An effective risk management program in healthcare settings , according to experts , must involve a risk assessment of the buildings , grounds , equipment , occupants , and internal systems plus policies and procedures for the timely reporting and resolution of situations that pose an immediate threat to life , health or property .”
Litigation Prevention : The Importance of Risk Management
In the traditional sense , risk management-related functions encompass activities that are intended to conserve financial resources from loss . An effective risk management program in healthcare settings , according to experts , must involve a risk assessment of the buildings , grounds , equipment , occupants , and internal systems plus policies and procedures for the timely reporting and resolution of situations that pose an immediate threat to life , health or property . According to the APIC Text ’ s legal chapter , a risk management program includes the following components of risk identification , risk analysis , risk control and risk financing :
• Reducing financial losses through effective investigation and management of claims .
• Developing a patient representative program
• Reviewing and coordinating insurance program .
• Inspecting the premises and discovering deficiencies in the physical plant
• Reviewing policies and procedures to reflect acceptable quality of care
• Investigating adverse incidents and reviewing incident reports
• Reviewing patient grievances
• Conducting educational programs to minimize future risks
• Conducting root cause analysis to determine what contributes to an adverse event
As Sheridan ( 2024 ) notes , “ When an issue of potential liability arises , organizations should consult with legal counsel to determine an accurate account of the findings in the matter . Resolution of legal issues usually depends on whether state or federal law applies to the situation , as well as determination of compliance with national patient safety goals , regulatory standards , organization policies , and , in the absence of written statutes , whether a previous case decision has established legal precedent .”
Kroll advises that all IPs develop a relationship with their hospital ’ s key stakeholders related to litigation .
“ I believe very much in a close partnership with your risk management and legal departments ,” she says . “ Having that partnership also helps you to understand , from a documentation and root-cause analysis standpoint , how we protect discoverability , so that people know that they can say whatever happened , and that ’ s not going to be something that they ’ re penalized for . There ’ s a clear line between what risk management does and what quality , infection , prevention , patient safety do . Many organizations have them in under the same umbrella , because if you do your performance management and your quality management , patient safety , infection prevention , you ’ re making the job of those risk managers easier .”
She adds , “ Medical records management can also help IPs by pulling medical records . With infection prevention , my experience is , I have had success in saying , ‘ Okay , as part of my documentation from this investigation I ’ m calling out specifically where that correlation is , and where it is in the record .’ Because that also helps point them to what to pull .”
Litigation Prevention : Practicing Good Medicine
Oftentimes , plaintiffs sue because they believe malpractice was involved . It is important to make the distinction that HAI-related litigation is separate from medical malpractice because it is geared more toward the healthcare institution than the actual clinicians , and so it is more of a civil , wrongful tort action that would be primarily aimed against the healthcare facility . Kroll sheds light on where IPs must draw the line . “ I think that the important part of this is around if an infection preventionist is reviewing a chart , and they ’ ve got concerns about the provider , we don ’ t have the expertise to be able to say , ‘ Gosh , this seems wrong ,’ but what we have is the ability to bring in our medical directors , our provider partners to say ‘ We have some concerns ,’ and then that provider partner can refer that for peer review and go through that process . So , if you find that as an IP , you have that avenue to escalate that , and to say , ‘ I ’ m concerned .’ I had that happen and pushed cases into that process . What ’ s hard for an IP is that is a peer-review , closed-door process ; you don ’ t get to know the outcome and you must trust that your partners in the peer review and in that part of the medical staffing will appropriately manage it .”
Goguen ( 2015 ) reminds us that failure to follow evidence-based practices can amount to medical negligence , and outlines three risk factors for acquiring an infection :
• Patient Risk Factors : These include the duration of the patient ’ s stay in a clinical setting , the severity of the illness or injury for which the patient was admitted , and the function and capacity of their immune system during their visit .
• Organizational Risk Factors : These include the cleanliness of the hospital and treatment setting in general , including the filtration of the HVAC system , concentration of patient beds , cleanliness of water systems , cleanliness of building surfaces , and sterility of medical devices .
• Iatrogenic Risk Factors : These include the care with which the doctors , hospital staff , nurses and other care providers perform . This includes the frequency with which hands are washed , use of antibiotics , and especially care used during invasive procedures such as intravenous administration of medication , intubation , and urine catheterization .
“ A lot of that is baked in because we look at individual risk factors as they relate to firing up an infection , and we consider that as part of our definition ,” Kroll says of the various risk factors involved . “ And this is also the part where a lot of what infection prevention and surveillance has historically done is very definition-based . And you ’ ve got this CDC and NHSN definition , but those don ’ t necessarily correlate with true patient harm . It ’ s hard to make a definition that does all of that , and so the other piece of it is recognizing that yes , we have these nationally notifiable conditions that we can aggregate up and slice dice and get information . For me , and something that I ’ ve done in our organization is transition the conversation from being about ‘ it met the definition ’ to saying , ‘ Did this cause patient harm or not ,’ and even if it ’ s reportable and it didn ’ t cause patient harm , really saying , ‘ Okay , we ’ re going
18 • www . healthcarehygienemagazine . com • september 2024