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Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1 QM - Implementation Deepening Topics.

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Präsentation zum Thema: "Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1 QM - Implementation Deepening Topics."—  Präsentation transkript:

1 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 1 QM - Implementation Deepening Topics

2 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 2 Stages of QM implementation Procedures Training of QM-responsibles Targets of clinic Training of QM-Team leaders Optimisation Top management Targets of departments Therapeutic standards Training of internal auditors Current state analysis QM-constitution QM-manual Certification

3 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 3 Documentation in QM-Systems Other QM-Documents (Methods, Directives, Forms, Checklists, Reports etc.) SOPs Standards QM-Manual

4 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 4 1. Purpose, targets, quality indicators 2. Scope 3. Co-applying documents 4. Abbreviations, terms and definitions 5. Responsibility 6. Procedure 7. Distribution 8. Amendments SOP - Structure

5 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 5  Targets:  Indications and contraindications  Patient group  Procedure:  Workflow (Flow-Chart)  What is essential / superfluous/ obsolete  Monitoring of development (MEASURES!)  Recommendation:  outpatient or stationary  Results:  Summary of the known results of the recommended or not recommended procedure Structure of guidelines complying to BÄK/KBV I

6 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 6  Proof and selection criteria:  Scientific evicende  Evidence based Medicine  Benefit, side effects, costs  Summary of the recommendations of the guideline  Planning of the implementation  Informations on usage of the guideline and efficacy  Period of validity, responsibility for updating  Informations on the elaboration of the guideline:  authors  consensus procedure Structure of guidelines complying to BÄK/KBV II

7 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 7 Patient wishes and Patient expectations P Optimal Diagnosis and Therapy of disease Optimising outcome minimising risks Patient rights, Drugs, Medical Devices, Hygienic requirements Current state of medical and nursing quality Evidence based Medicine Medical guidelines E S Treatment Standard Legislation and Authorities Safety Aspects Targets of a Treatment Standard

8 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 8 Surgical Procedure 1. Disease, Purpose, Targets, Quality indicators 2. Indications and Contraindications 3. Alternative procedures 4. Preoperative Diagnostic 5. Typical complication possibilities 6. Surgical procedure  e.g. anaesthesic procedure, preoperative planning, bedding, instruction for the surgery, dressing, instruments, consumption material, implants, needs of time, costs and earnings Example of a Treatment Standard I

9 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 9 Surgical Procedure 7. Post-treatment 8. Documentation 9. Hints and Remarks 10. Co-applying Documents 11. Responsibilites, Qualifications 12. Abbreviations, Terms and Definitions 13. Time of validity, Responsibility for updating 14. Procedure as Workflow (Flow-Chart) 15. Distribution 16. Amendments Example of a Treatment Standard II

10 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Target 2. Quality indicators 3. Abbreviation, terms and definitions 4. Diagnostic procedure 5. Scientific evidence 6. Literature 7. Co-applying documents 8. Alternatives 9. Costs 10. Distribution 11. Amendments Example of a Diagnostic Standard

11 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 11  Control of documents  Control of records  Audits  Control of nonconforming products and service  Corrective action  Preventive action 6 documented standards required in ISO

12 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 12 Steps toward systematic QM 1. Analyse and structure the processes 2. Define SOP + Text 3. Compile QM-manual

13 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 13  Conceive potential failures in beforehand, control these and take preventive action  Prepare for thinkable occurance of failures and effects  Systematic minimizing occurance of failures in process  Failure effect minimizing action and prevention  Failure assessment – Discussion with rating scales Note: 1. Prepare for the unexpected. It often happens in stress situations, when preventive walls fall! 2. QM is not an instrument only for the good seasons, it shows its unique strength in stress situations! Failure mode and effects analysis FMEA

14 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Listing of potential failures 2. Collect thinkable failure effects and reasons 3. Estimate ocurrence probability in rating scale Estimate impact of effects in rating scale Estimate detection probability in rating scale Calculate the risk priority number (Multiply the values of steps 3 – 5) 10 steps of FMEA I

15 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH Develop corrective actions 8. Assess the risk priority number again taking in consideration the effects of possible corrective actions 9. Compare the two risk priority numbers 10. Decide for measures with the greatest potential to reduce the risks 10 steps of FMEA I

16 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 16  Collect potential risk with brain storming  Assess the effects:  Probability of Ocurrance (1=unlikely, 2-3=very sparsely, 4-6=sparsely, 7-8=moderate, 9-10=high)  Impact of effects (1=hardly recognizable, 2-3=unimportant, 4-6=moderate severe, 7-8=severe effects, 9-10=extremely severe effects)  Probability of Detection (1=high, 2-5=moderate, 6-8=sparsely, 9=very sparsely, 10=unlikely)  O x I x D = RPN (risk priority number) (1=no, 125=medium, 1000=high Priority) FMEA

17 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 17 FMEA am Beispiel Allgemeinchirurgie Possible FailureOxIxD=RPN* Not documented patient informed consent Mix-up in Patient1101 Indication assessment too late Doctor not available29118 Oxygen mask not connected Fall of patient in post-anaesthesia care25990 *Note: Necessity for taking action also in case of high single assessment >7

18 Dr. Erwig Pinter QKB-Qualität im Krankenhaus Beratungsgesellschaft mbH 18 Risk-graph Occurrance probability Often6a6b6c6d probably5a5b5c5d occasionally4a4b4c4d conceivable3a3b3c3d unlikely2a2b2c2d unthinkable1a1b1c1d negligibleminorcriticalcatastrophic Extent of damage = acceptabler region = ALARP-region (As Low as Reasonably Practicable) = inaceptable region


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