March/April 2009

After a six-month hiatus, the Risk Management Report is back, and we hope it is easier than ever to read, save and forward to others. It will arrive in your inbox every two months and will contain the latest information on items of interest to risk managers, administrators, quality managers, safety officers and chief nursing officers. I hope you like the new format and welcome your comments and suggestions at dmcvey@thainsurance.com or 800/792-0060. Also, please visit the risk management portion of the Texas Hospital Insurance Exchange Web site.

Dana McVey
Vice President, Risk Management
Texas Hospital Insurance Exchange

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THIE Moves Offices

As of April 27, 2009, the Texas Hospital Insurance Exchange will have moved to a new location in Austin. Please make a note of and direct all correspondence to the new address:

8310-1 Capital of Texas Highway
Building 1, Suite 250
Austin, TX 78731

All telephone numbers, facsimile numbers and e-mail addresses will remain the same.

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CDC Updates Guidelines for
Disinfection and Sterilization

The Centers for Disease Control and Prevention has issued updated guidelines for cleaning, disinfecting and sterilizing medical devices and the health care environment. New topics include (1) inactivation of antibiotic-resistant bacteria, bioterrorist agents, emerging pathogens and bloodborne pathogens; (2) toxicologic, environmental and occupational concerns associated with disinfection and sterilization practices; 3) disinfection of patient care equipment used in ambulatory settings and home care; 4) new sterilization processes, such as hydrogen peroxide gas plasma and liquid peracetic acid; and 5) disinfection of complex medical instruments (e.g., endoscopes).
The guidelines were last updated in 1985.

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The Employee's Role in Minimizing Risk

By Randal Wilkerson
Vice President, Claims
Texas Hospital Insurance Exchange

Elevator-related incidents frequently occur in hospitals and medical office buildings. How a hospital employee reacts to such an event can go a long way toward minimizing the risk that a claim or suit will follow.
 
In one case, an elderly woman was visiting her husband in the ICU. After he was stabilized, she decided to return home to contact family members. She waited for the elevator with a few other people. When the elevator door opened, one employee was already on the elevator. As she followed the other visitors into the elevator, the door began to close and struck her hand and arm. After contact, the door retracted. She knew her hand hurt but did not think it was too bad. The employee did not ask her if she was injured, nor did any of the other people on the elevator.

As she left the parking lot, the woman noticed the pain in her hand was not going away. She went on with her plans, but because of the pain, she returned to the hospital's emergency department. X-rays confirmed bone fractures in her hand, and she was referred to a hand specialist for treatment. Thankfully, she recovered from the injury with minimal impairment. However, she was upset that the employee took no interest in her injury. She made a claim for her injuries.

Employees could help the hospital avoid such a situation by heeding the following advice:

• Strive to be aware of activities going on around you. Employees are the eyes and ears of the hospital.
• Be helpful to all visitors, particularly the elderly. In this case, not only was the visitor elderly, but her mind was not on what was going on around her.
• When an incident occurs, make sure the person is OK. If there is any doubt, refer them to the emergency department.
• After the incident, inform risk management as soon as possible so that other corrective action (like bill abatement) can be done in a timely manner if needed. If there are witnesses, obtain their names and contact information. Be sure to note the time and location of the incident.

There are also a few things that employees should not do:

• Do not tell the person that this type of incident has happened before and that the hospital has not done anything to correct the problem.
• If sending an e-mail about the incident or filling out an incident report, make it factual and timely. State what you saw or heard, not what you think happened, and avoid making disparaging comments that could be harmful to the defense of the hospital if they were discovered and read to a jury at trial. 
• Perhaps most important, if you see or hear something happen, do not walk away without offering assistance. In this case, the employee did not offer any aid or inquire about the well-being of the visitor. That inaction ultimately caused the claim.

Risk Management Implications
This case is illustrative of the need to train everyone on risk management. Every employee needs to understand the importance of quality and risk management as well as specific examples of when every employee needs to become a risk manager. For example, if there's a spill on the floor, employees should wipe it up or call for assistance (don't leave the wet spot unattended). If someone falls, employees should make sure the individual is offered medical care. The list is endless, but the point is that every employee should feel empowered to fix and report risks.