{"id":10918,"date":"2024-12-11T15:07:11","date_gmt":"2024-12-11T14:07:11","guid":{"rendered":"https:\/\/extali.eu\/docs\/5-pruefung\/5-1-pruefung-und-messung\/5-1-16-sicherheitsbegehung-durch-die-leitung\/"},"modified":"2025-02-04T13:37:44","modified_gmt":"2025-02-04T12:37:44","slug":"5-1-16-safety-inspection-by-the-management","status":"publish","type":"docs","link":"https:\/\/gutehospitalpraxis.de\/en\/handbuch\/5-pruefung\/5-1-pruefung-und-messung\/5-1-16-sicherheitsbegehung-durch-die-leitung\/","title":{"rendered":"5.1.16 Safety inspection by the management"},"content":{"rendered":"
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Download the VA as PDF<\/a>Download<\/a><\/div>\n\n\n\n

<\/p>\n<\/div>\n\n\n\n

1 Aim and purpose<\/h3>\n\n\n\n

Collect information from employees about danger points
Take action based on messages from staff
Direct response to safety problems by those responsible for management
Promote safety awareness among employees through visible management commitment to the topic.
Addressing employees in management positions on the topic of safety
Remind employees of the importance of patient safety in the overall mission of the organisation
<\/p>\n\n\n\n

2 Scope of application<\/h3>\n\n\n\n

Assemble a management team for the inspection: Head of the organisation, QM coordinator and\/or RM manager, safety specialists, head of technology. The area must be defined before the inspection. The area should be notified prior to the inspection.<\/p>\n\n\n\n

3 Description<\/h3>\n\n\n\n

3.1 Preparation<\/h4>\n\n\n\n

Determine areas Set dates at an early stage. Observe daily routines in the areas. Determine the flow chart: who will be interviewed? What will be looked at? Involve senior staff in the department Distribute questionnaire \"Attitude to safety culture\"<\/p>\n\n\n\n

3.2 Procedure<\/h4>\n\n\n\n

Formal introduction to the employees. Explain that the management wants to find out about safety problems and hazards. To do this, the employees must understand that it is not their mistakes that are being asked about, but the dangers that threaten to cause them to make mistakes. Explain that the management feels responsible for preventing such dangerous situations. Areas can be<\/p>\n\n\n\n

    \n
  • Dangers of medication<\/li>\n\n\n\n
  • Communication faults<\/li>\n\n\n\n
  • Team problems<\/li>\n\n\n\n
  • Distraction<\/li>\n\n\n\n
  • Inefficiency<\/li>\n\n\n\n
  • Documentation problems<\/li>\n<\/ul>\n\n\n\n

    Announce that the employees will receive feedback on what will happen regarding their comments. Finally, thank everyone for their time. Explain that the information will be analysed and measures will then be taken to eliminate the risks. We will also enquire how the measures are received by them. Refer to the \"Adverse events\" reporting system<\/p>\n\n\n\n

    3.3 Analysing the data<\/h4>\n\n\n\n

    All recorded hazards are classified according to frequency of occurrence, severity of impact on patients and recognisability (enter risk indicators). Make suggestions for remedial action Have the management decide on measures Summarise the results in a report and send it to the departments that took part in the inspection. Evaluate the \"Questionnaire on attitudes to safety culture\" survey<\/p>\n\n\n\n

    3.4 Tracking<\/h4>\n\n\n\n

    Report on the measures and their implementation throughout the hospital (in-house information) Enter measures in the list of corrective measures and have them followed up by the QM coordinator.<\/p>\n\n\n\n

    4 Documentation<\/h3>\n\n\n\n

    Create a report form Note the date, time, locations and participants in the inspections Note all messages Note observations The report should be given to the QM group to follow up on the findings. The report should be included in the management review.<\/p>\n\n\n\n

    5 Resources<\/h3>\n\n\n\n

    5.1 Time required<\/h4>\n\n\n\n

    An inspection takes approx. 1 hour, participants 6 managers, participation of employees depending on the size of the department (approx. 2 hours), follow-up approx. 1 hour. Consultation and decisions are the normal task of the management. Estimated time required for an inspection: approx. 10 working hours. Each department or clinic should be visited once in the course of a year.<\/p>\n\n\n\n

