Risk Management in Healthcare: The Top 10 Risks in Your Hospital
Hacked medical devices and bloodborne pathogens are just two risks you may need to watch out for if you work in a hospital.
Image via Unsplash.com/Scott Webb
Whether you’re in nursing school or a seasoned pro, you know how important risk management is in healthcare. Carefully planning for risks allows you to provide your patients with the high-quality care they deserve while keeping them safe. By implementing effective risk management strategies, you can also help reduce the number of medical malpractice claims that are brought against you, your team, or your hospital. That said, you can’t manage risks if you don’t know what to look for. Here are the top 10 risks to look out for and some suggestions to help reduce their likelihood of coming up.
Danger #1: Bloodborne Pathogens
- What It Is: Bloodborne pathogens are infectious microorganisms that live in human blood, bodily fluids, organs, and tissues. The most well known are Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus (HIV). According to the National Institutes of Health (NIH), people can become infected if they’re pricked with contaminated needles or sharps or if they somehow get infected bodily fluids in their eyes, nose, or mouth (e.g., rubbing your eyes with contaminated hands).
- Why It Matters: Anyone who works in an industry where they’d be exposed to human blood or “other potentially infectious material” (OPIM) are most at risk of becoming infected by bloodborne pathogens. ISSA put together a list of these occupations, which includes emergency medical service providers (e.g., EMTs, paramedics), healthcare employees in clinics and physicians’ offices (e.g., nurses, physicians, PAs), and even housekeepers in healthcare facilities.
- What You Can Do: If you work for a facility that has its own exposure control plan (ECP), OSHA encourages you to take some time to review the protocol your employer put in place for preventing and/or handling exposure incidents. The American Red Cross also has resources for avoiding and responding to bloodborne pathogen exposures.
Danger #2: Catheter-Associated Urinary Tract Infection (CAUTI)
- What It Is: A CAUTI is an infection in any part of the urinary system (i.e., urethra, bladder, ureters, and kidneys) that’s caused by prolonged urinary catheter use.
- Why It Matters: The Centers for Disease Control and Prevention (CDC) notes that 75 percent of all hospital-acquired UTIs are associated with catheters. In fact, CAUTIs are the most common type of healthcare-related infection in the U.S. It’s estimated that there are 449,334 such events every year, and that they’ve been responsible for 13,000 deaths so far.
- What You Can Do: Since catheters are necessary for treating a variety of conditions, the CDC published a guide for preventing CAUTIs. Generally, the CDC advises that you only use them when absolutely necessary. And, if you do need to use one, make sure to remove it as soon as possible.
Danger #3: Diagnostic Errors
- What It Is: The National Academy of Medicine defines a diagnostic error as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.” According to the Society to Improve Diagnosis in Medicine (SIDM), these errors fall into one of three categories: A delayed diagnosis (i.e., a diagnosis should’ve been made earlier), a wrong diagnosis, or a missed diagnosis.
- Why It Matters: Diagnostic errors have the potential to throw off every aspect of a patient’s care plan. For example, a cancerous tumor that’s mistaken for a boil or misdiagnosed as an ulcer can metastasize before the patient receives proper treatment. These types of errors can also lead to patients receiving treatments that may actually worsen their condition. In fact, the National Academy of Medicine notes that diagnostic errors are responsible for about 10 percent of patient deaths.
- What You Can Do: The World Health Organization (WHO) published a comprehensive guide on how to prevent diagnostic errors, as well as what to do if a mistake is made. The National Academy of Medicine suggests 10 different ways that nurses can help reduce diagnostic errors. Here are a few examples:
- Be an advocate for your patients and their needs.
- Facilitate communication between patients and their care teams.
- Provide your patients with the support they need if they receive a bad diagnosis, or if the diagnosis isn’t yet determined.
- Act as the eyes and ears of the diagnostic teams, and make sure to monitor your patients’ responses to treatment.
Danger #4: Hacked Medical Devices
- What It Is: Believe it or not, medical devices that can connect to the Internet and/or a hospital’s network are vulnerable to hackers. This isn’t just about FitBits, either. “Connected” devices include the equipment you find in healthcare settings (e.g., glucometers, heart rate monitors, MRIs), as well as the electronic devices that are implanted in patients, like pacemakers.
- Why It Matters: The first concern is that hackers could gain access to patients’ sensitive health and financial information. The second concern is that hackers could use these devices as entry points into the hospital’s main network. The third concern is that hackers would have the ability to influence a device’s behavior, which could interrupt the patient’s care and cause them serious harm. (In 2007, former Vice President Dick Cheney received a new pacemaker and asked the manufacturer to disable its WiFi for this very reason.)
- What You Can Do: In its ”Report on Improving Cybersecurity in the Health Care Industry”, the U.S. Department of Health and Human Services urges all healthcare employees to educate themselves on healthcare cybersecurity risks and best practices. With an increased level of awareness, nurses can put themselves in a better position to not only protect their patients, but also to identify potential warning signs in devices’ behavior and report those issues to the right people at the right time—whether it’s to a superior or the IT department. The American Nurses Association (ANA) also published a number of tips for nurses to support their organization’s cybersecurity efforts. Here are some examples:
- Choose a secure password and don’t share it with anyone.
- Delete emails, messages, and attachments from unknown sources.
- Use data encryption for all your devices.
- Report any concerns or problems you may have to your IT department.
Danger #5: Healthcare-Associated Venous Thromboembolism (HA-VTE)
- What It Is: Venous thromboembolism (VTE) is when a blood clot forms in a vein. If left untreated, the clot can break free and lodge itself in the arteries of the lungs, which would block oxygen from getting into the blood. The CDC defines healthcare-associated VTE as a blood clot that occurs “as a result of hospitalization, surgery, or other healthcare treatment or procedure.”
