V.

Leadership In Critical Care

 Standards of Practice
The standards of care for the acute and critical care nurse build upon ANA’s
Nursing: Scope and Standards of Practice to delineate expectations in this specialty
environment. The nursing process is used as the framework; it includes assessment,
diagnosis, outcomes identification, planning, implementation, and evaluation.

 Standard 1: Assessment
The nurse caring for the acutely and critically ill patient collects comprehensive
data pertinent to the patient’s health or situation.

> Competencies:
 Collects data from the patient, family, other healthcare providers, and the
community, as appropriate, to develop a holistic picture of patient needs
 Prioritizes data collection based on patient characteristics related to the
immediate condition and anticipated needs
 Uses valid evidence-based assessment techniques, instruments, and
tools
 Documents relevant data in a clear and retrievable format

 Standard 2: Diagnosis
The nurse caring for the acutely and critically ill patient analyzes and synthesizes
data from the assessment in determining nursing diagnoses or conditions
relevant
to care.

> Competencies:
 Derives diagnoses or relevant conditions from the assessment data
 Validates diagnoses with the patient, family, and other healthcare
providers
 Documents diagnoses and relevant issues in a clear and retrievable
format

 Standard 3: Outcomes Identification

The nurse caring for the acutely and critically ill patient identifies expected
outcomes for the patient.

> Competencies:
 Identifies outcomes from assessments and diagnoses
 Respects patient and family perspectives and values in formulating
culturally appropriate outcomes in collaboration with the patient and
family, and with the interprofessional team
 Considers associated risks, benefits, current evidence, clinical expertise,
and cost when formulating expected outcomes
  Modifies expected outcomes based on changes in patient condition or
situation
 Documents outcomes as measurable goals in a clear and retrievable
format
 Standard 4: Planning
The nurse caring for the acutely and critically ill patient develops a plan that
prescribes strategies and alternatives to attain outcomes.

> Competencies:
 Employs critical thinking and judgment in developing an individualized
plan using best evidence
 Collaborates with the patient, family, and interprofessional team to
develop the plan
 Establishes priorities and continuity of care within the plan
 Includes strategies for health promotion and prevention of further illness or
injury within the plan
 Considers associated risks, benefits, current evidence, clinical expertise,
resources, and cost when developing the plan
 Documents the plan in a clear and retrievable manner

 Standard 5: Implementation
The nurse caring for the acutely and critically ill patient implements the plan.

> Competencies:
 Employs strategies to promote and maintain safe environment
 Coordinates implementation of the plan with the patient, family, and
interprofessional team
 Intervenes to prevent and minimize complications and alleviate suffering
 Facilitates learning for patients, families, and the community
 Documents implementation in a clear and retrievable format
 Provides age- and developmentally appropriate care in a culturally and
ethnically sensitive manner

 Standard 6: Evaluation
The nurse caring for the acutely and critically ill patient evaluates processes and
outcomes.

> Competencies:
 Conducts systematic and ongoing evaluations using evidence-based
techniques, tools, and instruments
 Collaborates with the patient, family, and interprofessional team in the
evaluation process
 Revises the assessment, diagnoses, outcomes, and interventions based
on the information gained during the evaluation process
 Documents the results of evaluation in a clear and retrievable format
 Management and Leadership Role
The critical care nurse in her management and leadership role will be able to
render the following responsibilities:

a. Perform management and leadership skills in providing safe and quality

care
b. Accountability for safe critical care nursing practice
c. Delivery of effective health programs and services to critically-ill patients in
the acute setting
d. Management of the critical care nursing unit or acute care setting
e. Take lead and supervision among nursing support staff
f. Utilize appropriate mechanism for collaboration, networking, linkage –
building and referrals.

 Researcher Role
The critical care nurse in her researcher role will be able to render the following
responsibilities:
 Engage self in nursing or other health –related research with or under
supervision of an experienced researcher.
 Utilize guidelines in the evaluation of research study or report
 Apply the research process in improving patient care infusing concepts of quality
improvement and in partnership with other team-player

 Management System
The organization and management of critical care services are key components
that contribute to ICU performance and may impact patient outcomes and health care
costs. The guidelines for critical care delivery, clinical roles, and best practice model in
the ICU
(1) Medical interventions should be provided by intensivists leading multidisciplinary
groups;
(2) Patient care should be directed by ICU teams using a “closed” format in which
dedicated critical care teams take ownership of all aspects of care in the ICU;
(3) ICU physicians should be available for medical and administrative tasks without
competing clinical responsibilities;
(4) ICU physicians and nurses should have critical care credentials;
(5) Care teams should include critical care pharmacists and full-time respiratory care
practitioners as well as ICU physicians and nursing staff;
(6) ICU governance should be conducted by multidisciplinary groups.

