Executive Ending: "Risk Management" - Crozer-Keystone Health System - PA

Executive Ending:

Nancy Politarhos, RN, MSN

Assistant Vice President, Patient Services, Taylor Hospital

“Risk management."

It sounds like such a corporate term and something far from the realm of a nurse’s responsibility. Yet every day, we are called upon to do just that – manage risk. Be it the risk of a fall, medication error, or infection, risk management is a job that falls upon everyone’s shoulders.   

At CKHS, we are dedicated to mitigating risk to our patients and employees and have put in place processes and technology designed to help with this effort. An example to which everyone can relate is the Medication Administration Checking (MAK) system. 

MAK takes the guess work out of risk management by walking the user through a series of pre-programmed steps that have to be completed before he or she can access or administer medication. With this one piece of technology the opportunity for medication error has been significantly diminished. 

Of course not every risk can be addressed through technology. Take, for example, the “second victim.” This is the healthcare provider who has made an error in care and, as a result, harmed or killed a patient. We all know the second victim. He or she is one of our own – a co-worker, a friend – whose own wellbeing is now at risk because of this mistake.

An article on this subject in the July 14, 2011 issue of ISMP’s Medication Safety Alert states what many of us in healthcare already know, that “second victims suffer a medical emergency equivalent to post-traumatic stress disorder.”   

In response to this article, several members of CKHS’ nursing and physician leadership have come together to develop a program that ensures second victims receive the care and support that they require following such an event. The program is still in its infancy, however, and details will be shared when they are available. 

While the second victim program is an example of how we address risk at the system level, I want to stress that nursing units also play a critical role in risk management. Time and again, we’ve witnessed how a unit can identify a problem and as a result, drive change across the entire system. Therefore, I encourage you to be on the lookout for opportunities to enhance the safety of our work and healthcare environment and speak up! 

All of this brings me now to the subject of compliance. It is my opinion that one of the easiest ways to avoid risk at all is by complying with the moral, ethical and legal policies that govern our health system.  These policies have been put in place to protect both employees and patients from harm and, therefore, it’s in everyone’s best interest to adhere to them.   

I’ve been in healthcare long enough to know that risk is something that “comes with the territory.” However, I also believe that we all have a role in protecting our patients and ourselves from its ill effects.