Technology

1.    Risk Management

2.    Resources

Use of technology in LTC communities is multi faceted. Should we do wired or wireless. Monitor the environment versus each resident, beeper, cell phones or pagers. So many questions, so little time. This web site combines all issues with questions and applications. www.techforltc.org/ltc.cfm

Risk Management

The purposes and goals of a risk management program are:

1. To prevent the occurrence of accidents, injuries, or other adverse incidents to residents, employees, visitors and others.
2. To minimize the adverse effects of injuries or accidents when they occur (e.g., resident falls may not be 100% preventable; however, steps also can be taken to minimize the seriousness of an injury when a resident does fall).
3. To protect the financial assets of the organization by reducing frequency, severity (i.e., dollar amount), and impact (e.g., through insurance or other risk transfer) of malpractice or general negligence claims and lawsuits.

A comprehensive risk management program applies risk management techniques to all areas of operation from safety issues (e.g., resident wandering and elopement), to employee health (e.g., prevention of back injuries), to resident care (e.g., prevention of medication and dietary errors). The goals of risk management can never be accomplished by one individual or committee. Thus, an administrator or director of nursing may be responsible for developing and overseeing the risk management program, but the commitment, cooperation, and support necessary for a successful risk management program must come from a facility's owners, governing body, medical director and employees.

Good risk management programs have the following features: A single person assigned at each facility to be "risk manager" who handles interaction with staff before, during and after an incident or event. The risk manager also interacts with residents, their families, guardians, powers of attorney, or other third parties. The risk manager also interacts with the insurance carrier, defense attorneys and in a system the corporate wide risk manager. The risk manager trains and orients staff on safety, quality improvement, and most important, in proper documentation. The risk manager must be highly trained in conflict resolution and public relations.

KAHSA has developed a risk management toolkit (2005). It is updated with forms and handouts from workshops and webinars that have been presented since 2005. NEW!

Incident Reports and Investigation

When an incident or a "near miss" occurs it is important to have a system in place to report or document the event and investigate. Knowledge of the type and number of events allows the organization and its risk manager to predict future occurrences, implement preventive actions, and better protect residents, visitors, and staff from similar risk. Changes in policies, procedures, equipment and in some cases personnel may result in prevention of future incidents.

An effective incident reporting education program will assist all staff in knowing what should be reported and provide staff with a basic understanding of the organization's definition of an incident. Many definitions have been set forth, including a broad description such as "any circumstance that is unexpected within the normal operations of the facility or the anticipated disease/treatment process of a resident." Adverse event definitions have also been approached as simply "injuries related to medical management." Other publications on medically related events have further categorized events involving residents by type and severity. Examples of frequently reported adverse and unexpected events in the long-term care setting include falls, medication related events and wandering episodes.

Other examples might include the following:

• Unexplained death of a resident
• Unexpected transfer of a resident to a higher level of care
• Treatment error
• Resident who refuses care and services that put him/her at risk for negative outcomes
• Equipment problem resulting in injury or potential for injury
• Physician orders missed or otherwise not followed
• Accidental needle sticks
• Violence or potential violence affecting resident or staff
• Infection
• Resident/family complaints

Event report forms, at a minimum, should contain the following information:

• Date and time of the report

• Date and time of the event

• Location of the event

• Identification of the person affected (e.g., resident, visitor, employee)

• Identity of supervisor to whom the event was reported (if applicable) and that individual's response (i.e., orders given)

• Identity of resident's attending physician, whether event was reported to this individual, and, if so, the physician's recommendations

• Brief, factual description of the event

• Key observations of the event scene (e.g., if event was a fall, whether there was water on the floor or ice on the sidewalk, whether bed rails were raised)

• The manufacturer, model, and lot number (or batch number) of any medical device involved

• Condition of the person affected, including any complaints of injury, observed injuries, and a brief comment on any follow-up care.

If designed and used correctly, the reporting form will succinctly tell the risk manager whether follow-up is needed and how quickly that follow-up must be done.

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Risk Management Resources:

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