CLINICAL RISK MANAGEMENT

Clinical risk management

Clinical risk management

Introduction

Nurses in all levels and areas of practice have a stringent responsibility to reduce and where possible prevent the incidence and impact of adverse events in the contexts in which they work. In addition, it is widely recognised that nurses (who constitute the largest component of the health care workforce) are 'inseparably linked to patient safety' (Page, 2004, p. 23). As research studies conducted over the past decade have consistently shown, through their ongoing patient surveillance (involving continuous patient assessment, evaluation and monitoring) and informed interventions, nurses have played a fundamental role in the detection, prevention and 'rescue' of errors and adverse events. Accordingly, nurses have contributed substantially to achieving positive patient safety outcomes .Despite the role and success of nurses in managing and improving patient safety outcomes, it is nevertheless recognised that nurses, like others, could be better prepared educationally to discover and prevent risks/adverse events in health care and thereby contribute to the broader agenda (locally and globally) for safety and quality in health care. Just what form the safety education of nurses should take, however, remains open to question.

The patient's right to be safe

All people requiring or receiving health care have a right to be safe - that is, the right to be kept free of danger or risk of injury while in health care domains. This right carries with it a correlative duty on the part of health service providers to ensure that people who are receiving care are kept free from danger or risk of injury while receiving that care. In recent years, however, there has been increasing recognition around the world that health care is not as safe as it ought to be and that people's rights to be safe in health care domains are not always upheld.

Since the early 1990s research studies conducted respectively in the United States of America, Canada, the United Kingdom, and Australia, have found that between 4% and 16.6% of patients suffer from some kind of harm (including permanent disability and death) as a result of adverse events while in hospital. These studies have also found that a significant percentage (around 50%) of the reported harms could have been prevented - that is, they were 'preventable adverse events' (Kohn et al., 2000 and Leape, 1994).

Concerned by these and other reported findings, health care organisations around the world have responded by strategically implementing robust patient safety and quality care programs under the rubric of 'clinical risk management'.

Clinical risk management' (CRM) is defined for the purposes of this discussion as:

an approach to improving quality in healthcare which places special emphasis on identifying circumstances which put patients at risk of harm, and then acting to prevent or control those risks (Walshe and Dineen, 1998 - cited in McNeil et al., 2000).

The primary aim of CRM is to improve the safety and quality of health care services so as to reduce the incidence and impact of preventable adverse events to ...