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AN-NAJAH NATIONAL UNIVERSITY
FACULTY OF MEDICINE AND HEALTH SCIENCES
DEPARTMENT OF NURSING AND MIDWIFE
Instructor :Miss. Samah Ishtieh
STN:
Manar Yameen
Faten qandos
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Majd wazani
Nareman nassar
OUTLINE
1- Introduction
2- Definition
3- Risk management process
4- Risk Management Options
5- Incident Report
6- How to alleviate the fear ??
7- How To Make An Incident Report ???
8- Medication errors
9- Diagnostic procedure
10- Medical legal incident
11- Role Of The Nurse Manager
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INTRODUCTION

Risk management is component of quality management , but
it’s purpose is to identify , analyzes , and evaluate risks and
then to develop a plane for reducing the frequency .

Risk management is continuous daily program of detection ,
education , and intervention.
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DEFINITION
Risk : “hazard” , a chance of bad consequence.
Risk management : is the practice of identifying potential
risks in advance, analyzing them and taking
precautionary steps to reduce the risk.
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RISK MANAGEMENT OPTIONS
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RISK MANAGEMENT OPTIONS
(1)--Avoid: The best thing that you can do with a risk is to avoid it. If you can
prevent it from happening, it definitely won’t hurt your project. The easiest way
to avoid this risk is to walk away from the cliff, but that may not be an option
on this project.
(2)--Mitigate: If you can’t avoid the risk, you can mitigate it. This means taking
some sort of action that will cause it to do as little damage to your project as
possible.
(3)--Transfer: One effective way to deal with a risk is to pay someone else to
accept it for you. The most common way to do this is to buy insurance.
(4)--Accept: When you can’t avoid, mitigate, or transfer a risk, then you have to
accept it.
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INCIDENT REPORTS
INCIDINT REPORT 
are used to analyze the severity, frequency, and
causes of occurrence within the five risk
categories. Such analysis serves as a basis for
intervention.

Accurate and comprehensive reporting on both the
pt. chart and in the incident report is
organization and caregivers from litigation.
essential to protect the Incident reporting is often
the nurse’s responsibility. Reluctance to report
incidents is usually to fear of the consequences.

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HOW TO ALLEVIATE
THE FEAR
??
Holding staff education programs that emphasize
objective reporting
 Omitting inflammatory words and judgmental
statements.
 having a clear understanding that the purposes
of the incident reporting process are
documentation and fallow-up
 never using the report, under any circumstances,
for disciplinary action.

