الفهرس 
Concept of risk managementOnly 14 pages are availabe for public view
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Abstract
Today, risk management efforts in healthcare organizations are rallying behind patient safety and finding ways to work together more effectively and efficiently to ensure that their organizations deliver safe, high-quality patient care and continue to minimize risks, so risk management is essential to the fulfilment of the responsibilities of health care professionals to offer the highest quality of care, as well as to continuing evaluation and enhancement of the care and service given to the patients (Sevold et al.,2021).The present study was carried out to develop risk management policies for healthcare providers at critical care units of Menoufia university hospital. This was achieved through assessing the common risks at critical care units from health care providers’ perspective; assessing risk management system from the nursing and medical managers’ perspective; develop risk management policies for health care providers at critical care units and validate the developed risk management policies at critical care units.The current study was conducted at critical care units in Menoufia University Hospital at Shebin El-Kom, Menoufia Governorate, Egypt, in five critical care units which are eemergency ICU, medical ICU, chest ICU, anesthesia ICU and pediatric ICU.
Methodological descriptive design was utilized to attain the aim of the study. Three groups of samples were used to achieve study aim, which are group I: all medical and nursing unit managers of critical care units, n =10, group II: (115) healthcare providers.It is composed of all available staff nurses (75), all available physicians (27) and supportive personnel (13), group III: (28) experts which divided into two main categories as follow academic and non-academic to ascertain face, content and construct validity of the developed policies.To achieve the purpose of this study three instruments were used by the researcher including: instrument (I): risk assessment questionnaire with the socio-demographic data sheet It consisted of 46 items divided into two main dimensions which as types of risks and contributing factors for repeating risks. Instrument (II): risks management system questionnaire, which composed of 16 items divided into four dimensions. Instrument (III), validity sheet designed by the investigator for testing face, content, and constructs validity of the developed policies.The present study indicated that, most nurses (72%) was female, while, the highest percentage of physicians and supportive personnel (74.1%), (61.5%) respectively were male. Regarding age, most physicians (96.3%), and less than two third (57.3% (of nurses age, were between 20 – < 30 years. Regarding the year of experience, the majority of physicians (92.6%) had from (1- < 5) year of experience.
Regarding educational level majority of physician (88.9%) have baccalaureate degree of medicine and surgery, while nurses less than half of them) 43.4 (% have associate degree and minority of them (1.3%) had postgraduates’ degree. Regarding the working unit the highest percentage of the studied health care providers (25.2%) worked at anesthesia ICU followed by emergency ICU (22.6%), while the lowest percentage(14.8%) worked at Chest ICU.First, regarding risk assessment by health care provides, air born infectious disease was the most common among biological risks followed by blood borne infectious disease as reported by health care providers (98.3% and 90.4% respectively).Also, the majority of studied health care providers (80.3 %) reported that there is lack of fixed administration medication policy in the hospital.Second, among risks related to patients, exposure to hospital-acquired infections, exposure to ventilator risks and exposure to bed sores because of lack of care were reported by majority of health care providers as a common risk.
Third, in relation to assessment of possible risks related to hospital errors, lack of continuous training programs about risks and not using preventive measures to control infection risks reported by health care providers as the most common risks related to hospital errors.Fourth, for the risk related to staffing from health care providers perspective, the majority of studied health care providers, reported that shortage of nursing staff, inappropriate relation between number and levels of staffing in relation to patient’s number and ignore professional safety rules such as having fire extinguishers working efficiently were the most common risks related to staffing.Fifth, in relation to contributing factors for repeating risks about three fourths of total studied health care providers reported that not following infection control rules and the unit system does not specify a suitable plan for identifying and evaluating risks were the most common risks.Regarding the comparison of risk assessment dimensions levels and mean at critical care units the highest mean score of risks assessment was reported by nurses followed by physicians and finally supportive personnel.Concerning, contributing factors for repeated risk levels among health care providers at critical care units less than three fifths (58.6%) of studied health care providers assessed the critical care unit as having a high level of contributing factors for repeated risks.For correlation among studied variables with working units, chest ICU has significantly high-risk assessment mean scores (30.53 ± 3.48), while the lowest total mean score was at medical ICU (28.38 ± 6.93). Also, there are no significant difference among all items and total contributing factors.Regarding assessment about risk management system by medical and nursing unit managers, about two thirds of studied medical and nursing unit managers (70.0%)reported that there is no regular system for assessing all patient’s risk of safety. Also, the majority of studied medical and nursing unit managers (90.0%, 80.0%) respectively reported maintain current policies and procedures of patient’s safety and encourage staff to report when patient safety is at risk.
Additionally, 100% and 90.0% respectively of studied medical and nursing unit managers reported that there is no presence of risks management policies and a committee or supervisors for assessing the risks in the units, there is no effective risk prevention program for all staff, there is no active involvement of the orientation program and no continuing training and education for staff on topics related to patient’s safety and risk avoidance. Also, the highest mean score was at chest ICU regarding policies and procedures of patient’s safety at hospital. Likewise, there is non-significant differences between their total risk management system assessment scores of studied medical and nursing units’ managers in relation to departments.Concerning, the validation of risk management policies for health care providers at critical care units showed that three were total agreement among experts in relation to proposed risk management policies except some items need modification.Conclusion:The study recommended that:• The proposed risk management policies need to be adopted by hospital administrator at critical care units.• Risk management policies and procedures need to be reviewed, revised, and updated periodically.• The hospital needs to establish risk management committee and make coordination between infection control committee and quality assurance committee.• An in-service training unit inside the hospital need to upgrades nurses’ knowledge and practices, to enhance their awareness and facilitate their critical analysis of errors and developing alternative strategies.• Risk management concept, policies and procedures need to be introduced in nursing and medical curricula.• Future research needs to be done to assess the effectiveness of risk management policies & procedures and the effectiveness of risk management committee.• Future research needs to be done on a larger sample across different healthcare sectors in different governorate to generalize the results.