2. 风险管理方法建立
背景/事件辨识风险衡量后果预防性控制更正性控制稽核与确认FinanceKey debtor fails to payInadequate funds to transact businessCredit insurance policyBad debt provisionsCredit reference checks of customersRegular review of age analysisAudit appropriateness & effectiveness/compliance of controls
Start Simple develop sophisticationUnable to fund capital projects Use contingency fundsSupply only within in approved credit limits(Corrective)(Preventive)根据澳洲/纽西兰 AS/NZ 4360 风险管理框架
8. FMEA的目的防患未然(Prevent the problems before they occurred)
设计屏障(Focus on protections that can prevent the failure from reaching the patients)
降低损害(Mitigate the effects if the failure reaches on patients)
26. Healthcare FMEA发展自FMEA的概念,由VA national center for patient safety 所研发
协助医疗院所建立完善的病人安全管理系统,包含组织、体制及技术面的运作,使医院经营符合评鉴要求,达到病人安全的目标
将FMEA三维的风险分析简化为二维
透过决策树分析决定采取改善行动的优先顺序
37. 医疗作业当中的高风险流程Medication use
Operative and other procedures that place patients at risk(radiotherapy,CT scan,MRI etc)
Use of blood components
Care or services provided to high risk population
Outcome related to resuscitation
Sentinel events
52. 范例:PSA testStep3A.描绘出PSA检查流程的主要步骤
Process Step Process Step Process Step Process Step Process Step
PSA test
orderedDraw
SampleAnalyze
SampleReport to
PhysicianResults
Filed(HIS)
53. 范例:PSA test(续)Step3B.将每一个步骤予以编号
1 2 3 4 5
PSA test
orderedDraw
SampleAnalyze
SampleReport to
PhysicianResults
Filed(HIS)
54. 范例:PSA test(续)Step3C.对于复杂的流程,可选择重点描绘出次流程
1 2 3 4 5
Scope
PSA test
orderedDraw
SampleAnalyze
SampleReport to
PhysicianResults
Filed(HIS)
55. 范例:PSA test (续)Step3D. 对于次流程中的每一个步骤予以编号
1 2 3 4 5
Sub-Processes Sub-Processes Sub-Processes Sub-Processes Sub-Processes
Order written A. ID Patient A. Review order A. Report Received A. Results Filed
B. Entered in HIS B.Select proper B.Centrifuge
C.Received in Lab tube/equip Specimen
C. Draw blood C. Verify
D. Label Calibration
D. Run QC
E. Run Sample Scope
F. Report Result
G. Enter in HISPSA test
orderedDraw
SampleAnalyze
SampleReport to
PhysicianResults
Filed(HIS)
61. 决策树(Decision Tree)分析问题是否为关键(critical)点
(Single point weakness)
有无有效衡量管制方法
能否明显看出失效
是否进行Step5矫正
62. 决策树(Decision Tree)分析(续)
NO
YES NO
YES
YES
NO
对于停止的决定
必须记录理由 NO YES
对于停止的决定
必须记录理由1、该失效模式或步骤是否会造成系统相当大的危害?(如危害指数>8)2、该项是否为整体流程中唯一的一处弱点或关键?(一旦失效会造成系统失败)3、是否已有有效的控制措施可侦测该失效模式的发生?4、该危害是否很明确,即使缺乏控制也能轻易察觉?继续进行HFMEA步骤5stop
64. 范例:PSA test (续)
1 2 3 4 5
Sub-Processes Sub-Processes Sub-Processes Sub-Processes Sub-Processes
Order written A. ID Patient A. Review order A. Report Received A. Results Filed
B. Entered in HIS B.Select proper B.Centrifuge
C.Received in Lab tube/equip Specimen
C. Draw blood C. Verify
D. Label Calibration
D. Run QC
E. Run Sample Scope
F. Report Result
G. Enter in HISPSA test
orderedDraw
SampleAnalyze
SampleReport to
PhysicianResults
Filed(HIS)
65. 范例:PSA test(续) Step3E. Analysis Sample(Sub-process flow diagram)
3A 3B 3C 3D 3E 3F 3G
Review
orderCentri.
SpecimenVerify
Calibra.Run
QcRun
sampleReport
resultEnter
In HIS
66. 范例:PSA test(续) Step4A. 危害分析:列出每一个流程/步骤的可能失效模式
3A 3B 3C 3D 3E 3F 3G
Failure Mode: Failure Mode : Failure Failure Failure Mode: Failure Mode: Failure
Mode: Mode: Mode:
1.Wrong test 1.Equip broken 1.Instrument 1.QC 1.Mech.error 1.Computer 1.Not
orderde 2.Wrong speed not Calibra. Result crash entered
2.Order not 3.Specimen not 2.Bad calibra not 2.Result entered
Received clotted stored accept. For wrong P’t
4.No power 3.Result not
5.Wrong test entered
tube Scope 4.Result misread
by tech. Use
worksheet
Review
orderCentri.
SpecimenVerify
Calibra.Run
QcRun
sampleReport
resultEnter
In HIS
145. 异常事件判定树(IDT)IDT是根据流程图,公平且一致的检视相关的个人,把焦点集中于组织系统而非指责个人,其中包含四个tests:
1. The deliberate test–是指此伤害是否为蓄意造成
2. The incapacity test–是否因个人健康或其他原因而造成病人伤害
3. The foresight test–是否违反安全规范或标准作业规范而造成错误
4. The substitution test–换成另ㄧ个人是否会犯同样的错误.
151. Organize a team that knows the process.Clarify current knowledge of the process.nderstand causes of process variation .USelect the process improvement.Find a process to improve.(寻找可改善的流程)(组织一个了解该流程的团队)(阐明对该流程的认知)(了解该流程产生变量的原因)(选择改善流程)第四阶段:设计及执行行动计划
152. Plan the improvement and continued data collection.Do the improvement, data collection and analysis.Check the results and lessons learned from the team effort.Act to hold the gain and to continue to improve the process.拟订改善计划并进行持续性的数据收集进行改善,继续数据收集及分析检查成果及由团队中学习建立措施以保持好的部分,并继续做流程改善第四阶段:设计及执行行动计划