About four thousand years ago, the ‘Babylonian Code of Hammurabi’ prescribed severe punishment for medical practitioners who through malpractice caused injury or death. Thus, Risk Management history in health organizations dates back to this period. In the 1970s, health care providers faced an unprecedented crisis due to the escalation of lawsuits occasioned by malpractices. Faced with these litigations involving huge amounts of money, health care organizations and agencies established risk management personnel and set up activities and programs (Stanhope, 2006). These activities and programs were put in place to prevent ‘adverse patient outcomes and potentially compensable events. This essay focuses on: first, needle prick risks among nurses in a health care setting; second, establishing the context of needle brick risks by considering the role of each of the four different levels within the organization has in the risk management process; third, identifying the scope of needle brick risks among categories such as patient care, clinical staff, other employees, property, financial, corporate governance, and other risks; fourth, analyzing needle prick risks to determine the level of risk; fifth, describing briefly, the devised strategy to either accept or deal with needle prick risks, explaining communication strategies; lastly, outlining the monitoring and review the successes of the strategies.
It is vital at this point of discussion, first of all, all understand risk management and the management process before looking at needle brick as a risk factor among nurses in a health care setting. For health care entities, risk management is referred to as ‘an organized effort to identify, assess, and reduce, where necessary risks to patients, staff, visitors, and the property of the institution’ (Huber, 2006). Risk management may also be described as programs designed to decelerate incidents of harm that can be prevented in order to minimize possible loss of finance to the organization in case of occurrence of an accident or injury, for instance, caused by needle brick risks. Essentially, the risk management process in a health organization deals with the protection of the property of that institution. To achieve this goal, risk management personnel need to follow four steps in progression in the risk management process (Stanhope, 2006)). First, they should perform a diagnostic procedure that involves identifying the risks and their possible potential, for instance, needle brick risks and potential dangers they pose. Second, they should make the assessment or analysis of the risks identified, for instance, needle brick risks, where the probability of adverse effects from risk situations is calculated. Third, they should employ risk control and treatment procedure to reverse the risk potential. And fourth, put in place appropriate risk financing strategies (Heath, 1998).
The risk identification process involvesthe collection of information about a patient’s current and past care occurrences, and also other risks that may pose possible loss to the institution. There are several tools institutions should apply to identify areas of risk. These include: first, the use of incident reports as primary tools for identifying risk areas (Kavaler, 2003). The health institution should proactively examine all information on recorded incidents in order to identify areas of risk. In addition, health organizations may also examine the information from other diverse sources to analyze incident reports to allocate potential risk areas; Second, Health institutions may use other sources available other than incident reports to identify actual or potential risk areas. These may be through; morbidity and mortality conferences, and quality management meetings. It is essential for risk managers and quality assurance managers to attend such meetings. These meetings assist them to gather information on actual medical errors or potential needle prick risk areas that might otherwise not have been made aware of (Rousel, 2003). In addition, these meetings, for instance, may address pharmacy issues which can provide information about such things as drugs that have been recalled, adverse reaction of drugs, and medical errors or delays, if such information is not reported to risk management routinely (JCR Staff, 2004); lastly, the department concerned with medical records in the institution should be instructed to forward to the department of risk management all medical records requests received from reputable plaintiff law firms in the locality (Zimmerman, 1990). Many of these medical records requests from litigation firms may not be relevant to thlawsuitsal law suits against the institution but, it is vital because there will be situations in which needle prick incident report was not concluded on a nurse who had an adverse event, and if the risk management section receives the medical request notice, it can investigate the needle prick incident prior to the law suit notification. A health care institution might also employ several other external sources available to diagnose actual or potential needle prick risk areas and medical error situations. For instance, when the health institution has an insurance cover through a commercial insurer, insurance professionals can carry out a review of the institution to identify the risk or potential risk areas (Wachter, 2008)).
It is important to realize that identification of needle prick risks among nurses in a health care setting is a continuous process. It is not a one-time static analysis (Wilson, 1999). Therefore, diagnosis of possible needle prick risks of liability such as; complains of nurses about exposure, unexpected treatment outcomes, and adverse events that did, or could, result injuries to nurses, must be an ongoing process within institutions. Early data alerts can be retrieved in security reports, nurse complains, quality assessment studies, or licensure surveys (Kavaler, 2003).