    6 Responsibility<\/h3>\n\n\n\n

    Organisation: QM coordinator Participation: Hospital management, department management, QM coordination, safety specialists, head of technology Decision on prioritisation, initiation of measures: Management Follow-up: QM coordinator Communication of results and measures: Press office <\/p>\n\n\n\n

    7 Notes and comments<\/h3>\n\n\n\n

    <\/p>\n\n\n\n

    8 Applicable documents<\/h3>\n\n\n\n

    8.1 Literature<\/h4>\n\n\n\n

    Frankel \u0410, Graydon-Baker \u0415, Neppl \u0421, Simmonds \u0422, Gustafson \u041c, Gandhi \u0422\u041a. \"Patient Safety Leadership WalkRounds.\" Joint Commission Joumal of Quality and Safety. 2003, Vol 29(1), 16-26.<\/p>\n\n\n\n

    Leonard \u041c, Frankel \u0410, Simmonds \u0422, Vega \u041a\u0412. Achieving Safe and Relia\u042be Healthcare: Strategies and Solutions. Chicago: Health Administration Press, 2004.<\/p>\n\n\n\n

    Gandhi \u0422\u041a, Graydon-Baker \u0415, Barnes JN, Neppl \u0421, Stapinski \u0421, Silverman J, Churchi11 W, Johnson \u0420, Gustafson \u041c. \"Creating an integrated patient safety team.\" Joint Commission Joumal of Quality and Safety. 2003, Vol 29(8), 383-90<\/p>\n\n\n\n

    8.2 Terms<\/h4>\n\n\n\n

    <\/p>\n\n\n\n

    Attachments<\/h3>\n\n\n\n

    Annual planning for inspections
    Announcement letter for inspection
    List of questions for the inspection
    Report form for inspection
    Questionnaire \"Attitude towards safety culture\"<\/p>","protected":false},"excerpt":{"rendered":"

    1 Ziel und Zweck Informationen von Mitarbeitern \u00fcber Gefahrenpunkte sammelnMa\u00dfnahmen ergreifen aufgrund von Mitteilungen des PersonalsDirekte Reaktion auf Sicherheitsprobleme durch die LeitungsverantwortlichenSicherheitsbewusstsein bei Mitarbeitern f\u00f6rdern durch sichtbares Engagement der Leitung f\u00fcr das Thema.Ansprache der Mitarbeiter in Leitungsfunktionen auf das Thema SicherheitMitarbeiter an die Wichtigkeit der Patientensicherheit in der Gesamtaufgabe der Organisation erinnern 2 Anwendungsbereich Leitungsteam […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":10884,"menu_order":17,"comment_status":"open","ping_status":"closed","template":"","doc_tag":[],"doc_badge":[],"class_list":["post-10918","docs","type-docs","status-publish","hentry","no-post-thumbnail"],"acf":[],"author_avatar":"https:\/\/secure.gravatar.com\/avatar\/c6b2616140d9fcd6a1c5d6d2ebbf43422308c9322c032ef03f88ec3235855dcf?s=96&d=mm&r=g","author_name":"admin","_links":{"self":[{"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/docs\/10918","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/docs"}],"about":[{"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/types\/docs"}],"author":[{"embeddable":true,"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/comments?post=10918"}],"version-history":[{"count":1,"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/docs\/10918\/revisions"}],"predecessor-version":[{"id":15010,"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/docs\/10918\/revisions\/15010"}],"up":[{"embeddable":true,"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/docs\/10884"}],"wp:attachment":[{"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/media?parent=10918"}],"wp:term":[{"taxonomy":"doc_tag","embeddable":true,"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/doc_tag?post=10918"},{"taxonomy":"doc_badge","embeddable":true,"href":"https:\/\/gutehospitalpraxis.de\/en\/wp-json\/wp\/v2\/doc_badge?post=10918"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}