 Physical Design and Equipment

 ICU design is complex and should include both clinically oriented and design-
based multi professional team members. The goal of the design process is to create a
healing environment, a design that produces measurable improvements in the physical
or psychological states of patients, staff, physicians, and visitors. Evidence shows that
the physical environment affects the physiology, psychology, and social behaviors of
those who experience it . Elements of a healing environment include: materials and
finishes that reduce noise levels, minimize glare, and support infection control; floor
plans, equipment, and other features, such as human engineering principles, may
enhance efficiency and effectiveness of patient care and minimize workplace injury;
stress-reducing furnishings and décor, incorporating natural light and views of nature;
and thoughtful provision for the creature comforts of patients, families, and staff.

The critical care unit consists of four major zones, each housing a primary function or
set of interrelated functions.
 The Patient Care Zone consists of patient rooms and adjacent areas; its primary
function is direct patient care.
 The Clinical Support Zone consists of functions closely related to direct patient
care; not only inpatient rooms but also in other areas of the unit.
 The Unit Support Zone refers to areas of the unit where administrative, materials
management, and staff support functions occur.
 The Family Support Zone refers to areas designed to support families and
visitors.

 Patient Care Zone

 Clear Floor Area
Clear floor space is space not occupied by the patient, fixed room
furnishings, and equipment. Clear floor area dimensions must allow room for
services that are brought to the bedside, such as portable imaging,
echocardiology, transcranial Doppler examination equipment, electrocardiogram,
nuclear medicine, dialysis equipment, and more.

 The oxygen system must also be easy to access during intubation or extubation
procedures. Face and aerosol masks should be accessible from either side of the
bed. Because several devices use compressed air, including ventilators and
pneumatic percussion devices, adequate space is needed for additional medical
compressed air outlets.

 IV Pumps
Designers must provide adequate electrical outlets, as well as space, for
pumps and IV bags for administering IV fluids and medications, as indicated by
the interdisciplinary care team. Most pumps connect electronically to patient
monitoring or data acquisition systems.
 Medications
Medication needed on a frequent or emergency basis must be readily
available either within or near patient rooms. A computer-controlled dispensing
system will fulfill this requirement (See Preparing and Dispensing Patient
Medications in the following section). Bedside medication storage should be
secure and able to accommodate large or odd-sized articles, such as IV bags
and large syringes. To reduce staff travel, consideration may be given to placing
a small refrigerator in patient rooms for medications that must remain cold, or
provide a central refrigerator for staff to access medications.

 Supplies
In-room storage and handling of patient care supplies must minimize on-
hand inventory and waste while economizing efforts of the bedside staff. Infection
control is an important consideration and storage for clean and soiled items must
prevent cross contamination by visitors and staff, and between the patient’s
gastrointestinal and pulmonary tracts. The design should provide adequate,
convenient space to handle linen during changes, a clean, dry surface (fixed or
portable) for stacking clean linen, and a hamper for soiled linen. Separate
storage should be provided for clean and used gloves, gowns, hair coverings,
shoe covers, and eye protection.

 Doors
The door system should be sized to permit rapid movement of patients,
bariatric beds, equipment, and personnel into or out of patient rooms in the event
of a crisis. Sliding glass doors with breakaway capacity may provide beneficial
additional width as well as increased visibility to the patient.

 Windows
Natural light is essential to the well-being of patients and staff, and is
required by most codes. Each patient care space should provide visual access to
the outdoors, other than skylights, with not less than one window of appropriate
size per patient bed area. Window coverings should be easy to clean, in
accordance with infection control guidelines.

Providing patients an outside view preferably overlooking a garden and

other natural setting may help relieve anxiety and stress improve care, enhance
patients’ comfort. In cases where a patient’s bed must face the interior of the unit
to permit close observation by staff, an adjustable mirror mounted on the wall or
ceiling may provide the patient a view of the outdoors.

