A prescription of the risk management system is essential for a health care service that is effectively run. A significant reason that justifies the implementation of a risk management system in health care services is that health risks have both negative and positive connotations. Positive connotations enable health care practitioners to recognize the potential for injury or harm due to exposure to health risks. The risk management process assists health care practitioners in nullifying the potential injuries or harms. On the other hand, negative connotations are based on the health practitioners’ fear of the public’s distrust of health care professionals. For instance, if a health care professional fails to protect patients from malpractices and harm, claims will escalate and these may cause backlash from society which could be harmful on several different levels, which may include policing of the health care system with possible resultant loss of professional autonomy. This paper focuses on the health risk management process of shortage of Central Sterilization Supply Department (CSSD) in a health care setting.
The Context of Shortage of CSSD Risk Factor
The Central Sterilization Supply Department is essential to all health care facilities as it aides all patient areas and the operation theatre, it collects reusable from departments, cleans, sterilizes, and supplies equipment for sterilization and dressing packs. The CSSD has equipment that is automated for washing, disinfection, autoclaving and others. Health care practitioners should ensure that their institutions have put in place proper quality assurance procedures to guarantee safety at all levels. These procedures may involve; effective handling of contaminated materials, decontamination procedures, proper cleaning procedures, procedures for caring the instruments, the procedure for checking the working condition and sharpness of instruments, procedures for replacing instruments that are condemned, procedures for monitoring sterilization cycle, and procedures of using indicators to measure adequacy of sterilization. At this point of the discussion, it is vital to understand the general meaning of risk management and risk management process before looking at the shortage of the Sterilization Supply Department as a risk factor in a health care setting (Alexander & Fawcett, 2000).
The Scope of Shortage of CSSD
Health care institutions refer to health risk management as ‘an organized effort to identify, assess, and reduce where necessary, risks to patients, staff, visitors, and property of the institution’. In other words, risk management involves programs meant to reduce incidences of harm and injury that are preventable for the sole purpose of minimizing possible losses of finance to the organization in case of occurrence of an accident or injury, for instance, arising from shortage of Sterilization Supply Department risks. The risk management process, on the other hand, is essentially concerned with institutional property protection (Hubber, 2006).
To be able to protect institutional property, the risk management personnel in a need to follow in progression, four steps in the risk management process. The first step risk managers should undertake is the diagnosis procedure which involves; risk identification, for instance, the shortage of Sterilization Supply Department risk factors and the potential risks they posed. Secondly, risk managers should assess or analyze the risks identified for example. It is at this point that risk managers are able to calculate the probability of the harmful effects from the risk situation to stakeholders. The third step involves risk managers employing risk control and treatment procedures to reduce the adverse effects posed by these risks in a health care setting. In the fourth and the last step, risk managers adopt appropriate risk financing procedures to mitigate health risks such as the ones arising from the shortage of the Sterilization Supply Department (Stanhope, 2006).
In summary therefore, shortage of CSSD as a risk factor in the risk management process can move from: identification of loss exposures due to accidents resulting from this risk that may affect the objectives of the institution to; choosing the best management techniques of the risks associated with a shortage of sterilization supply department, to; eventual monitoring of the outcomes of the techniques selected to determine strategies that are effective and appropriate to reduce or avoid risks associated with a shortage of sterilization supply department (Heath, 1998).
Shortage of CSSD Risk Identification
The identification process of shortage of sterilization supply department risk factor in a health care institution is essential in risk management process. In this step, risk managers need to collect all information about current or past incidences that might have occurred as a result of shortage of sterilization supply departments within the institution. Institutions can apply several tools that assist them in identifying potential risk areas. These tools include: the use of incident reports by risk managers as primary tools that can assist them in identifying potential risk areas that are exposed to a shortage of central sterilization supply department as a risk factor. In this regard, the health care institution needs to examine all information related to incidences recorded to be able to identify areas of this risk. Additionally, health care institutions may also seek to examine information from other diverse sources to effectively analyze incidence reports to identify potential risk areas that may result due to shortage of sterilization supply department risk factors within a health care setting (Kavaler, 2003).
