Patientenversorgung – aber sicher.

Zusammenfassung

Die Sicherheitskultur einer Organisation hat einen entscheidenden Einfluss darauf, welchen Stellenwert Patientensicherheit im Handeln des einzelnen Mitarbeiters einnimmt und durch welche Maßnahmen des Risikomanagements die Organisation in ihrer Gesamtheit sicherer wird. Bei der Entwicklung einer Sicherheitskultur spielen die sicherheitsbezogenen Einstellungen der Klinikleitungen und Praxisinhaber die entscheidende Rolle („top-down Prozess“). „Sicherheitskultur“ wird auch mit „informierter Kultur“ gleichgesetzt, sodass ein wesentliches Kennzeichen für die Reife einer Sicherheitskultur der Umgang mit sicherheitsrelevanter Information darstellt. Diese auf beobachteten oder erlebten Zwischenfällen, Fehlern oder Prozessabweichungen beruhende Information kann von Mitarbeitern gesammelt und der Organisation mittels geeigneter Meldesysteme zur Verfügung gestellt werden. Diese als „Zwischenfallberichtssystem“ oder „(Critical) Incident Reporting System“ bezeichneten Systeme sind ihrem Wesen nach proaktiv und lösungsorientiert ausgelegt und dienen ausschließlich der Vermeidung künftiger Zwischenfälle und nicht der Klärung von Schuld- und Haftungsfragen. Informierte Kultur hat auch den Informationsverlust an den perioperativen Schnittstellen im Fokus und standardisiert die Informationsübermittlung mittels Checklisten (z. B. Safe Surgery Checkliste der WHO). Eine gleichbleibend hohe Prozessqualität der Behandlungsabläufe wird durch eine Standardisierung (z. B. Standard Operating Procedures) erreicht.

Da qualifizierte Mitarbeiter die entscheidende Ressource für sicherheitsbewusstes Arbeiten sind, sollte die Qualifizierung neben dem Erwerb von medizinisch-technischem Wissen und Fertigkeiten („technical skills“) auch das Erlernen von nicht-technischen Fähigkeiten beinhalten. Als Schulungskonzepte gewinnen in der Hals-Nasen-Ohrenheilkunde zunehmend Teamtrainings mit Patientensimulatoren („Full-Scale Simulatoren“) an Bedeutung.

Abstract

Safe Patient Care

Safety culture is positioned at the heart of an organisation’s vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture (“top-down process”). A type marker for organizational culture and thus a predictor for an organizations maturity in respect to safety is information flow and in particular an organization’s general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed „informed culture“. An informed culture is free of blame and open for information provided by incidents. „Incident reporting systems“ are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organisation’s “safe surgery checklist” is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality.

Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate simulation based team trainings into their curriculum.

Schlüsselwörter

Sicherheitskultur - Risikomanagement - Incident Reporting - Standards - Teamtraining

Key words

safety culture - risk management - incident reporting - standard operating ­procedures - team training

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