 Patient Room Furnishings

Critical care patient rooms, at a minimum, contain the following: a hospital
bed designed for the critically ill patient, soiled linen collection hamper or similar
device; containers to collect trash and waste products; and containers to collect
 hazardous waste products, such as needles and syringes The design should
include secure storage of patient and family clothing and limited personal effect

 Temperature Control
In consultation with the care team, patients and families should be able to
control patient room temperature.

 Lighting
Patients exposed to increased intensity of natural sunlight have been
shown to experience less perceived stress, use fewer analgesics, and have
improved sleep quality and quantity. Bright light, both natural and artificial, has
been shown to reduce depression among patients . Artificial light for general
illumination and specific tasks is essential.

 Lifting Devices
Several studies have found that work-related injuries have become a
major problem on critical care units, and lifting is one of the most common
causes of injury. To enhance patient and caregiver safety, mechanical lift devices
can be built into the ceiling, or mobile lifts can be provided. If mobile lifts are
provided, storage space must also be provided in close proximity to the patient
room.

 Hand Hygiene, Toilet Facilities, and Fluid Disposal

A variety of fixtures and options are available for fluid disposal, hand
washing, and toilet facilities in patient rooms.

 Sinks.
Sinks in patient rooms should be placed near the entrance and near
disposal systems . Dispensers for soap should be located near the sink. A paper
towel dispenser and trash receptacle should be next to the sink to minimize
dripping of water onto adjacent surfaces. Sinks should enable hands-free
operation. Foot-controlled devices are not recommended, since the design and
mounting methods for these devices create difficult housekeeping and infection
control conditions.

 Fluid Disposal
Each patient room should have direct access to a fixture for the disposal
of fluids. Closed systems that do not spread aerosols are preferred. Options
include macerators, bedpan washer/sterilizers, or clinical sinks placed within the
room or between two rooms. A toilet (water closet) fixture may also satisfy the
requirement for fluid and waste disposal. If fluid disposal is not made available in
the room or in a connecting room, it should be provided in close proximity via the
corridor, although this option is not optimal.

 Dialysis Equipment
 If the design requirements include bedside renal dialysis or continuous
renal replacement therapy, appropriately conditioned water and drain facilities
must be provided, with the capacity to deliver deionized water if necessary.
Water and drain connections should be separate from handwashing sinks and
located so that dialysis equipment can be placed on either side of the patient’s
bed.

 Sharps and Device Disposal

Management of sharps, such as needles, blades, wires, and devices
soiled with body fluids, feces, and urine, necessitates serious design
consideration. Sharps containers must be placed within patient rooms where they
are visible and within reach, be placed in an area free from obstruction, and in
some cases, be portable. Large sharps containers allow easy and safe disposal
of sharps from invasive procedures. Smaller bedside containers often cannot
hold larger items, such as guide wires and catheters.

 Isolation
For infectious patients, formal isolation facilities must be available.
Negative pressure, relative to adjacent spaces, can be used to prevent the
spread of airborne pathogens from an infected patient

 Clinical Support Zone

 Emergency Eyewash Station
Workers in the ICU are exposed to many hazardous fluids. Despite
universal precautions, splashes of chemicals/bodily fluids can occur. The
institution will need to determine whether an emergency eyewash station may be
used to address the issue.

 Teamwork Areas
The quality of patient care has been shown to improve when delivered by
a multidisciplinary team of clinician specialists, pharmacists respiratory and other
therapists, dieticians, social service professionals, chaplains, and other health
professionals Additional work areas, both general and function specific (such as
an imaging room, or a space for preparing and dispensing patient medications).
All work areas should provide adequate, convenient storage for reference
manuals, policy or procedure manuals, hospital formularies, telephone lists and
other paper resource materials needed by users, as well as sufficient computer,
data, and telecommunications ports.

 Centralized Monitoring
Space should be allocated not only for monitoring devices, but for printers
and other support equipment. Monitoring functions should not infringe upon
clerical functions. Monitors should be positioned to enable medical staff to easily
see and hear patients from multiple vantage points. New technology, including
 text messaging, allows unique alarms to alert staff to changes in patient
parameters, malfunctioning devices, or life-threatening situations, and the design
should accommodate this technology

 Documentation and Review

Medical rounds provide healthcare professionals with the opportunity to
develop integrated care plans . In the ICU, multidisciplinary rounds often occur in
various formats. The number of staff who may be rounding or consulting with the
patient at one time should help define the amount of work surface space required
for documentation and review of patient records. Areas supporting
documentation and review should be located and designed to minimize
distractions and potential errors. for either bedside or conference room rounds,
implying that unit design and layout should be able to accommodate various
rounding preferences and styles.