Secondly, other than the use of incident reports to identify the actual or potential risk areas that are exposed to shortage of CSSD risk factors, health care institutions may also use other sources available. For instance, by attending morbidity and mortality conferences, and quality management meetings, risk managers and assurance managers can gather information on actual medical errors or potential risk areas due to shortage of sterilization supply department risks. Such meetings may effectively assist the health institution to find information that may assist in addressing issues resulting from this risk factor, if such information is not routinely reported to the risk management department (JCR Staff, 2004).
Thirdly, the medical records department should be directed by the institution to forward all medical record reports received from reputable law firms within the area to the risk management department (Rousel, 2003). It is important to understand that many of these records from litigant organizations may not be relevant to probable lawsuits to the health institution but may be helpful in situations in which an incident report may not have been concluded on a patient who had been affected. This enables the risk management section on receipt of the medical request notice from the medical department, to investigate the incident prior to the lawsuit notification (Zimmermann, 1990).
Several other external source options can be applied by the health institution to diagnose actual or potential risks resulting from shortage of sterilization supply department risk factor situations. For example, in situations where health institutions are covered by commercial insurance, professionals from the insurance industry can carry out a comprehensive review to determine and identify potential risk areas posed by this risk factor (Wachter, 2008).
The risk identification process is a continuous process. It requires continuous analysis. Hence, the possible risk diagnosis must be a process that is ongoing within the institution. This ongoing process may include; documentation of patient complaints about healthcare provision, unexpected treatment outcomes, or adverse events that cause harm due to a risk factor (Wilson, 1999).
Risk analysis of shortage of CSSD
The assessment or analysis of the shortage of sterilization supply department risk factor is the second step a health care institution should undertake after diagnosing this risk. A healthcare institution has to take responsive measures to address an incident/accident as a resulting shortage of sterilization supplies. The steps undertaken should be proactive and may include; reporting the occurrences of adverse incidences by putting in place guidelines or policies that provide direction to employees about the process to follow an adverse event or medical error that happens as a result of the shortage of CSSD risk factor. The policies established, should identify all the people and functions concerned that should be notified. They may include; the health institution administrative representatives, personnel involved in risk management, and media relations. These policies and guidelines regarding the sterilization supplies department should be adopted and should direct the health institution to report all adverse events to the risk management section within a day (Kavaler, 2003).
The guidelines or policies should also provide direction on cases that happen after business hours. In case of such cases, the policy should direct the health care practitioner to notify the administration or any official acting in that capacity. Another aspect of these guidelines or policies put in place should address, is the disclosure of the unexpected outcome within the healthcare setting. An investigation should follow immediately once a disclosure has been made about the occurrence of the incident. A healthcare institution should also make an initial assessment to determine whether there is a need for further investigation. In case the health institution determines a significant injury or harm to a patient, it must undertake an investigation. On the other hand, incidences of minor nature may not require an investigation (Daly, 2004).
Consequently, the need to carry out an investigation depends much on the facts of the incident reported. In case the reported adverse event caused by shortage of sterilization supply department risk factor involves a clear deviation from the standard health care that led to the death of a patient or caused a serious injury or if it involves a probable malfunction of the equipment that led to serious injury or death to the patient, an immediate investigation should be taken by the institution. The organization should employ key strategies for gathering information whenever an adverse event or medical error happens. The investigating authority should then review the medical records. The purpose of the review of the records is to ensure that they are complete. If for any reason, proper entries have not been recorded, the junior technicians in the CSSD department who fail to make the necessary entries should be directed to make their notation in the medical chart. The late entry notes should be made or filled in a timely manner, and within a fourth night since the time of the event occurrence. Clearly, the notes should be marked as late entry notes and that they are factual and objective in their content (Woods, 2005).
Evaluation of CSSD Shortage Risk
The assessment or analysis of risks or adverse events associated with shortage of sterilization supply department entails the evaluation of past experiences and current exposures. This process assists in eliminating or reducing substantial effects of risk on; the community image, cash flow, medical staff morale, administration, and other stakeholders. The seriousness of this risk is determined in terms of; the probable severity to the individual or the institution, the possible number of people it has caused harm or injury, and the likelihood and/or the rate of occurrences on incidences related to this risk. Information from closed claims is most helpful in gaining an insight into the assessment or evaluation of the current risks resulting as a result of this risk factor. In essence therefore, a priority of high-risk activities for risk managers develops from risk assessment information. The analysis carried out shows that, shortage of CSSD may cause devastating effects such as loss of life of the patient and risks spreading to other patients. Therefore it is an extreme risk that requires the immediate action of the health care institution (Woods, 2005).