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CONT….
A reportable incident should include any
unexpected or unplanned occurrence that affect
apt. , family member, or staff.
HOW TO MAKE AN INCIDENT REPORT ???
1.
discovery. nurses, physician, pt., families, or
any employee or volunteer may report actual
or potential risk.
2.
Notification. the risk manager receives the
completed incident form within 24 hours after
incident.
3.
Investigation. the risk manager or
representative investigates the incident
immediately.
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CONT….
4. Consultation. the risk manager consults with
the referring physician, risk management
committee member , or both to obtain
additional information and guidance.
5. Action. the risk manager should clarify any
misinformation to the pt. or family , explaining
exactly what happened.
6. Recording. the risk manager shoud be asure
that all records, including incident report are
filed in a central depository.
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EXAMPLE OF RISK :
Medication
errors
Diagnostic
procedure
Medical legal
incident
A reportable incident
occurs when a
medication or fluid is
omitted , the wrong is
administered or the
medication is given to
the wrong patient at
wrong time in the wrong
dosage or by the wrong
rout .
Any incident occurring
before, during, or after
such procedures as blood
sample stick , biopsy, xray examination , lumber
puncture , or other
invasive procedure is
categorized as a
diagnostic procedure
incident.
If a patient or family
refuses treatment as
order and prescribed or
refuses to sign consent
forms , the situation is
categorized as a medical
– legal incident .
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MEDICATION ERRORS :
Patient A
Weight was
transcribed
incorrectly from
emergency room
sheet .
Double dose given
the solution:
Error discover after
first dose and
corrected second
dose omitted .
Patient B
Patient C
Tegretol dosage
written in medex as
( Tegretol 100mg
chewable tab _ 50mg
PO BID )Tegretol
100mg given PO at
1400 .
During round at
3:30 pm 9%sodium
chloride at 75 cc
per hour hanging .
Order was D5W.
Fluid last checked
at 2:00pm .
Change to correct
fluid . Doctor
notified
Meds checked at
1430 and error noted
50 mg Tegretol
should have been
given Doctor notified
second dose held.
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DIAGNOSTIC PROCEDURE :
Patient A
When I checked the IV site
, I saw that it was red and
swollen . For this reason , I
discontinued the IV . When
I remove the tape , I noted a
small area on skin
breakdown where the tape
had been . There was also a
small knot on the medial
aspect of the left antecubital
above the IV insertion site .
Doctor notified Wound
dressed .
Patient B
Patient found on the floor
after lumbar puncture . Right
side rail down . Examined by
physician ,BP 120/80 , T98.6
,R72 . No injury noted on
exam.
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MEDICAL LEGAL INCIDENT
Patient A
After a visit from a member of
the clergy , patient indicated he
was no longer in need of
medical attention and asked to
be discharged . Physician called
. Doctor explained potential
side effect if treatment was
discontinued . Patient
continued to ask for discharge .
Doctor explain against medical
advice (AMA) form . Patient
signed AMA form and left at
1300 without medication.
Patient B
Patient refused to sign consent
for bone marrow biopsy . States
side effects not understood .
Doctor reviewed reason for test
and side effects three different
times . Doctor informed the
patient that without consent he
could not perform the test .
Offered to call in another
physician for second opinion .
Patient agreed . After doctor left
, patient signed consent form.
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PATIENT OR FAMILY DISSATISFACTION
WITH CARE
When a patient or family indicates general
dissatisfaction with care and the situation cannot
be or has not been resolved, then an incident
report is filed.
Patient A. mother complained that she had found
child saturated with urine every morning .
explain to mother that diapers and linen are
changed at 0600 when 0600 feedings and meds
are given.
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Patients back , buttocks , and perineal areas are
free of skin breakdown. Parents continue to be
distressed. Discussed with primary nurse.
Patient B. Mr. Smith obviously very angry. Greeted
me at the door complaining that his wife had not
been treated properly in our emergency room the
night before. Wanted
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to speak to someone from administration .
Was unable to reach the administrator on
call. suggested Mr. Smith call
administrator in the morning . Mr. Smith
thanked me for my time and assured me
that he would call the administrator the
next day.
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ROLE OF THE NURSE MANAGER
The nurse manager plays a key role in the 
success of any risk management program.
Nurse manager can reduce risk by helping
their staff view health and illness from
the patients perspective. Usually the
staffs understanding of quality differs
from the patients expectations and
perceptions. By understanding the
meaning of the course of illness to the
patient and the family, the nurse
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will manage risk better because that 
understanding can enable the nurse to
individualize patient care. This
individualized attention produce respect
and , in turn , reduces risk. A patient
incident or a patients or a family
expression of dissatisfaction regarding
care indicates not only some slippage in
quality of care but also potential liability .
A distraught , dissatisfied , complaining
patient is a high risk ; a satisfied
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Patient or family is a low risk. A risk management
or liability control program should therefore
emphasize a personal approach. Many claims are
filed because of a breakdown in communication
between the health care provider and the patient
. In many instances , after an incident or bad
outcome , a quick visit or call from an
organizations' representative to the patient or
family can sooth tempers and clarify
misinformation.
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In the examples given , prompt attention and care
by the nurse manager protected the patients
involved and may have averted a potential
liability claim . Once an incident has occurred .
The important factors in successful risk
management are:
-1Recognition of the incident
-2Quick follow-up and action
-3Personal contact
-4Immediate restitution
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