 Pharmacy Services
Pharmacy services should be readily accessible, available 24/7, and
provide all medications needed. Space in the unit should be designated for point-
of-care pharmacist activity and may include a dedicated computer terminal and
workstation. Pneumatic tube systems may be used to transport pharmaceuticals
to and from the main pharmacy.

 Medication Rooms
Secured medication rooms should provide adequate space for medication
storage, a refrigerator restricted to pharmaceuticals, space for an automated
dispensing machine or a secure lock system for controlled substances and
patient-specific medications, and a hands-free hot/cold sink. Ample countertop
space and disposable sharps containers should be provided. Windows should
allow visualization of the patient area during medication retrieval and preparation.
Medication rooms should provide computer access to medication references and
electronic patient records. A telephone is beneficial for communication with the
pharmacy. An intercom or other device will permit communication with patient
rooms and the rest of the unit.

 Laboratory
ICUs must have access to 24-hr clinical laboratory services. These can be
provided by the central hospital laboratory or a satellite laboratory within or near
the ICU. If satellite facilities are implemented, they must provide minimum
chemistry and hematology testing, including arterial blood gas analysis and
mixed venous blood gas analysis. Space on the unit may be allocated for point-
of-care bedside testing equipment. If blood gas analysis is frequent in the unit,
consideration of space for a blood gas analyzer, including co-oximetry, may be
included in the overall design. With the increasing prevalence of drug-resistant
pathogens, care should be taken to provide for separate storage and handling of
specimens from patients in isolation rooms. Pneumatic tube systems may be
used for rapid transport of specimens to and from the laboratory.
 Imaging
Imaging services should be readily accessible to the ICU. The unit should
provide adequate storage for portable imaging machines. The patient archive
communication system and a reading room with film-view boxes and/or digital
access with high-resolution screens should be available within or adjacent to the
unit.

 Respiratory Therapy
A respiratory therapist is frequently a part of the critical care team and
respiratory equipment and supplies are constantly in use (6). A respiratory
therapy office, department, or support space within or near the ICU provides
storage for supplies and equipment, such as ventilators and oxygen tanks,
including separate storage for soiled equipment.

 Emergency Equipment and Supplies

Provisions should be made for storage and rapid retrieval of one or more
“crash carts” with emergency life-support equipment and supplies containing
equipment, such as “difficult airway” carts, central venous access carts, and
fiberoptic bronchoscopy carts (2). Institutional policies governing the ratio of
crash carts to patient beds will dictate how much space to allocate. Emergency
carts can be located in visible alcoves along a corridor with an uninterrupted
power supply to charge the equipment’s batteries. They should not be stored in a
room or behind a door where they may be hard to find in a crisis. There should
be sufficient storage for other emergency equipment and supplies. The design
should consider space needed for an emergency oxygen tank and extension
cords.

 Nonemergency Equipment
Multiple areas should be allocated for storing nonemergency equipment,
such as specialty beds, stretchers, wheelchairs, isolation carts, traction devices,
diagnostic equipment, bronchoscopy carts, and other specialty carts.

 Hazardous Waste.
Storage space for hazardous materials, such as “red bags,” sharps, and
radioactive materials, should be planned. Prompt removal of these items from the
bedside to a separate location reduces risk to the patient and medical staff
personnel. Policies and procedures for the institution should direct disposal and
storage of such items. This function can be co-located with the soiled utility
space.

 Patient Transportation
ICU design must consider both vertical and horizontal transport paths.
Patient elevators should be deep and wide enough to accommodate patient
 beds, support equipment, and transportation staff. Some elevators have electrical
power supplies for emergency use. Separate elevators for service traffic are
recommended. Other considerations include corridor widths, door-swing
directions, and timed hold-open hardware. Emergency power sources should be
available in the event of medical equipment battery depletion during patient
transport.

 Unit Support Zone

 Multipurpose Conference Room. There is a need for larger meetings than can
occur in individual offices. A large conference room or classroom proportionate
with staff size can accommodate a variety of needs, including
educational/training conferences, multidisciplinary staff meetings, formal didactic
rounds and impromptu meetings, in-service education, or debriefings.

