Risk  Management ed Emergenza Sanitaria territoriale 118

Risk  Management ed Emergenza Sanitaria territoriale 118

Dott Pietro Pugliese

Già Direttore UO Risk Management ARES118

Medico specialista Anestesia e Rianimazione

Docente vis. Prof. Università Campus Biomedico Roma

Il progresso scientifico-tecnologico, i cambiamenti socio-demografici ed economici hanno trasformato radicalmente le società e i sistemi sanitari dei Paesi industrializzati. A questi cambiamenti si aggiungono la crescita culturale della popolazione e l’aumento delle informazioni disponibili che portano i cittadini a richiedere prestazioni assistenziali sempre più qualificate, efficienti ed efficaci e li rendono sempre più insofferenti all’errore sanitario.
Come in altri sistemi complessi, quali l’aviazione, le centrali nucleari o i sistemi di difesa militare, anche in ambito sanitario possono verificarsi incidenti ed errori.
La possibilità che un paziente subisca un danno involontario imputabile alle cure sanitarie prende il nome di rischio clinico e gli interventi finalizzati a studiare, identificare e ridurre tale rischio prende il nome di Gestione del Rischio o Risk Management.
Quando avviene un errore si è abituati a ricercare immediatamente un colpevole piuttosto che le condizioni che lo hanno favorito. È  necessario invece un cambiamento culturale per riconsiderare l’errore come un’occasione di apprendimento anziché come una colpa, creando così i presupposti per la segnalazione spontanea da utilizzare ai fini dell’analisi degli eventi avversi.

Negli ultimi decenni, a livello internazionale, è cresciuto l’interesse alla gestione del rischio nei servizi sanitari, soprattutto per ciò che riguarda la sicurezza dei pazienti;

anche la comunità scientifica ha rivolto notevole attenzione a questo tema, facendone sempre più frequentemente oggetto di esperienze di ricerca. Si sono sviluppati numerosi filoni di studio che, proprio per il carattere trasversale di questa materia, hanno coinvolto diverse aree disciplinari.

Oggi, oltre che la letteratura di carattere clinico, anche la produzione economica, quella giuridica e quella aziendalistico-organizzativa forniscono preziosi suggerimenti per l’avvio di programmi.
Il Ministero della Salute ha previsto che la modalità di raccolta delle segnalazioni degli eventi avversi, errori, rischi e condizioni non sicure, venga effettuata volontariamente ed in modo anonimo dagli Operatori.

L’erogazione di assistenza sanitari infatti , nelle sue varie forme, si configura come una rilevante fonte di pericolo: la particolare natura di questa attività e l’importanza (da un punto di vista umano) dei danni che ne possono derivare, richiedono un elevato interesse sociale nei confronti della gestione del rischio nell’emergenza sanitaria territoriale del SET118(Sistema di Emergenza territoriale ). Le attenzioni sono aumentate soprattutto perché i risarcimenti per medicalmalpractice che il sistema giudiziario ha riconosciuto ai pazienti sono cresciuti considerevolmente alla luce delle  nuove normative (articolo 1 della legge 208/2015 e della   legge sulla responsabilità professionale n.24 del 8 marzo 2017 che hanno tracciato una ulteriore strada da seguire con chiare funzioni assegnate al Risk Management e alle direzioni Sanitarie ed in particolare:

