orignial post Option #2: The principles of Risk Management apply to all advanced

orignial post
Option #2: The principles of Risk Management apply to all advanced practice registered nurses and in all business settings. Discuss a situation where risk management applies to your current or future APN practice setting, or planned business. Also discuss how you handle (will handle) risk management.Option #2: The principles of Risk Management apply to all advanced practice registered nurses and in all business settings. Discuss a situation where risk management applies to your current or future APN practice setting, or planned business. Also discuss how you handle (will handle) risk management.
peer response to:
Risk management is an imperative process to understand when working in healthcare and its importance to patient safety. Risk management is a set of administrative processes and procedures to prevent patient risks (McGowan et al., 2022). The Institute of Medicine developed a report responding to the numerous people dying from medical errors, and later, Congress authorized an act on patient safety and quality improvement (McGowan et al., 2022). Its fundamental principles are Patient Safety Organizations (PSOs), collection and distribution of information related to patient safety, patient safety database, development of policies amongst staff to improve patient safety, medical-error reporting systems, and data collection from the state (McGowan et al., 2022). The act aims to encourage confidential and voluntary reporting of adverse events that occur to patients to improve patient safety (McGowan et al., 2022). All healthcare employees working in larger institutions generally have risk management teams or programs involved in identifying errors and improving processes to prevent adverse events. There are instances where errors are not reported due to fears of punishment, retaliation, or termination. If hospitals report medical errors, this improves the culture of transparency and promotes patient safety (McGowan et al., 2022). Errors are the most common cause of patient harm, and the costs of errors result in higher expenses related to morbidity, mortality, prolonged hospital stays, and further testing or treatments (Santurro et al., 2021).
A study completed in 2021 compared medical malpractice claims on physicians, advanced practice registered nurses (APRNs), and physician assistants (PAs). The study found that medical malpractice claims involving APRNs were frequently due to a diagnosis of broken teeth, and the claims occurred when the APRN was not co-named with the supervising physician (Myers et al., 2021). The study purported that the claims against the APRNs possibly reflected that the physician was not present and involved during the event (Myers et al., 2021). According to the study, only 10 to 20 percent of claims naming an APRN were diagnosis-related compared to a prior study in 2017 that reported 40 to 50 percent of claims (Myers et al., 2021). Their results suggested that although claims towards only APRNs are rare, a target of high-risk claims involves outpatient airway procedures (Myers et al., 2021). The study aimed to identify target areas to develop patient safety initiatives and training programs to prevent harm in the future (Myers et al., 2021). This study is essential for future nurse anesthetists in the program to educate themselves on these claims and verify that their future practices have policies and procedures to reduce patient harm and mitigate claims.
With value-based care reimbursement and pay-for-performance programs, hospitals and healthcare systems are expanding risk management programs for patient safety and medical liability from reactive to proactive measures (New England Journal of Medicine Group [NEJM Group], 2018). Risk management plans should include education and training, patient and family grievances, goals and metrics, communication on contingency plans, protocols, and response mitigation (NEJM Group, 2018). Many hospitals and healthcare facilities involve risk management after events occur reactively to investigate the occurrence and develop future policies or procedures to prevent repeat events. In the clinic I worked at before moving to Virginia, all the medical assistants would not implement any order by the provider until it was entered and signed off in the patient’s electronic medical record. This was implemented reactively after an error occurred with a verbal order for a vaccine.
In my current practice, my supervising physician and I have called out to the company’s management on identified risks. For example, the clinic provides medication-assisted treatment and counseling for clients with substance use disorders (SUD). This clinic does not provide primary care services currently. The medical assistant (MA) takes vitals, including blood pressure (BP), with an automatic wrist cuff during every patient intake. Due to the variability of inadequate and skewed higher readings by wrist cuffs, there is a high percentage of patients with documented high blood pressure results. Since the clinic cannot treat the elevated blood pressure due to the inability to offer primary care services, my supervising physician and I have questioned why the MAs must take BPs with an inconsistent automatic wrist cuff. If a patient has elevated blood pressure considered hypertensive urgency and later has a myocardial infarction, lawyers can claim the SUD clinic was the last to measure the BP. Although the providers cannot provide primary care services, do we refer all patients to the local ER based on a one-time high BP reading by an automated wrist cuff?
Another example is the lack of proper equipment for alcohol testing in the clinic. All point-of-care urine drug screens do not test for alcohol in the 12-panel drug screen. If a patient is seeking treatment for alcohol use disorder, we currently do not have a reliable way to test in the office if the person is intoxicated from alcohol. If the patient leaves the clinic in a car, as the driver, and is involved in a motor vehicle crash under the influence, then is the clinic at risk because the patient was last seen there and seeking help for alcohol use disorder? These examples are not meant to spotlight in a negative manner the current practice I work for but are used as examples for further discussion and knowledge on APRNs’ roles in identifying possible risks and the development of policies or procedures to mitigate patient harm. The goal is to be proactive in identifying risks and not reactive after an event occurs. Activities need to be created to identify errors, produce evidence, and recommend clinical risk management to improve the quality and safety of patients (Santurro et al., 2021). Risk management requires effort from all interprofessional team members to implement policies and procedures and execute them daily (McGowan et al., 2022).
My business adventure plan aims to provide free post-hospitalization and post-procedure care to unhoused vulnerable populations in a medical respite program. Since the care provided is free to the patient, the program will be covered under the Federal Tort Claims Act (FTCA) to waive employees’ malpractice claims who act in their scope of practice (Health Resources & Services Administration [HRSA], 2023). This is a waiver of immunity if the practitioner acts within their scope of practice at the facility and does not accept reimbursement from third-party payors (HRSA, 2023). Despite offering free services and being covered under the FTCA for medical malpractice, the business will still need to implement procedures and policies to reduce risks of patient harm. Risk of harm can include medication errors, equipment failure, confirmation of patient identity, allergy review, infection risk, diagnostic errors, and patient falls (McGowan et al., 2022). These risks will need to be discussed by the business owners, who need to take a proactive approach to minimize them through the development of policies and procedures. Informed consent is a requirement in all healthcare settings and is considered a patient safety issue (Shah et al., 2022). The focus is shifting to more on communication and less on signatures due to reports of barriers to obtaining and patients’ lack of understanding (Shah et al., 2022). Practitioners must actively engage patients to enhance communication and perform teach-back methods to ensure understanding (Shah et al., 2022). Another risk that must be addressed is security to protect confidential health information. All healthcare providers who carry a laptop to work remotely need a cybersecurity system to prevent access to personal health information in case of theft, hacking, or loss of the computer. Regardless of whether there are risk management programs at facilities, every facility needs to have policies and procedures in place to enhance the organization’s performance and mitigate patient harm. Again, risk management involves developing and implementing protocols and policies and applies to all businesses to ensure the best outcomes for patients and organizations (Maryville University, n.d.). This assignment has highlighted the need for all practitioners to identify and evaluate risks and implement measures to address and prevent them, regardless of the area of current or future employment.