Internal Memo

Internal Memo

Subject: Risk Financing for Medication Errors in Post-Discharge Care Settings Related to Unsupervised Student Nurses

There have been many recorded complaints related to medication errors in the post-charge care program. Upon investigation, it was identified that the reported errors were caused by nursing students carrying out medication reconciliation roles during discharge and management of transitional care without senior supervision. Alqenae et al. (2020), in a systematic review, concluded that medication errors related to adverse drug events (ADEs) and medication-related harm were found to be common after discharge from the hospital. The medication errors occurring during the transition of patient care from the hospital compromise patient safety. Medication errors expose Parkwest Medical Center to significant financial risks. The hospital is accountable for costs related to mild reactions and ADEs due to practitioner errors. Medication errors also risk legal issues resulting in Parkwest Medical Center paying huge compensations to the affected patients. Therefore, this financial risk management will help reduce the financial impacts related to medication errors.

Key Performance Indicators and Measures Associated with Medication Errors

The key performance indicators (KPIs) and measures associated with medication errors include the percentage of reported and recorded errors, rate of reported errors, medication protocols, documentation of medication errors, verification systems, and personnel. The percentage and rate of medication errors focused on the percentage and rate of errors occurring due to the administration, prescription, and dispensing of medication to patients out of the total number of medications prescribed. The error percentage and rate can help identify the probability of the errors occurring.

Medication protocols include the guidelines for medication description and administration of medication within clinical settings. Medication protocols define who, when, where, and the required level of communication in the medication process. Medication administration protocols have significantly related to the probability of medication errors occurring (van der Veen et al., 2018). The existence of medication protocols reduces the occurrence of errors during the medication process.

The documentation of medication errors as a KPI related to medication errors includes keeping a log of all errors and their outcomes. The documentation of errors may indicate the type of error, when it occurred and was reported, and related outcomes. Documentation of errors has been noted to improve error reporting and initiation of action (Alomi et al., 2019). Further, verification systems and personnel mean having systems and the right personnel, such as an eMAR and qualified pharmacist and physician, to verify the medication before administration to patients. The availability of verification systems and personnel related to medication protocols indicates a lower probability of medication errors occurring.

Strategies to Identify Risk Financing Issues in Parkwest Medical Center

Risk financing issues within Parkwest Medical Center can be identified by having a clearly established context of the risk and associated outcomes. This will help classify the risk and identify related staff and the associated financial risks to the organization due to the risks. Another strategy is identifying the external and internal factors related to medication errors. This will focus on the hospital and the context of the errors and the associated risks. Surveys and interviews can be used to determine the factors of medication errors and their context. Establishing the factors of medication errors can help the organization determine responsibility and select a risk-financing approach. Finally, a situation analysis is viewed as an appropriate strategy to identify risk financing issues related to medication errors as it will develop a deeper understanding of the errors and related financial issues and how they impact the organization’s strategic plans.

Recommendations for Risk Financing Options related to Medication Error Risks

Insurance policies are recommended for risk financing due to risks related to medication errors. The specifically recommended insurance methods for risk financing due to medication errors include the establishment of captives, risk retention groups, and risk purchasing groups. Captives provide better long-term coverage for the organization and align with its commitment to patient safety, a patient-centered culture, and its willingness to assume accountability in health care outcomes. In addition, risk retention groups (RRGs) and risk purchasing groups (RPGs) will enable the organization to share the liability of medication errors and related risks with other healthcare organizations. RRGs and RPGs will provide liability insurance to the organization and assist in risk financing.

Legal and Ethical Financial Risk Obligations of an Accountable Care Organization (ACO)

ACOs are expected to reduce and control all expenditures related to health care. This means that they must at all times provide services that are efficient and do not lead to unintended and unplanned health expenditures. ACOs are also expected to maintain patient autonomy. Patients have the right to know their care providers. In the case of financing health expenditures or risks related to services provided by the ACO, the patient has the right to choose their insurance provider, irrespective of the organization’s insurance provider. Unless ethically justified, the ACO must deal with the insurance provider the patient is insured under. At the same time, ACOs are expected to maintain privacy and confidentiality. ACOs are expected to adopt a shared risk model for financial risks related to patient care (Duncan et al., 2021). ACOs must educate patients on the dual responsibility of the organization and the patient for health care expenditures and other related costs.