The second step an institution of health care should take after diagnosing the risk is to assess or analysis this risk. Whenever an adverse event occurs on nurses due to exposure, an institution and risk management department is obligated to take specific steps that are proactive. These steps include: first, the institution reporting the occurrence of the adverse event or medical error due to exposure of needle prick risks. Every institution is required to put in place guidelines or policies that provide direction to nursing personnel about the steps to follow when an adverse incident occurs. These policies or guidelines should clearly identify the people and functions that should be notified for instance; representatives of the hospital administration, risk management personnel, and the media relations. Policies and guidelines should also be put in place directing that incidents or adverse events be reported to the department of risk management within 24 hours (Kavaler, 2003). Incase an incident occurs after business hours, the policy should direct the health care provider to notify the administration or an individual acting in that capacity. The policies or guidelines put in place should also address the disclosure of the unexpected outcome within an institution. Once the disclosure has been made, an investigation should be carried out immediately by the institution. At this point, an institution must make an initial determination about whether the incident requires further investigation. If a significant injury to a patient is determined for instance, some form of investigation should probably be done. On the other hand, if the incident was a minor one, for example a patient fell and was not injured, it may not warrant an investigation. However, the need to carry out an immediate investigation depends on the facts of the incident. Incase the reported adverse event involves a clear deviation from the standard health care that led in the death of a nurse or caused a serious injury to a nurse, an immediate investigation should be done. Institutions should employ key strategies for gathering information whenever an adverse event caused by needle pricks affects nurses (Daly, 2004). The investigating authority should review the medical records of nurses, especially such items as x-ray films, fetal monitoring tracings, or any other crucial elements of the record. The records should be reviewed to ensure that they are complete. If for any reason, proper entries have not been recorded, personnel who have failed to make the necessary entries should be directed to make their notation in the medical chart. This late entry notes should be made fill them in a manner that is timely, and within 48 hours of the event occurrence. Again, the notes should be marked as late entry notes and the factual and objective in their content (Woods, 2005).
Assessment or analyses of risks or adverse events entail the evaluation of past experiences and current exposures to eliminate or reduce substantially the effects of risks especially on nurses and other heath care stakeholders. The seriousness of needle prick risk is determined in terms of; the probable severity to the individual nurses or the institution, the possible number of nurses injured, and the likelihood and/or the rate of injury occurrences on nurses. Information from closed claims is most helpful in gaining an insight in the assessment or evaluation of the current needle prick risks. In essence therefore, a priority of high needle prick risk activities for risk managers develops from risk assessment information (Woods, 2005).
The third step in the risk management process involves taking needle risk control or treatment measures after initial assessment has been carried out. Nurses exposed to needle prick risks need to be assessed and treated if possible. Nurses who have definitely or potentially been exposed to serious incidents of needle risks, should report them immediately so that the risk can be assessed and treated. This can be done in order to prevent incident related infections to nurses through the prescribed treatment and control procedure: first, the incident must be reported by the nurse immediately as soon as possible before the end of the shift to a direct supervisor on duty; two, the incident must be reported to the risk management department in detail including all relevant information such as, the character of exposure, clinical diagnosis of the patient, actions taken after the incident to control the exposure or rectify the incident; three, referrals and arrangements necessary must be made with the individual incident; four, the emergency room staff and the department in charge of infection control should organize post exposure prophylaxis such as antibiotics or antiretroviral therapy incase affected nurses need these; five, the emergency physicians must determine whether the affected nurse qualifies to receive chemo-prophylaxis and should prescribe medication; six, the exposed nurse must be included on a medical prescription chart and the appropriate drugs given; seven. The medication must be availed and necessary information regarding administering prophylaxis given individually to nurses exposed. Medication receipt must be listed on a medicine prescription chart, after which the chart is past over the occupational clinic for storage. The nurses must report any side effect, signs or symptoms of illness immediately to occupational health clinic. Risk control or treatment means institutions reaction or response to significant areas of risk, as well as a response to limit the liability connected with the risks that have occurred. Risk control and treatment is the most common function associated with programs of risk management (Wilson, 2001). The activities of risk control within a health care institution must be seen as a single formal program, due to elements that are varied, interrelated and overlapping. Risk control activities are often compared to those of safety management because the basic objectives are similar (Wachter, 2008). Quality assessment activities may at times cloud the specifics of risk control. For instance, it is not unusual for a risk control program to be a collaborative effort that involves risk management quality assessment. Ideally, risk control programs illustrate potential liability problems in areas such as; bodily harm, liability to losses, loss of property, and consequential losses. It is important to note that, the governing board of health institutions is responsible for the overall risk control system (Youngberg, 1998).
Risks that pose harm or death to nurses are risks that should be managed in a health care setting. Once risks on adverse events related to needle prick exposure to nurses are identified and assessed, health care providers’ should take appropriate measures to control and treat them (Young, 2002). They must also adopt action plans that ensure time and resources are appropriately utilized in areas of high risks. The institution must ensure that clear guidelines on how to handle safely contaminated needles. This will ensure the health, safety and precaution of both nurse, and even other staff and patients. Consequently, health care providers must design actions that are effective in terms of prevention, control, and management of these risks through use of appropriate; systems, management, and effective culture (Candlin, 2002).
First, health care institutions should deploy effective nursing systems that include structures and processes at national, organizational, and individual health care practitioner’s level. They should provide nurses with guidance through policies and procedures, training and development, sustained monitoring of incident occurrences through surveillance, audit, and research. Second, the institutions of health care should use prudent management which includes providing nurses appropriate support and clear commitment in addressing these risks. They should consider these along side other challenges within health care settings. The management should put it as a priority by ensuring that correct processes are established for effective nursing risk control and treatment. Education and training for nurses is mandatory in some areas. Health care institutions must have a wide variety of management strategies that can be used in training and education of nurses to the employment of safety officers who ensure that regulatory standards are met. Third, health care institutions must develop a culture that involves continuous improvement of nursing quality through individual behavior, whereby a nurse can be seen as role models who conversant with the systems and processes of managing hazards and risks. Effective risk control practices in an institution and concerned staff assists in maintaining an overall culture of good practice, making compliance easy (Alexander, 2000).