 Supplies. Supplies of all kinds – whether linen, paper goods, patient care items,
or administrative forms – are typically delivered to the unit immediately if required
for patient treatment daily, or weekly. These may be transported via dedicated
lifts. Supplies may arrive on carts or pallets. To control infection, boxes and
containers should be opened outside the unit, and transferred to on-unit storage.
If possible, circulation paths for supply carts should be segregated from clinical
zones and family areas, both vertically (via elevators) and horizontally (via
corridors or passageways).

 Clean Utility/Workroom. A place is needed for storing all clean and sterile
supplies, both disposable and reprocessed. It should be centrally located, easily
accessed by multidisciplinary staff, segregated from the soiled utility room, and
large enough to accommodate rolling carts (such as linen carts and IV
medication pumps). The primary clean utility room may be supplemented by
satellite work locations proximal to patient beds. If the unit is large or in a pod
format, designers may want to provide multiple clean utility rooms and/or allocate
dedicated linen storage space per pod. Providing alcoves for mobile bedside
carts within rooms can reduce clutter outside rooms.

Clean utility/workrooms should contain a work counter and handwashing station.

Easy-to-clean shelving and storage cabinets should be off the floor and within
easy reach. Security is a consideration, since syringes and sharps may be stored
there.

 Soiled Utility/Workroom. The soiled utility room should be physically separated

from, and have no direct connection to, the clean utility/workroom. They may
provide temporary storage for carts containing patient meal trays not yet
collected by dietary personnel, and for used and soiled items that will be
reprocessed or disposed of elsewhere. Holding spaces should be sized
according to anticipated soiled materials volume, and organized to accommodate
 several categories of waste, including hazardous materials. Steps should be
taken to reduce overall waste. Disposal procedures will vary by hospital.

 Housekeeping. The unit should provide adequate storage space for

housekeeping equipment and supplies, such as housekeeping carts, vacuums,
buffers, mops, buckets, and ladders. To secure equipment, consider
implementing a keypad or other control system.

 Staff Lounge. A staff lounge in or near the ICU should provide a private,
comfortable, spacious, and relaxing environment. The lounge should include
comfortable seating, a table with chairs for dining, and food storage and facilities
like refrigerator, microwave oven, and water dispenser. Critical information for
staff members may be displayed on a bulletin board in the lounge or near staff
restrooms.

 Lockers. A secure space for lockers for staff belongings may be allocated within
or adjacent to the staff lounge. In larger facilities, these spaces may be
designated for different segments of the staff or shared by more than one unit.
Because many nurses or other staff may prefer to keep some belongings at the
patient bedside or at work stations, designers should consider providing secure
drawers or shelves at these locations.

 Family Support Zone

 Signage and Wayfinding

Patient room numbers should be clearly marked. Directional signage
should be easy to read, understand, and follow. In many locations, multilingual
signage should be considered. Wayfinding techniques, such as landmarks, art,
and floor patterns may be considered Clearly worded requests to turn off cellular
telephones, explaining the potential of interference with vital life support and
telemetry monitoring, should be posted at ICU access points and in waiting
rooms or family support areas . Signage should also be posted to remind staff to
turn their pagers to “vibrate” mode.

 Family Lounge
A family and visitor’s lounge should be provided adjacent to or near each
ICU pod, located so as to avoid disrupting patient, staff, and supply circulation
patterns. Family members will tend to cluster immediately outside the patient’s
room or the unit if the lounge is perceived to be too far from the ICU. Family and
visitors’ lounges may be decentralized around the ICU, closer to patient rooms.

 Consultation Rooms
Rooms for private conversations between interdisciplinary team members
and families are recommended. Designers should make every effort to protect
privacy, if possible, consultation rooms should afford direct access from the unit
 and from the lounge, so that personnel do not need to cross the seating area.
This private space can be used for patient updates, and if necessary, for
grieving. Financial counseling, pastoral care, social services, and other family
support is typically available to ICU families.

 Meditation Spaces
Rooms near the ICU should be provided for meditation, reflection, and
spiritual contemplation. Particular attention should be paid to designing
restorative space for multiple cultures and faiths, so that all users feel welcome
and comfortable.

 ICU Equipment
The type and quantity of equipment will vary with the type, size and function of
the unit and must be appropriate to the workload of the unit, judged by contemporary
standards. There must be a regular system in place for replacement and checking
the safety of equipment.