References

Alomi, Y. A., Al-Shubaar, N., Lubad, N., & Albusalih, F. A. (2019). Adherence Assessment of Medication Errors Reporting System at the Public Hospital in Riyadh, Saudi Arabia. International Journal of Pharmacology and Clinical Sciences, 8(2), 105–109. https://doi.org/10.5530/IJPCS.2019.8.18

Alqenae, F. A., Steinke, D., & Keers, R. N. (2020). Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review. Drug Safety 2020 43:6, 43(6), 517–537. https://doi.org/10.1007/S40264-020-00918-3

Duncan, I., Mackenzie, A., Bonfiglio, E., Wrigley, T., & Liao, X. (2021). Shared Savings Model Risk in the MSSP Program. North American Actuarial Journal. https://doi.org/10.1080/10920277.2021.1993927

van der Veen, W., van den Bemt, P. M. L. A., Wouters, H., Bates, D. W., Twisk, J. W. R., de Gier, J. J., Taxis, K., Duyvendak, M., Luttikhuis, K. O., Ros, J. J. W., Vasbinder, E. C., Atrafi, M., Brasse, B., & Mangelaars, I. (2018). Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals. Journal of the American Medical Informatics Association, 25(4), 385–392. https://doi.org/10.1093/JAMIA/OCX077

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Create a 2-3 page internal memo for a risk-management team. Summarize a risk financing issue for a selected organization in the memo.

Introduction
Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in a sequence.

Financial risk management helps reduce the financial impact of risk. It also determines the best approach for handling adverse situations from a financial standpoint. Healthcare leaders must have a solid understanding of the basics of regulation, government and public risk sharing, and also the era of ACOs.

There is a constant tension between the management of medical errors and the improvement of the quality of care. You may be asked to participate in risk management and risk financing activities in your role as a health care leader.

If a risk management team asked you to research and summarize financial risks in your organization today, would you know the following:

What information to include?
What format to use?
How to present alternatives and make a recommendation?
How to locate credible data from which the issue is to be evaluated?
Read further in the Assessment 2 Context [PDF] document, which contains important information on the following topics:

Regulations.
Risk Management.
Risk Sharing.
Risk Financing.
As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as a part of your assessment.

Imagine that a supervisor enters your work setting accompanied by an unexpected visitor from CMS. Your supervisor introduces you to the Medicare surveyor, who will be interviewing you.

What is the risk-management process in your organization?
What criteria would you use to determine how well your organization is performing as an ACO?
What data or resources would be helpful to you?
How would you explain the concepts of risk management and risking financing activities to your subordinates?
How would you explain a risk financing continuum to your subordinates?
Overview and Preparation
Note: This assessment must be completed before starting Assessment 3.

Imagine yourself in the role of a risk manager. Select a topic related to risk financing and identify a risk financing issue. This issue may be from a selected organization or from your workplace. As an example, you might select the issue of financing potential malpractice suits at a medical clinic. Refer to the resources provided for this assessment to ensure that you have a solid understanding of the financial dynamics related to this type of issue.

Instructions
Memo – Risk Financing Issue
Create a 2– 3-page internal memo. Follow the steps below and include them in the memo:

Concisely describe the issue and the organization.
Summarize the legal and ethical financial risk obligations of an ACO.
Describe how you would identify and manage risk financing issues within this organization. Support your choice of strategies with relevant resources.
Recommend two or three of the best options for risk financing for this issue, as it relates to the organization in question.
Include at least three APA-formatted in-text citations and accompanying congruent APA-formatted references. Your sources can be a course textbook, assigned reading, or any other scholarly source.
Additional Requirements
Written communication: Written communication should be free from errors that detract from the overall message.
Memo format: Format your memo so that it reflects the professional standards of your organization or accepted standards of a professional memo in the industry.
Length of paper: 2–3 double-spaced pages for the written portion of the assessment.
Number of resources: A minimum of three resources.
Font and font size: Times New Roman, 12 point.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 2: Apply a risk-management model or framework to a specific risk-management priority.
Identify key performance indicators and measures associated with a specific risk-management issue.
Discuss strategies used to identify risk financing issues in a selected organization.
Provide recommendations for risk financing options related to an identified financial risk issue.
Competency 4: Analyze applicable legal and ethical institution-based values as they relate to quality assessment.
Summarize the legal and ethical financial risk obligations of an accountable care organization.
Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for professionals in health care administration.
Prepare a professional memo summarizing a risk financing issue for a specified organization.