in health facilities are different, depending on the health services they offer. In the case of catheter-related infections, it is important that this condition, which is a risk, be managed before it happens. This is because it is expensive to deal with, and to manage hospital acquired conditions once they happen. Therefore, a plan should be put in place for health facilities vulnerable to this risk, to ensure that they manage the risk. Managing this risk involves various steps. Once the risk is identified, its regulatory requirements are put into consideration, as well as the implications, the environment within which the risk might occur is also assessed. Monitoring and assessment of the process is equally important to determine the progress or the effect the risk management program is making on the health facility. In addition, risk management process requires different resources, to make it effective. There are various factors that influence the risk management process, and these can influence it positively or negatively. The organizational culture is one of the factors that play a major role. If the organizational culture is conducive, then the risk management will be successful. Additionally, the risk management process must include all the staff of the health facility, including some patients and their families. This is therefore, a collective role that must be played by different parties, to ensure the safety of patients. Managers therefore need to ensure that all conditions in their organization are favorable for the success of their proactive risk management.
References
“The Joint Commission.” (2012). Preventing Central Line Associated Bloodstream Infection: A
Global Challenge, A Global Perspective. Retrieved 5 February 2013 http://www.jointcommission.org/assets/1/18/CLABSI_Monograph.pdf
Kavaler, F. & Spiegel, A. (2003). Risk Management in Health Care Institutions: A Strategic
Approach. London: Jones & Bartlett Learning
O’Grady, N. & Pittet, D. (2004). Catheter-related Infections In The Critically Ill. New
York: Springer.
Sharpe, C. (1999). Nursing Malpractice: Liability and Risk Management. New York:
Greenwood Publishing Group.
Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA:
Jones and Bartlett.
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