CSSD Risk Control Measures
After comprehensively identifying and assessing the risk factor, the third step in the risk management process that should be undertaken by healthcare practitioners involves taking risk control or treatment measures. Risk control or treatment is the means by which healthcare institutions react or respond to significant areas of risk posed by the inadequacy of sterilization supply department risk factor, as well as it may be a response to limit the liability connected with the risks that have happened (Wilson, 2001).
The risk control and treatment function is the most common function associated with risk management programs. The CSSD activities of risk control within a health care institution must be seen as a single formal program, due to elements that are varied, interrelated and overlapping. Risk control activities of the central sterilization department are often compared to those of safety management because the basic objectives are similar (Wachter, 2008).
This is because quality assessment activities of health care risks may at times cloud the specifics of risk control measures. It is not unusual for a risk control program to be a collaborative effort that involves risk management quality assessment. Ideally, risk control programs illustrate potential liability problems in areas such as; bodily harm, liability to losses, loss of property, and consequential losses. It is important to note that, the governing board of health institutions is responsible for the overall risk control system (Youngberg, 1998).
Policy Development Measures to Control CSSD Shortage Risk
Risks that pose harm or death to patients are risks that should be effectively managed in a health care setting. Once risks on adverse events are identified and assessed, health care providers should take appropriate measures to control and treat these risks. They must adopt action plans that ensure that time and resources are appropriately utilized in areas that reflect high risks. This is particularly necessary to risks posed by the shortage of central sterilization supply department (Young, 2002).
Institutions must carry out risk assessments when considering the safety and adequacy of surgical equipment. The institution must ensure that it considers clear points when processing theatre instruments. For instance, first, it must ensure that theatres are provided with facilities that are appropriate and suitable to successfully carry out an operation. In most cases, sterile instruments pass directly into the theatre for employment and hence protection packaging is not necessary. Second, health care institutions should ensure that all their theatre staff is professionally trained and educated. This assists them in observing high aseptic technique standards. It also ensures that the staff is not affected by the distractions of, for instance, their counterparts in the wards. Thirdly, the institution must have an adequate supply of instruments necessary for an operation. This will ensure the health, safety and precaution of both patients and staff. Fourthly, health care institutions must ensure that the availability of sterilizing facilities is ready at all times for use. Care should be observed at all times as considerable capital investment is needed placing instrument responsibility for processing theatre instruments to CSSD. Consequently, health care providers must design actions that are effective in terms of prevention, control, and management of risks through the use of appropriate; systems, management, and effective culture (Candlin, 2002).
Strategy to Deal with or Accept Shortage of CSSD
Health care institutions need to deploy effective systems in risk management. These systems should include; structures and processes from the national, organizational and individual health care practitioner’s level. Guidance should be provided through; policies and procedures, training and development, research, audit and surveillance, which is planned and sustained monitoring of occurrences, Furthermore; health care institutions should adopt prudent management that will provide appropriate support and commitment in addressing risks. These should be considered not in isolation but together with other challenges arising within the health care setting. Management needs to prioritize risk management by ensuring that, effective risk control and treatment processes are established. Education and training are mandatory in some areas, therefore, health care institutions must have a wide variety of management strategies that can be used in training and education of staff to the employment of safety officers who ensure that regulatory standards are met. In addition, health care institutions must develop a culture that involves continuous improvement of quality through individual behavior, whereby staff can be seen as role models who are conversant with the systems and processes of managing hazards and risks. Effective risk control practices in an institution and concerned staff assist in maintaining an overall culture of good practice, making compliance easy (Alexander, 2000).
