The expanding reach of risk management

Although risk management is an industry that came into vogue 20 years ago because of a malpractice crisis, it has evolved beyond the singular concern of professional liability. That's evidenced by the entries for the seventh annual Excellence in Healthcare Risk Management Award competition. Each of this year's winners put a nontraditional twist on risk management.     

The expanding role of ICU medical directors: from patient management to unit management

Over the past three decades the focus of physicians delivering intensive care has been on patient management whereas the management of critical care units has been done primarily by nurses. This article reviews existing literature and the arguments supporting a more active role for physicians in the management of critical care units.     

The pharmacist's role in risk management

The role of risk management is vitally important in the hospital. As institutions grow and the field of health care advances into the future, the number of patient-associated risks will continue to multiply. In response, the Joint Commission has changed its policies to reflect the importance of patient outcomes. This new Joint Commission focus, coupled with the increasing number of patient risks, will create the need for health care professionals to recognize their role in risk management. In anticipation of the future, pharmacy has been guiding itself toward that role for some time. With a large portion of the profession participating in activities such as DUE and QA programs, pharmacists can be a useful resource to the risk manager. Participation in retrospective analysis such as ADRs and peer review committees also aids the pharmacy profession in establishing guidelines that will decrease future patient risks. Future trends in drug development will increase the pharmacist's role in drug selection, in an effort to ensure both safety and cost containment. The profession's continuing development and implementation of practice standards will ensure that pharmacy remains dedicated to improving patient outcomes and decreasing patient risks. In addition, by learning to use the risk manager as both a source of information and a partner in identifying pharmacy-related areas of risk, the pharmacy profession will be able to continue its pursuit of improved quality of patient care.     

The law and the expanding nursing role.

Nursing has moved through two major phases in licensure. From 1900 to 1938 basic registration acts were passed and amended. In 1938 the goal became mandatory licensure for all those who nursed for hire. This move was linked with the stratification of the nursing role to include both practical and registered nurses. The third and current phase in licensure began in 1971 with the Idaho revision of the nurse practice act; 30 states have now revised their nurse practice acts to facilitate role expansion for registered nurses. Several approaches are being used in these laws including mandating new board regulations, expanding the definitions of nursing; increasing the power of physicians to delegate, and mandating the use of standardized protocols to guide the practice of nurses who are accepting new responsibilities.     

The role of the health information management department in hospital risk management

The HIM department plays a great part in risk management. With appropriate risk management safeguards, the threat of medical malpractice claims can be reduced. This article discusses the use of the medical record in the risk management process.     

Evidence-based practice and the management of risk in nursing

This paper examines how nurses manage research evidence of risk in practice policy. Groups of specialist nurses were observed during the construction of consensus guidelines for three common nursing tasks. The process of interpreting and using research evidence included perceiving and prioritizing outcomes, evaluating their likely impact for patients and staff, and determining an acceptable balance of risk, cost and benefit for multiple contexts and stakeholder groups. The study illustrates some of the unarticulated rules of risk management in nursing, which were powerful mediators in the uptake and interpretation of research. The implications of these frames of reference are discussed in relation to the promotion of evidence-based nursing practice.     

The role of placental examination and its pathology in obstetric risk management

The placenta is a marker of biologic events that occur during pregnancy. Placental pathologic examination gives insight to pregnancy-related insults, which affect the newborn at and after birth. Clinicians and risk managers can use this information to identify the cause of newborn complications in cases suggested to be birth-related injuries.