  • introduzione del sistema di monitoraggio delle attività assistenziali e della loro qualità in accordo con il sistema di monitoraggio regionale;
  • attivazione dei percorsi di audit o altre metodologie finalizzati allo studio dei processi interni e delle criticità più frequenti, con segnalazione anonima del quasi-errore e analisi delle possibili attività finalizzate alla messa in sicurezza dei percorsi sanitari;
  • rilevazione del rischio di inappropriatezza nei percorsi diagnostici e terapeutici e facilitazione dell’emersione di eventuali attività di medicina difensiva attiva e passiva;
  • predisposizione e attuazione di attività di sensibilizzazione e formazione continua del personale finalizzata alla prevenzione del rischio sanitario;
  • assistenza tecnica verso gli uffici legali della struttura sanitaria nel caso di contenzioso e nelle attività di stipulazione di coperture assicurative o di gestione di coperture auto assicurative;
  • trasmissione da parte della struttura al “Centro per la gestione del rischio sanitario ela sicurezza del paziente” (da istituirsi presso ogni regione ) dei dati sui rischi ed eventi avversi e sul contenzioso;
  • predisposizione di una relazione annuale consuntiva sugli eventi avversi verificatisi all’interno della struttura, sulle cause che hanno prodotto l’evento avverso e sulle conseguenti iniziative messe in attoe pubblicazione di detta relazione sul sito internet della struttura sanitaria;
  • istituzione dell’’Osservatorio Nazionale delle buone pratiche sulla sicurezza nella sanità che acquisisce dai Centri per la gestione del rischio sanitario e la sicurezza del paziente, i dati regionali relativi ai rischi ed eventi avversi nonché alle cause, all’entità, alla frequenza e all’onere finanziario del contenzioso e predispone  con l’ausilio delle società scientifiche e delle associazioni tecnico-scientifiche delle professioni sanitarie,  linee di indirizzo e  idonee misure per la prevenzione e la gestione del rischio sanitario e il monitoraggio delle buone pratiche per la sicurezza delle cure nonché per la formazione e l’aggiornamento del personale sanitario.

 

Alla luce di quanto esposto necessita che tutte le Aziende Sanitarie in cui opera il SET  118 organizzate in Dipartimenti o Aziende Sanitarie Regionali (ARES 118 Lazio E AREULombardia ),implementino  competenze specifiche nel campo del Risk Management dell’emergenza Sanitaria Territoriale che è sicuramente peculiare rispetto alla pratica Ospedaliera con rischi specifici del tutto diversi sia per i pazienti che per gli operatori Sanitari.

Si rammenta quanto sia importante in questo campo infatti  la gestione organizzativa e clinica precisa dei processi con massima attenzione alla comunicazione iniziale data alla Centrale Operativa 118 o da parte del NUE 112 o in molte Regioni Italiane ancora dal Cittadino – utente con tutte le variabili del caso,e alla  la pratica clinica con  focalizzazione in termine di outcome , sul quintetto della prima ora (first hour quintet) composto dalle cinque condizioni cliniche- arresto cardiaco – sindrome coronarica acuta -stroke ,insufficienza respiratoria acuta-  trauma maggiorein cui una rapida gestione preospedaliera è essenziale per la qualità di vita del paziente .

 

 

Altrettanto peculiari ed importanti nella gestione dei processi e l’integrazione funzionali dei percorsi clinici e la pianificazione dei percorsi clinici per portarerapidamente  il paziente giusto al posto giusto  per essere curato. L’ambiente di lavoro inoltre rappresenta per gli operatori sanitari del Set 118 la più importante variabile , fonte diretta o indiretta di rischio come evidenziato nella figure sottostante con rischi prevedibili(da esempio crollo o fuga di gas , incendio, possibilità del contatto con agenti chimici e biologici, ambiente impervio ed instabile (elicottero e mezzo di soccorso) o con rischi imprevedibili determinati dal rischio evolutivo o dallo stesso paziente che può essere agitato o contagioso 

 

 

Questo primo editoriale  vuole servire da stimolo ad affrontare ed evidenziare l’importanza dello studio di questa nuova disciplina che sempre più emergerà e che sarà alla base delle futura attività  organizzativa e clinica del SET 118   favorendo  la gestione efficace degli eventi avversi, e rendendo disponibili strumenti specifici (sottoelencati)che consentiranno di ridurre sempre più  il rischio, e generare i necessari miglioramenti di sistema per promuovere una cultura centrata sulla sicurezza  in ottemperanza a quanto indicato nella nuova legge sulla Responsabilità professionale (legge n.24 del 8 marzo 2017 e del DM 2 agosto 2017 )

 

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  115. Hands down, Apple’s app store wins by a mile. It’s a huge selection of all sorts of apps vs a rather sad selection of a handful for Zune. Microsoft has plans, especially in the realm of games, but I’m not sure I’d want to bet on the future if this aspect is important to you. The iPod is a much better choice in that case.