- Why It Matters: The CDC estimates that VTE affects about 900,000 people every year in the U.S. and results in about 100,000 early deaths. Additionally, about one in 10 hospital deaths are attributed to blood clots in lungs. To that point, the International Society on Thrombosis and Haemostasis (ISTH) notes that “60 percent of all VTE cases occur during or within 90 days of hospitalization, making it a leading preventable cause of hospital death.”
- What You Can Do: Find out if your healthcare facility has VTE protocol in place. If it does, familiarize yourself with the guidelines and encourage your colleagues do the same. You can also review the comprehensive guide on preventing hospital-associated VTE from the Agency for Healthcare Research and Quality (AHRQ).
Danger #6: Hospital-Acquired Pneumonia
- What It Is: Hospital-acquired pneumonia is a lung infection that’s acquired during a patient’s hospital stay. It usually comes on if they’ve been at the hospital more than two days.
- Why It Matters: Hospital-acquired pneumonia can be far more serious than community-acquired pneumonia and can even be fatal. Hospital patients are already sick, so their bodies have a harder time fighting off illness. Additionally, germs found in hospitals can be more dangerous because they’re more resistant to antibiotics than those found elsewhere.
- What You Can Do: The CDC published an extensive resource on preventing the spread of pneumonia, and the National Institutes of Health (NIH) shared a list of actions you can take to prevent spreading pneumonia to your patients. Here are some examples:
- Wash your hands regularly and for the proper amount of time.
- Make sure to use hand sanitizer when appropriate.
- Always wear gowns during patient visits.
- Elevate the head of the patient’s bed so they can breathe more easily.
- Never skip basic oral care. This can help reduce the number of microbes in their mouth that they can then breathe into their lungs.
Danger #7: Medication Errors
- What It Is: The National Council for Medication Error Reporting and Prevention defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer.” Medcom provided a list of common types of medication errors, which include:
- Prescribing the wrong drug, given the patient’s medical history.
- Missing or skipping a dose of a medication.
- Administering a drug outside the predetermined interval of time.
- Delivering a higher or lower dose of a drug than was prescribed.
- Administering the medication through the wrong route.
- Incorrectly formulating or compounding a medication.
- Why It Matters: According to AHRQ, adverse drug events account for nearly 700,000 emergency department visits and 100,000 hospitalizations each year, and about half of them are preventable. These errors could not only prevent patients from receiving proper treatment, but also prove to be fatal.
- What You Can Do: Both the FDA and the WHO published useful guidelines for reducing medication errors and improving patient safety. Their suggestions include:
- Familiarizing yourself with the medication procedures that your hospital, facility, or clinic has put in place.
- Double- and triple-checking dosages before administering medication.
- Matching the patient’s name and ID to the medication you’re administering.
- Being aware of the patients’ conditions and allergies.
- Documenting every action you take before, during, and after administering treatment.
Danger #8: Methicillin-Resistant Staphylococcus Aureus (MRSA)
- What It Is: According to the Mayo Clinic, MRSA is an infection that’s “caused by a type of staph bacteria that’s become resistant to many of the antibiotics used to treat ordinary staph infections.” The CDC adds that it can be spread through direct contact with an infected wound or contaminated hands.
- Why It Matters: MRSA is very easy to spread and can cause infections in your bloodstream, heart, lungs, bones, and joints. If left untreated, MRSA can become life-threatening.
- What You Can Do: MRSA can be difficult to prevent completely, but you can reduce your patients’ chances of contracting it by administering antibiotics both before and after surgery. Following surgery, wash your hands thoroughly before you touch the patient, and make sure that visitors wash their hands, too. The CDC published its guidelines for preventing the spread of MRSA in hospitals.
Danger #9: Post-Discharge Adverse Events
- What It Is: A post-discharge adverse event is any injury a patient sustains after they’ve been discharged that is a direct result of the care they received. Typically, this type of adverse event occurs about one month after discharge and usually results in the patient being readmitted to the hospital. There are a number of complications that can happen post-discharge; the most common are hospital-acquired infections and medication errors.
- Why It Matters: According to the AHRQ, about 20 percent of patients experience complications within three weeks of being discharged from the hospital—and 61 percent of those are considered to be preventable issues.
- What You Can Do: The AHRQ recommends not discharging patients while test results are pending, since those results may indicate that the patient requires further hospital care. You should also ensure that the patient understands their own discharge plan, including what medications they’re taking and the correct dosages for each. Another great resource is the Family Caregiver Alliance, which has published information on how to build discharge plans, as well as tips on what families and caregivers can do to guarantee a smooth discharge process.
Danger #10: Sepsis
- What It Is: The CDC explains that sepsis is “the body’s extreme response to an infection.” Specifically, it causes inflammation and, if left untreated, can lead to organ failure, tissue damage, and even death. Any type of infection can cause sepsis—no matter whether it’s bacterial, viral, fungal, or parasitic.
- Why It Matters: More than 1.5 million Americans get sepsis each year, and about 250,000 die from it annually. Additionally, one in three patients who die in hospitals have sepsis. It’s particularly dangerous for older adults and for those with weakened immune systems.
- What You Can Do: Becker’s Hospital Review collected strategies for tackling sepsis from a group of healthcare professionals. One easy thing you can do to prevent your patients from developing sepsis is to make sure their infections are being treated properly and in a timely manner. If any patients have open wounds, be sure to clean them regularly. The Sepsis Alliance also recommends that everyone wash their hands frequently and follow proper handwashing procedures. It’s a simple task, but it will help prevent you from inadvertently spreading infections or illnesses to other patients.
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