Beaumont Hospital

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Beaumont HIV Service Leads Way in Risk Management

Wednesday April 13, 2011

The Infectious Disease Clinic at Beaumont Hospital has recently completed a comprehensive risk assessment and management programme, one of the first at service level within the Irish health service.

The benefits of risk assessment and proactive risk management have long been recognised by large corporations. More recently the health service has seen its potential and in the future developing a risk assessment registry will become part of health care.

Beaumont's HIV service, however, was keen to reap the benefits as quickly as possible. According to Professor Samuel McConkey, Head of the Department of Infectious Diseases at Beaumont, finding out what are the most likely and most serious avoidable risks and dealing with them in advance means a better service for patients.

"It's not unlike the way perceptions changed with regard to drink driving," he says. "It involves a completely new way of looking at things. Instead of waiting until something goes wrong and then trying to fix it, the aim is to identify, prioritise and act on the risks before they happen."

The 12 month project began in December 2009 and involved clinical and non-clinical staff as well as patient representatives in four workshops. The aim was to reduce the likelihood of adverse outcomes for patients. In the workshops participants used a standardised tool developed by the Health Service Executive to identify, analyse, evaluate and rate risks and to identify mitigating factors. This approach ensured consistency with programmes now being developed elsewhere in the health services.

A total of 14 specific risks were identified in the HIV service, many related to medication. Half of these risks were assessed as being "high". These were drug dispensing errors, medication prescription errors, serious drug interactions causing adverse events, unsafe sex and lack of disclosure to sexual partners by people with HIV, exposure to tuberculosis for staff and patients, patient non-attendance at clinics and unavailability of medical records.

Among the measures identified to address these risks were additional pharmacy resources, simplification of guidelines for prescribers, increased social work resources, the introduction of a patient "buddy" system, early identification of possible TB patients, text message clinic appointment reminders and a digital electronic record specifically for HIV patients.

The process has also involved specialist doctors in the HIV clinic reaching out to GPs, helping to educate them, for example, on the risks of potentially serious drug interactions.

"The risk identification and management process takes the view of the patient and the things that may happen to them," Professor McConkey emphasises. "It means that we take responsibility for addressing the highest-priority risks which are within our direct control and that the hospital's senior executives are fully aware of the risks and are responsible for the ones which they can address. It enables everyone to have a clear understanding of the risks and to prioritise the approaches needed to manage them," he says.

Professor McConkey also points out that the process does more than identify the high risks. "Of the 14 risks we identified, six were medium and one was low, so the prioritisation process lets us focus our time and energy on the higher risks and to park or agree to accept the moderate risks and low risks, as in reality we are not be able to change everything. The higher risks indicate those areas of care in which we should perform clinical audit. The process is ongoing, with the creation and review of the risk log. When the next major review comes along, in 18 months, the level of risk may have changed and new ones my be identified."