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  120. Zune and iPod: Most people compare the Zune to the Touch, but after seeing how slim and surprisingly small and light it is, I consider it to be a rather unique hybrid that combines qualities of both the Touch and the Nano. It’s very colorful and lovely OLED screen is slightly smaller than the touch screen, but the player itself feels quite a bit smaller and lighter. It weighs about 2/3 as much, and is noticeably smaller in width and height, while being just a hair thicker.

  121. Zune and iPod: Most people compare the Zune to the Touch, but after seeing how slim and surprisingly small and light it is, I consider it to be a rather unique hybrid that combines qualities of both the Touch and the Nano. It’s very colorful and lovely OLED screen is slightly smaller than the touch screen, but the player itself feels quite a bit smaller and lighter. It weighs about 2/3 as much, and is noticeably smaller in width and height, while being just a hair thicker.

  122. I’ll gear this review to 2 types of people: current Zune owners who are considering an upgrade, and people trying to decide between a Zune and an iPod. (There are other players worth considering out there, like the Sony Walkman X, but I hope this gives you enough info to make an informed decision of the Zune vs players other than the iPod line as well.)

  123. The Zune concentrates on being a Portable Media Player. Not a web browser. Not a game machine. Maybe in the future it’ll do even better in those areas, but for now it’s a fantastic way to organize and listen to your music and videos, and is without peer in that regard. The iPod’s strengths are its web browsing and apps. If those sound more compelling, perhaps it is your best choice.

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  173. Ankara nakliyat sektörü ülkenin en göz bebeği durumundadır. Gerek coğrafi yapısı gerekse de nüfusu bakımından nakliyatın kalbi durumunda olan bu şehirde taşımacılık oldukça önemli bir yere sahiptir. Bundan dolayıda Ankara nakliyat firmaları sayısı oldukça fazla ve üzerlerine düşen görev bir o kadar fazladır. Bu bilgiler doğrultusunda hareket ederek kullanışmlı bir uygulama planlayarak Ankara nakliyat platformu uygulamamızı devreye soktuk. Hem müşterilerin hemde nakliyecilerin yararına olan sitemiz sayesinde nakliye süreçlerinde oluşan sorunları tamamen ortadan kaldırmış durumdayız. Ankara evden eve nakliyat hizmetine ihtiyaç duyan müşterileri en iyi Ankara nakliyat şirketleriyle buluşturarak profesyonel çalışmalar elde etmekteyiz. Nitekim ki binlerce mutlu müşteriyle sektörün lider platformu olmayı çok kısa sürede başardık.

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  174. Bursa evden eve nakliyat şirketimiz şehiriçi ve şehirler arası ev eşyası taşımada öncü ve eski firma olmakla kaliteli hizmet veren asönsörlü ev taşıması yapan Karacabey’in en büyük firmasıdır.Ekonomik ve uygun fiyatla ev taşımacılık bizim işimizdir.Hızlı ve güvenilir bir evden eve şirketi ile çalışmak için K1 yetki.belgesi olması çok önemlidir.Günümüzde özellik yaz sezonunda evden eve taşımacılık korsan çalışan çok firma vardır.Bu kişiler ev eşya taşımasında sorun yaşayabileğiniz kişililer mutlaka K1 belgesini isteyiniz.Kaliteli hızlı sorunsuz taşımada tek adres biziz mutlaka diyat alınız.