Whenever a needle prick risk occurs in a health institution, even at times when guidance and policy have been adhered to, well-coordinated and multi-disciplinary response will reduce the impact of this risk. This can be done by controlling and treating the impact of risks that are ongoing. Needle prick risks in health care settings might either cause minor or major impacts to nurses with implications that may be widespread that include, harm or death of nurses. Therefore, health care providers must design policies which should; have details of all people nurses and their roles during the incident, clear processes of communication, and clear actions to be taken including the assessment of the risks. Proper communication is important in these circumstances, as it is within all health care provisions. Health organizations should also establish meetings with nurses during this period to facilitate appropriate response (Rousel, 2003).
Health care institutions should also put in place management programs that ensure standard needle prick risk controls are adhered to for example: one, ensuring hand hygiene routines by using proper hand hygiene procedures to help prevent, control, and treat needle prick infections; two, use of protective equipment by nurses at all times for instance, use of protective gloves, footwear, eye and mouth protection, aprons and gowns; three, prevention of occupational risks for instance, nurses should cover all breaks in skin, and avoid sharp injuries by avoiding; re-sheathing of sharps such as needles, sharp receptacles near the point of use, retrieving any items from sharp receptacles, splashes of with blood or fluids that come from the body. Any exposure incidents should be reported in accordance with the local policies (Dyro, 2004). Additionally, all health care providers must protect nurses and patients from exposure to risks that may result to litigation; four, proper management of equipment used during medical care to prevent re-use of single use devises (Craven, 2008). It also ensures that those devises that can be reused are handled safely and decontaminated as required between use on the same patient and before use on a different patient; five, the program ensures that basic cleaning measures are important parts of health care and should be done before any required disinfection processes; fifth, health care institutions must embrace appropriate environmental control programs which ensure cleanliness and maintenance that are kept at optimum levels. This program also ensures all items or property within the health care setting is adequately decontaminated and well maintained to prevent occurrence of risks; last but not least, health institutions must put in place safe disposal of waste programs which include sharps like needles. This program cushions an organization from inappropriate exposure to risks found contaminating clinical waste. This assists in protecting all health care workers, patients, and others (Hosford, 2008).
There are a number of methods and techniques health care institutions can use to control needle prick risks. These are: one, buying insurance policy against adverse events among nurses that cannot be avoided. In addition, an institution may accept the risk because the probability of loss is not great and the potential financial loss is within the institutions capability to manage; two, the institution may also employ nurse exposure avoidance technique. This technique assists in ridding the institution of the services, and personnel, that may result to needle risks; three, loss prevention technique can be performed by risk managers by examining the nurse medical record , nurse incident reports, and complaints from nurses in order to detect and investigate needle risks early. Institutions can avoid some risks in specific services by involving medical and auxiliary staff training and preventive maintenance programs. Some risk prevention techniques might advise institutions to keep patients informed of all risks thereby making them rely on the satisfied patient to take legal action; four, loss reduction technique involves the management of claims, ensuring that all records are preserved, and putting all personnel on alert in the event of a loss. Risk minimization techniques also aim to control adverse events by concentrating on activities such as training of nurses, policy revisions and procedures without abandoning high risk services; five, exposure segregation technique enables the administration to decide to separate out the specific offending services, personnel, or activities that have been identified as exposure risks to the institution. This technique assists the risk manager to suggest internal measures of control. For example, to reduce medication errors in a hospital, all pharmaceuticals can be disbursed from a central location (JCR Staff, (2004); six, through contractual transfer technique, an institution is able to transfer the risk through insurance to the organization that provides the service. This enables a health institution to provide a high risk service while avoiding liability to losses; last but not least, health institutions implement electronic information to enhance health care provision. Electronic information systems will for instance; facilitate accurate and timely medical records in terms of admissions and discharge. All health care services provided can accurately be documented by information electronic system, as well as coordinating billing and collection of medical services. Electronic information systems also aid organizations in compiling clinical practice profiles and in assessing the compliance of nurses with practice guidelines and utilization standards (Kilpatrick, 1999).
The fourth and last process in risk management involves risk financing. Risk financing involves health organizations purchasing policies to protect them when there has been a risk exposure. The objective of risk management is to try to prevent the exposure from occurring in the first place. For risks impossible to prevent, risk management tries to minimize them. All health care institutions should realize the true value of risk management process as a driving force in quality improvement and cost reduction. Risk management approaches can be employed in all health care settings. Different health care settings utilize different methods to reduce the occurrence of risks. For example, the hospital management may encourage better relationships with patients in the form of more patient and education to avoid law suits.
In conclusion, all institutions involved health care have a duty of ensuring that they care for the environment and public health, and especially have the responsibilities in relation to waste materials they produce or use. It is the duty of all these institutions to ensure that there are no adverse health and environmental implications of their waste handling, treatment, and disposal activities.
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