The Journal of Stomal Therapy Australia - Australian Association of ...

Risk management in stomal therapy practice
Nola Polmear RN, RM, CHN, STN (Cred) Onc, BCN, BA, MSocSci • Stomal Therapy Department, Royal Hobart
Hospital
*This paper won the 2006-2007 Coloplast National Education Fund senior section
Risk management was developed as an organisational strategy
to deal with problems that might occur, particularly with regard
to technology and the advent of the new millennium or ‘YK2’.
In healthcare it is strongly aligned to the quality improvement
cycle and quality outcomes for patients.
The purpose of this paper is to explain what risk management is
all about, using an example that stomal therapy nurses (STNs)
are familiar with in their practice. That is, the risk that a patient
will proceed to the operating theatre for an impending stoma
without pre-operative siting. Siting is used to demonstrate how
the risk management process can work, to demonstrate the
fluidity of the process, and to act as an incentive to STNs to use
risk management strategies in their practice.
The risk management process has five tiers with communication
and consultation being imperative to the process:
1. Establishing the context of the risk – setting the scene.
2. Identifying risks – what, when, where, why?
3. Analysing risks – consequences and likelihood.
4. Evaluating risks – comparing against standards and setting
priorities.
5. Treating risks – assessing, planning, implementing and
evaluating.
With final consideration given to ongoing monitor and review 1 .
“Risk management … is a holistic management process applicable
in all kinds of organisations, at all levels and to individuals.” 2
Risk management may be applied to specific projects or to
manage specifically recognised areas of risk. It is part of a process
linked with quality improvement and should be continuous and
ongoing. Clinical risk management
...is based on the effective identification, analysis and management
of potential and actual corporate, clinical and organisational risks
and adverse events which are inherent in the provision of health care
services to the community 3 .”
The importance of risk management for STNs lies in the essence
of their clinical practice, that is, the successful restoration of
patients to the community following ostomy surgery. STNs
need to be conscientious in thought and effort in the review
of their practice and the identification and management of
risks that may impinge on the successful rehabilitation of their
patients. Imbued in risk management is the requirement to
search for and deal with organisational problems, their causative
or contributory factors and ways to appropriately reduce the
likelihood of recurrence or consequences of the risk.
We need to move beyond anecdotal clinical experience to be
more explicit when bridging the gap between commonality of
experience and therapeutic interventions that are as accurate,
as safe and as efficacious as possible 4 . The objective of the
Australian Association of Stomal Therapy Nurses Inc (AASTN)
is that STNs “reflect the promotion of quality of care for a wide
range of people with specific needs ” 5 .
Standard 1 – Professional Role and Self Development, states
“The STN fulfils the obligation of the professional role through:
reflective practice, evaluation, practice based assessment tools,
continuous professional development and credentialling” 6 . The
concept is further reflected in the notion that STNs, as advanced
registered nurses, are able to conceptualise their practice and
“use theory, research evidence, observations and experience to
think about practice in a way that considers factors other than
the immediate event or circumstances” 4 . The risk management
process is one... “of continuous improvement that is best
embedded into existing practices” 7 .
Establish the Context
Establishing the context in which the risk management process is
to take place entails a description of internal and external users
of stomal therapy services, developing standards by which to
judge the function and management process, and the structure
on which the project is to be based 1 .
Already established is the commitment of STNs to the provision
of expert care and to function as advanced registered nurse
practitioners. The AASTN Standards of Stomal Therapy Practice
are the embodiment of the STN function and position within the
nursing profession and the healthcare system. STNs provide a
service to their patients; internal to this agency are other nurses,
medical staff, and allied healthcare professionals; external to this
agency are the patients and the wider community.
An STN of many years experience, Pat Blackley states that
satisfactory quality of life for stomal therapy patients is very
much dependent on a new ostomate’s ability to “regain an
acceptable style of living after discharge from hospital” 8 .
Blackley draws our attention to the International Ostomy
Association (IOA) Charter of Rights for people experiencing
ostomy surgery. The Charter states “... all should have a right
to a satisfactory quality of life after their surgery and that this
Charter shall be realised in all the countries of the world” 8 .
Both the AASTN Standards of Stomal Therapy Practice for
STNs Practice and the IOA Charter of Rights for ostomates are
a communication of the need to provide and extract expert care,
and to seek out and prevent risks that may have an adverse
16 JOURNAL OF STOMAL THERAPY AUSTRALIA 2007 27(3)