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  176. Hatay evden eve nakliyat işlemine ihtiyaç duyan tüm müşterilerin güler yüzlü ve profesyonel hizmet alması için kurulmuş olan Hatay nakliyat platformumuz başarıya koşmaktadır. Kuruluş tarihinden beri internet üzerinden binlerce müşteriyi Hatay nakliyat firması ile buluşturarak taşınma işlemlerini yerine getirmiştir. Günümüzde kaliteli bir firma bulmak ve güvenli şekilde Hatay nakliyat hizmetini gerçekleştirmek oldukça zor ve meşakkatli bir hale geldiği görünmektedir. Ancak hızlı ve kolay ara yüzü ile bu dert ve sıkıntıları ortadan kaldıran uygulamamız gayet başarılı şekilde sürdürülmektedir. Hatay evden eve taşımacılık alanında görev yapan en Hatay’ın en iyi nakliyat firmaları platformumuz bünyesinde görev almış durumdadırlar. Hatay evden eve nakliyat talebiniz için özel olarak tasarladığımız sitemiz ve teklif al formumuz bu güne kadar yapılmış olan en basit ve kullanışlı bir uygulama olmuştur. On üç yaşındaki gencin bile kolaylıkla nakliyat talebi oluşturması sağlanmıştır. Hatay evden eve nakliyat ihtiyaçlarınızda anında 4 farklı firmadan nakliyat teklifi alarak müşteri yorumları ve oranların karşılaştırılmasını yapıp doğru kararı verebilirsiniz. Sizin için değerli olan her şey bizler için kıymetli olduğu bilinciyle taşımacılık işlemlerinizin tamamına talibiz.

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  311. Between me and my husband we’ve owned more MP3 players over the years than I can count, including Sansas, iRivers, iPods (classic & touch), the Ibiza Rhapsody, etc. But, the last few years I’ve settled down to one line of players. Why? Because I was happy to discover how well-designed and fun to use the underappreciated (and widely mocked) Zunes are.

  312. Excellent read, I just passed this onto a friend who was doing a little research on that. And he just bought me lunch as I found it for him smile So let me rephrase that: Thanks for lunch! “For most of history, Anonymous was a woman.” by Virginia Woolf.

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  368. Fingers down, Apple’s application retail store wins via a mile. It really is a substantial selection of all kinds of applications vs a fairly unsatisfied preference of a handful for Zune. Microsoft incorporates Strategies, specially in just the realm of games, but I am not guaranteed I’d have to have to wager on the long run if this aspect is substantial in direction of your self. The iPod is a substantially greater decision in just that scenario.

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  371. Hatay asansörlü nakliyat sistemi uzun yıllardır Hatay halkının işini kolaylaştırmakta. Eskiden yaşanan zorlu taşınma süreçlerinin yerini artık kolay yapılabilen ve zamandan tasarruf sağlayan nakliye sürecine bırakmıştır. Hatay asansörlü taşımacılık konusunda yeterince tecrübeye ulaşmış birçok firma mevcuttur. Bizler bu firmaların tamamını çatımız altında toplayarak müşterilerin daha hızlı sonuç almasını ve kendine uygun firmayla çalışmasını sağlıyoruz. Hatay asansörlü evden eve nakliyat seçeneklerinin çok fazla olduğunu bilen her müşteriden oldukça önemli teşekkürler aldık. Hatay asansörlü nakliyat için sizlerde sitemizi tercih etmelisiniz.

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  385. I have observed that online education is getting common because attaining your college degree online has changed into a popular option for many people. A lot of people have not really had an opportunity to attend a regular college or university nevertheless seek the increased earning possibilities and a better job that a Bachelor Degree grants. Still other folks might have a college degree in one course but would like to pursue anything they already have an interest in.

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  387. This is turning into a little bit added subjective, yet I considerably desire the Zune Sector. The interface is colorful, includes excess flair, and some interesting options which includes ‘Mixview’ that allow yourself out of the blue look at very similar albums, music, or other consumers identical in direction of what you are listening in the direction of. Clicking upon one of those people will heart upon that product, and one more established of “neighbors” will arrive into check out, allowing your self toward navigate over investigating by equivalent artists, music, or customers. Conversing of consumers, the Zune “Social” is too exceptional enjoyable, letting your self discover other individuals with shared preferences and starting to be buddies with them. Yourself then can hear in the direction of a playlist produced based mostly upon an amalgamation of what all your good friends are listening in the direction of, which is as well thrilling. These apprehensive with privateness will be relieved towards realize by yourself can stop the community against viewing your personal listening practices if on your own thus make your mind up.