 Basic Equipment Should Include:

 Ventilators for invasive and/or non-invasive ventilation
 Hand ventilating assemblies
 Suction apparatus
 Airway access equipment, including a bronchoscope and equipment to assist
with the management of the difficult airway
 Vascular access equipment
 Defibrillation and pacing facilities
 Equipment to control patient temperature
 Chest drainage equipment
 Infusion and specialized pumps
 Portable transport equipment
 Specialized beds
 Lifting/weighing equipment
 Monitoring equipment, both non-invasive and invasive

 Monitoring Equipment
 Electrocardiograph- equipment to monitor and continuously display the
electrocardiograph.
 Pressure monitoring- equipment to monitor and continuously and simultaneously
display arterial, central venous and at least one other pressure (eg pulmonary
artery, intracranial pressure).
 Temperature- capacity to monitor central and cutaneous temperature.
 Pulse oximeter
  End tidal CO2 monitor- capnography must be available at each bed in the
Intensive Care Unit and must be used to confirm tracheal placement of the
endotracheal or tracheostomy tube immediately after insertion, and continuously
in patients who are ventilator dependent.
 Continuous monitoring of ventilation- when a ventilator is in use, ventilatory
volumes should be measured although it is accepted that this is not always
possible with some ventilators used for pediatric and neonatal patients. Airway
and respiratory circuit pressure must be monitored continuously, and prompt
warning given of excessive pressures.
 Endotracheal cuff monitoring- equipment to measure cuff pressure intermittently.
 Non-invasive arterial pressure monitoring
 Portable equipment for mechanical ventilation and monitoring of ventilation and
respiratory and circulatory status.

 Risk Management
Risk management is the process of analyzing processes and practices that are in
place, identifying risk factors, and implementing procedures to address those risks.
Successful healthcare risk management strategy is likely to improve costs and
efficiency for individual healthcare organizations, more important, it can help to save
lives and improve the experience for patients, caretakers and the overall healthcare
system.

 9 Ways to Manage Risks in Healthcare

1. Provide Employee Education

Building a solid risk management strategy does little good if employees
aren’t up to speed on the overall strategy, as well as the tactical implementation
of prevention and response. Employee involvement helps foster a culture around
your risk management strategy.

2. Foster a Reporting Culture

Employees should consistently report incidents to help with risk
management. One key component of this is ensuring people aren’t fearful of
punishment for reporting. A successful reporting culture is established with a
focus on patient safety, and a perspective that all parties involved in the
organization – families, patients, actioners and leaders – are responsible and
should be active participants. One example is Virginia Mason’s Patient Safety
Alert System (PSA system), where employees report anything that harmed or
could have harmed a patient through an online reporting system. A specialist
reviews each report and determines the appropriate cause of action.

3. Promote Transparency. Transparency goes hand in hand with a reporting

culture.

4. Ensure Clear Departmental Communication

 Clear communication can also help integrate risk management practices
into the daily workflow. Maintain a constant dialogue centered around safety,
encourage reporting regularly, celebrate wins and seek ideas from employees to
improve.

5. Win Leadership Support

Top levels of leadership endorses healthcare risk management as a
priority, encouraging employees to be proactive in implementing the strategy. For
leaders, a risk management plan can improve the bottom line, reputation and
efficiency of the organization while supporting patient safety and accreditation
standards.

6. Create a Standardized Process

When a standardized process is established, the organization can
examine data across departments to better understand the overall strategy.
Without harmonization across departments, organizations run the risk of differing
implementation and lose the visibility a larger dataset could offer.

7. Perform Assessments and Monitor Progress

Consistent assessment, conducted through reviews, audits or reports,
provides a perspective on how specific policies and procedures have helped to
eliminate risks or not.

8. Prioritize
Healthcare organizations prioritize by understanding what events could
happen, their likelihood, and the degree of impact. Then, the risk managers
establish how the organization can mitigate, limit impact and measure the
potential effects if those risks cannot be managed. Through this prioritization, risk
managers should also define the responsibility to manage the risks, and regularly
evaluate if an identified risk is still a possibility.

9. Streamline Risk Management Processes

Risk management and quality improvement practices often go hand in
hand. One example is the process of patient discharge. While a quality
improvement professional will want to understand readmission, the planning
process and coordination, a risk manager will also want to ensure patient
satisfaction to reduce the risk of litigation.