Strukturiertes klinisches Risikomanagement in einer Akutklinik

Background

A hospital is a dangerous place for patients. Multiple studies have demonstrated that errors are a significant problem in hospitals. At the same time it has been shown that a structured healthcare risk management offers numerous tools for risk reduction or risk prevention. The relevance of data due to errors in hospitals is unambiguous, therefore it is necessary to focus on this issue.

Objective

This article describes the basic principles and the implementation of a structured healthcare risk management. The process and tools of healthcare risk management are presented and explained.

Methods

A review of the literature on healthcare risk management was conducted and the currently used and established tools of healthcare risk management are presented.

Results

In the process of healthcare risk management several effective tools for the reduction and prevention of errors are available. These tools must be established in a structured risk management process.

Conclusion

A structured healthcare risk management in a hospital is no longer a ??nice to have?? but an absolutely ??must?? for the professional care of emergency patients.     

Influence of intense light stimulation on trigeminal and cervical pain perception thresholds

Thirty-three migraineurs and 23 healthy controls were submitted to pressure algometry before and after light-induced discomfort was elicited by progressive light stimulation in a monoblind fashion. Pressure algometries were performed on the emergence of the supraorbital, infraorbital, mental and greater occipital nerves, and over the temporal muscles, always throughout the same sequence and from right to left. Measurements were carried out before and immediately after light stimulation and after 10 min of the second algometry. The final result for each site measured at each time-point was the mean of the three measurements. Light stimulation was carried out progressively until light-induced discomfort was reported, to a maximum of 20,000 lux. A heat-blocking glass protected patients' eyes. Migraineurs presented significant and persistent drops in pain perception thresholds after light stimulation, at all sites tested (P = 0.002 to < 0.0001). These drops were not seen in controls, in whom, conversely, a less significant increase was seen on right infraorbital and left temporal muscle sites. Our results indicate that in migraineurs, light may have a relevant role in trigeminal and cervical pain perception thresholds.     

Physical inactivity in aging and dementia: a review of its relationship to pain

Aims. The goal of this brief review is to address studies examining the relationship between physical inactivity and pain in aging and dementia. Background. A decrease in the level of physical activity is characteristic of older persons, both with and without dementia. Passive behaviour is often considered to be part of the apathy frequently observed in patients with dementia, although it could also be a sign of pain. Design. Literature review. Method. Searches were performed in PubMed and Embase. A total of 15 studies concerning the relationship between physical inactivity and pain in older persons with and without dementia were identified (older persons without dementia: 12; with dementia: 3). Results. In older persons without dementia, a positive relationship between physical inactivity and pain has been demonstrated. In older persons with dementia, pain may cause physical inactivity and physical inactivity may cause pain. Conclusions. In older persons, a positive relationship between physical inactivity and pain was demonstrated. More specifically, pain may cause physical inactivity. In older persons with dementia pain may cause physical inactivity and vice versa. Relevance to clinical practice. Nurses’ awareness of physical inactivity as an indication of pain in older persons with and without dementia may reduce the risk of underdiagnosis and subsequent undertreatment of pain.