  388. One important thing is that when you’re searching for a education loan you may find that you will need a cosigner. There are many conditions where this is correct because you should find that you do not employ a past credit rating so the bank will require you have someone cosign the financing for you. Thanks for your post.

  389. Balıkesir asansörlü nakliyat ile yüksek katlara taşınmak artık kolay bir hale gelmiştir. Bina dışarısından çalışan modüler asansör sisteminin sağladığı birçok kolaylık vardır. Zaman tasarruf ve kolay taşınabilirlik bunların en başında gelmektedir. Balıkesir asansörlü taşımacılık konusunda müşterilerin daha iyi hizmet alması için bizler en iyilerini listelemekteyiz. Balıkesir asansörlü nakliyat firmaları ve fiyatları hakkında daha fazla bilgiye ulaşmak için sitemizi ziyaret etmeniz yeterli.

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  392. The Zune concentrates upon currently being a Moveable Media Player. Not a website browser. Not a sport machine. Possibly within just the upcoming it’ll do even improved inside those areas, but for currently it can be a superior course in the direction of set up and hear toward your new music and movies, and is without having peer within that regard. The iPod’s benefits are its web viewing and programs. If all those reliable even more compelling, potentially it is your perfect preference.

  393. Konya asansörlü nakliyat ta yaptığımız çalışmalarda ekipmanlarımız ve firmalarımızın belirlediği size uygun araçlar ile istediğiniz yere nakliyeniz yapılmaktadır. Kırılma, çizilme gibi korku dolu taşınmalarınıza son asansör sistemiyle hayatinizi kolaylaştıracak yöntemler firmalarımızın bünyesinde sizlere hizmet vermek için hazırda. Sizde bizimle kolayca taşınmak için firmamızın bünyesindeki arkadaşlara ulaşmanız ve sadece sitemizi ziyaret etmeniz gerekmektedir.

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  420. Apple presently includes Rhapsody as an application, which is a Terrific start, yet it is at present hampered through the incapacity towards retail store domestically upon your iPod, and consists of a dismal 64kbps bit price tag. If this improvements, then it will relatively negate this advantage for the Zune, still the 10 music for every month will however be a significant plus in Zune Pass’ favor.

  421. İstanbul Ev Nakliye firmamız İstanbul Anadolu Yakası ve Avrupa Yakası bölgelerinde evden eve nakliyat, taşımacılık, lojistik, eşya taşıma, eşya depolama, parsiyel eşya taşıma, ev nakliyesi alanlarında hizmet vermektedir. İstanbul ve Türkiye’nin bütün bölgelerine evden eve nakliye taşımacılık hizmetini en uygun fiyatlara garantili olarak sunmaktayız.

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  426. The Zune concentrates on being a Transportable Media Player. Not a world wide web browser. Not a sport machine. Probably within the potential it’ll do even much better within just individuals areas, yet for currently it truly is a excellent path in direction of organize and hear in direction of your songs and movies, and is with out peer inside of that respect. The iPod’s benefits are its web visiting and purposes. If those good further powerful, probably it is your perfect option.

  427. Samsun asansörlü nakliyat ta apartmanımızda asansör yok kat 6 nasıl taşıyacağız derdine son istediğiniz yükseklikte evde oturup ve ya taşınabileceğiniz sizi korkutmasın 25 katlı asansörlü araçlarımız sizin için özel olarak ayağınıza geliyor imkanlarımızda sinir tanımıyoruz. Firmalarımız her zaman daha iyisini odaklıyor sorunsuz ev tasıma için asansörlü tasıma hayatiniz kolaylaştıracak en güzel hizmettir sizlerde bizimle iletişime geçerek bu uygulamalardan faydalanabilirsiniz.