Whenever risks occur in health care institutions, even with the already established policies and procedures, a well-coordinated and multi-disciplinary response will reduce the impact of risk. Shortage in the CSSD may cause major impacts with implications that may be widespread including, harm or death of patients. Therefore, health care providers must design policies that should; have details of all people involved and their roles during the incident, clear processes of communication, and clear actions to be taken including the assessment of the risks. Proper communication is important in these circumstances, as it is within all health care provisions. Health organizations should also establish meetings during this period to facilitate appropriate response (Rousel, 2003).
Effective CSSD Shortage Risk Management Programs
Health care institutions are required to put in place programs to manage risks in the health care institution. The first in the discussion are management programs. Management programs ensure that standard risk controls are adhered to. Health care institutions therefore must ensure that the CSSD receives all the necessary equipment needed to carry out proper sterilization of all hospital equipment to avoid and control the spreading of diseases in patients. Moreover, the CSSD should not at all times have a shortage in protective equipment used by staff. The equipment may include; powder-free gloves, footwear, eyes and mouth protection, aprons and gowns. Staff should therefore report any exposure incidences immediately in accordance with the local policy. All health care providers must therefore protect health care workers and patients from exposure to risks that may result in litigation (Dyro, 2004).
Secondly, programs on the proper management of equipment used during medical care to prevent re-use of single-use devices must be put in place. These programs will assist in preventing single patient use instruments from being used on other patients. It also ensures that those devises that can be reused are handled safely and decontaminated as required between use on the same patient and before use on another. In addition, the program ensures that basic cleaning measures are important parts of health care and should be done before any required disinfection processes (Craven, 2008).
Thirdly, health care institutions must embrace appropriate environmental control programs which insist on cleanliness and maintenance that should be kept at optimum levels. This program also ensures that all items or property within the health care setting is adequately decontaminated and well maintained to prevent the occurrence of risks. Last but not least, health institutions must put in place safe disposal of waste programs which include sharps. This program cushions an organization from inappropriate exposure to risks found in clinical waste. This assists in protecting all health care workers, patients, and others (Hosford, 2008).
Administrative Policies to Monitor and Review CSSD Shortage Risks
To properly manage accidents/incidents associated with CSSD shortages, the management of health care institutions need to implement appropriate administrative policies to this effect. These policies include: implementing methods and performance standards of preparing and handling materials of sterile nature; ensuring that all hospital policies and procedures are followed diligently by all members; implementation of safety policies and documenting of all accidents or incidences; recommending inventory level in the CSSD department to meet current demands; ensuring that junior staff in CSSD department record and clean all surgical equipment, anesthesia, tubing, and bottles in the washer machine appropriately (Craven, 2008);
Additionally, other administrative policies should; ensure that all sterilization machines in the CSSD operate safely and effectively; ensure safe storage of all sterile packs in the store; make sure that junior staff check and keep the CSSD stock levels and monitor the dates of expiry; establish and maintain professional relationships that are positive within the department and with every CSSD client, and monitor effectively to ensure that all non-sterile instruments of surgical nature are collected by junior technicians from the wards or department; and finally ensure that junior technicians deliver all processed CSSD packs to the wards and CSSD department (Young, 2002).
The fourth and last process in risk management is risk financing. This involves health organizations purchasing policies to protect them when there has been a risk exposure such as a shortage of CSSDs. The objective of risk management is to try to prevent the exposure from occurring in the first place. For risks impossible to prevent, risk management tries to minimize them (Heath, 1998).
CSSD is a very sensitive department in any health care institution. Therefore, health institutions must ensure that the department is well equipped with the necessary facilities and personnel to undertake efficient sterilization and hygiene. Health care institutions should realize the true value of risk management process as a driving force in quality improvement and cost reduction. Risk management approaches can be employed in all health care settings. Different health care settings utilize different methods to reduce the occurrence of risks. Health care institutions with long-term facilities for care may concentrate on the minimization and prevention of patient accidents. Organizations with managed care are more concerned with many risk issues such as legal issues that concern agreements of contract, and liability extent that health institutions hold for risk exposures. Furthermore, all institutions involved in health care must ensure that they care for both the safety of their employees and the patients. They have a responsibility to ensure that the equipment used in their health institutions are safe (Kilpatrick, 1999).
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