Theme 10

Controlled Substances

Theme 10 Controlled Substances

Objectives Discuss the legality of incidence reports Identify issues and will Discuss the legal responsibilities of the nurse handling deaths and related issues

Reference and reading

Risk management Quality Improvement Customer Service Programs A guide for management and staff Potter and Perry [1997].Fundamentals of Nursing Practice.[4th Ed].USA:McMillian

Incident report

Where does it come from?

M O Health April 2005

Health Reform Health System Standards Division

Clinical Governance

Clinical Governance Ensure a consistent and reliable approach to addressing quality

Clinical Governance
A system through which organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in Healthcare will flourish

Health System Standards

Clinical Governance [Improving Quality of Service] Has 4 elements Professional Performance Resource Use [efficiency] Risk Management Consumer Satisfaction

Quality care
Cannot always improve a patients outcome But We certainly influence the patients satisfaction with the care that you give Actions have made a positive effect on our patients

Quality Improvement
Are we doing the right thing?

Are we doing it right?

How can we do it better?

9 dimensions of Quality
Efficient Effective Safe Appropriate Accessible Continuous Capable Sustainable

Risk Management
Reducing the risks of adverse events occurring in organizations by: Assessing Reviewing Seeking ways to prevent reoccurrences Risk in a clinical setting can result in harm to patients

Risk Management
Minimize Harm
&

Maximize Safety

Risk Management
1.Infection control 2. Incident reporting

Filling of forms-incident reporting[UOR} [Legal Document]

Why report the incident?

Identifying Reducing Preventing unusual occurrences to patients

Learning lesson -from incident investigation on the complaints Minimize reoccurrences of the incident

Unusual Occurrence reporting [UOR]

An incident is any occurrence which is not consistent with the routine operation of the medical center routine care and treatment of the patient.

UOR
It may be accident or situation which might result in accident A reportable incident [Unusual occurrence] is any event, unsafe condition or situation which may lead or has led to a patient /visitor with injury.

Incidences
Clinical risks Adverse drug reactions Medication error Unexpected deaths Unavailability of medical consumables Non clinical risks Failure of computer system Patient and family dissatisfaction

Examples of incidences
Behavior related Substance Abuse in the hospital compound Complaint Patient or family member expresses a significant concern regarding quality of care /indicates a tendency towards legal action

Examples
Communication Issue between health care providers/patient and family or visitor that significantly impact patient care Documentation Missing or incomplete medical records,discrepanies in chart.etc

Examples
Fall Patient, visitor or any volunteer Equipment Unavailable, inadequate or faulty

Examples
Treatment and Procedure Inadequate preparation and technique Safety Unavailable fire extinguishers/universal precaution not follwed or unsafe building or grounds

Examples
Medications Inaccurate administration Narcotics Incorrect count. Protocol not followed Loss of property Hospital or patient property including attempted theft

UOR
CWM Hospital Highest incidences 1.Drug Administration

2.Medical consumables-Unavailability

UOR Forms
Drug administration Not giving drugs Claim that they gave the drug Patient said NO DRUG GIVEN Negligence of the nurse Relatives can go to court

Drugs administration
Administer the drug Sign the drug chart Forms are signed Drug not given Forms are not signed Drug is given

Filling of UOR Form

Staff member [reportee] completes and signs part 1 & 2 of the form Forward to their Supervisor/head The supervisor completes Part 3 of UOR and forward completed report to Risk Manager

Risk Manager
Response from RM Writes a memo to ward,unit,dept-explain the incident Respond to ward, unit and dept RM-Own investigation according to what they say Negligence Refer to Head of unit

HOD
See the officer concerned Displinary action Warning Letters to be given To prevent re occurrence Improve the service Outcome

UOR
Supervisor to feedback to reportee and all staff Recommendations for improvement Actions taken[if any] as a result of UOR

Risk Manager
Required to send a quarterly report outlining all incidences. To the quality Improvement committee in their division/Hospital Risk Advisor at MOH

Levels of Risks
Low Risk Routine management Medium Risk Supervisor responsible to manage High Risk HOD responsible to manage/RCA to be done Extreme Risk-executive yo manage/RCA

Root Cause Analysis

Death Disability-Permanent Court Money will be paid

Root cause analysis

Involved Risk manager Matron or sister Doctor

Living will/advance directives

A type of advanced medical directive that provides specific instructions about what medical treatment the client chooses to omit or refuse.[e.g. CPR] in the event that the client is unable to make those decision. This is a written document

Issues and Will

Doctors and Lawyers responsibilities Is a declaration by a person about their property to be disposed after death For the will to be valid the person must be of sound mind Not to be influenced by another person

Deaths
Doctor is authorized to certify deaths Filling of Death Certificate Ensure of correct information To inform the relatives Doctor and Sister

Responsibilities of the Nurse

Dressing of the dead body Identification of the body mishandling can cause emotional stress Mislabeling can create legal problems

Responsibilities of the Nurse

Transfer to Mortuary by the nurse Safe keeping of clients property in the ward for relatives to collect Recording of the name of the deceased in the book and signed Ensure that you handle and treat dead bodies with respect and dignity

Post mortem
Relative to agree Consent must be obtained Done in CWM Hospital

Theme 10
Objectives Discuss the legality of incidence reports Identify issues and will Discuss the legal responsibilities of the nurse handling deaths and related issues

Theme 10

Thank you