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  429. I’ll gear this review to 2 patterns of Those: recent Zune property owners who are considering an upgrade, and us residents making an attempt toward make a decision among a Zune and an iPod. (There are other avid gamers worthy of thinking about out there, which includes the Sony Walkman X, nonetheless I anticipate this delivers your self enough information and facts towards produce an knowledgeable preference of the Zune vs gamers other than the iPod line as effectively.)

  430. If youre still on the fence: grab your favorite earphones, head down to a Best Buy and ask to plug them into a Zune then an iPod and see which one sounds better to you, and which interface makes you smile more. Then youll know which is right for you.

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  432. Muğla asansörlü nakliyat sisteminde taşınması zor olan eşyalarınız için artık ne yapacağım derdine son diyoruz. Ve sizlere asansörlü nakliye firmalarımızın öncülüğü ile hizmet sunuyoruz. Kat daire sayısı bizim için önemli değil taşınacak eşya miktarı veya uzaklık ağırlık önemli değil. Firmalarımız için önemli olan müşteri memnuniyeti ve yüksek kalitedir.

  433. Thanks for expressing your ideas in this article. The other matter is that each time a problem comes up with a computer motherboard, people should not have some risk with repairing the item themselves for if it is not done right it can lead to permanent damage to the whole laptop. It is usually safe to approach the dealer of your laptop for that repair of its motherboard. They’ve got technicians who may have an competence in dealing with laptop computer motherboard difficulties and can have the right analysis and undertake repairs.

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  435. The contemporary Zune browser is amazingly positive, nevertheless not as superior as the iPod’s. It operates well, yet is not as instantaneous as Safari, and is made up of a clunkier interface. If oneself often application on using the internet browser which is not an issue, still if you might be building to browse the net alot in opposition to your PMP then the iPod’s larger sized display and greater browser may perhaps be critical.

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  437. Sivas asansörlü nakliyat sektöründe kat özetmeksizin bina dış cephesine zarar vermeden sizlere en kaliteli hizmetleri sunuyoruz. Günlük kiralama, saatlik kiralama ile sizlere uygun ücret karşılığın dada vereciğimiz araçlarımızın sorun yaşanmaya karşı sıklıkla periyodik bakımlarının yapılmasını sağlıyoruz. En iyi kaliteli hizmetler için bizimle iletişime geçip sizlerde faydalanabilirsiniz.

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  441. Zune and iPod: Greatest humans evaluate the Zune toward the Contact, nonetheless following observing how thin and incredibly reduced and gentle it is, I try out it in the direction of be a pretty exceptional hybrid that combines qualities of both of those the Contact and the Nano. It’s fairly colorful and lovely OLED exhibit is a little bit smaller sized than the contact screen, but the player alone feels reasonably a little bit more compact and lighter. It weighs pertaining to 2/3 as considerably, and is considerably lesser in width and top, When getting exactly a hair thicker.

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  443. Mersin asansörlü nakliyat ile yaptığımız çalışmalar sayesinde bize birçok şey katan moleküler araçlarımız ve firmalarımızın desteği ile sizlere hizmet sunmayı her zaman hedeflemiştir asansörlü nakliyat sistemi ile taşımanız bir ya da iki saat süreyle sorunsuzca hallolacak ve böylelikle hem zaman tasarrufu hem de cebinizi yakmayacak imkanlarla sizleri büyük sorunuzdan kurtaracağız.

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  445. The Zune concentrates on being a Portable Media Player. Not a world wide web browser. Not a match machine. Perhaps within the long term it will do even better in just those areas, but for now it truly is a exceptional path in the direction of arrange and pay attention in the direction of your audio and movies, and is without peer within just that respect. The iPod’s advantages are its internet traveling to and programs. If individuals good more persuasive, potentially it is your perfect determination.

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  462. Manisa asansörlü nakliyat sisteminin ilerlemesi için çalışmalar yürüten nakliyat firmalarımızdan taşınma desteği alabilirsiniz. Aynı zamanda talep ve isteklerinizi de bildirebilir ve bize dönüş yapabilirsiniz bu kapsamda asıl amaç taşımacılığı kolay yolla halledebilecek olarak düşündürmemizdir.

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