Hazard MANAGEMENT IN THE CORRECTIONAL SETTING

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What is Risk Management?. Hazard administration is the procedure of utilizing approaches, techniques, conventions and frameworks to lessen the probability of mistakes and/or unfavorable results. Where may you see hazard administration being utilized?. Atomic Power IndustryMost sorts of manufacturingAutomobile designSurgeryHospitals.

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´╗┐Hazard MANAGEMENT IN THE CORRECTIONAL SETTING Jacqueline Moore President Moore and Associates February 2006

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What is Risk Management? Chance administration is the way toward utilizing approaches, methods, conventions and frameworks to lessen the probability of blunders as well as unfriendly results

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Where may you see chance administration being utilized?

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Nuclear Power Industry Most sorts of assembling Automobile outline Surgery Hospitals

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RISK MANGAMENT DIAGRAM Egg

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ARREST DIVERT

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ARREST DIVERT CUSTODY INTAKE SCREEN

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ARREST DIVERT CUSTODY INTAKE SCREEN NURSING INTAKE SCREEN

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ARREST DIVERT CUSTODY INTAKE SCREEN NURSING INTAKE SCREEN MEDICAL INTAKE SCREEN

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ARREST DIVERT CUSTODY INTAKE SCREEN NURSING INTAKE SCREEN MEDICAL INTAKE SCREEN SICK CALL REQUEST SYSTEM

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ARREST DIVERT CUSTODY INTAKE SCREEN NURSING INTAKE SCREEN MEDICAL INTAKE SCREEN SICK CALL REQUEST SYSTEM HOUSING SYSTEM

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ARREST DIVERT CUSTODY INTAKE SCREEN NURSING INTAKE SCREEN MEDICAL INTAKE SCREEN SICK CALL REQUEST SYSTEM HOUSING SYSTEM CUSTODY OBSERVATION

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ARREST DIVERT CUSTODY INTAKE SCREEN NURSING INTAKE SCREEN MEDICAL INTAKE SCREEN SICK CALL REQUEST SYSTEM HOUSING SYSTEM CUSTODY OBSERVATION CUSTODY AND HC COMMUNICATION

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ARREST DIVERT CUSTODY INTAKE SCREEN NURSING INTAKE SCREEN MEDICAL INTAKE SCREEN SICK CALL REQUEST SYSTEM HOUSING SYSTEM CUSTODY OBSERVATION CUSTODY AND HC COMMUNICATION

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Scenario One Background 18 year old male who has been detained for one month. Imprison has 40 hour for each week nursing and accessible as needs be care nightfall. No therapeutic issues noted at admission One month later he whines of stomach agony. States he has a past filled with umbilical hernia. Nurture exam hints at no umbilical hernia. What do you do next?

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Physical Exam PE uncovered no distensions re umbilical territory Abdomen non-delicate Bowel developments typical Vital signs T 97.6, P96 skin warm and dry Inmate not able to state where he had already looked for treatment Inmate given Motrin

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Next Day Inmate back to center with protestations of stomach agony and retching There is no exam table in treatment room, persistent asked for to lie on floor Palpation showed negative McBurneys Sign

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after four days Contacts nurture again in 4 days. Says agony is more terrible. Mother contacts office expressing her child is in extreme torment. Nurture looks at patient. No proof of umbilical hernia. What do you do next?

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Patient grumbles of spewing on day 5. Nurture looks at patient. Archives no indications of umbilical hernia. Calls MD and gets arrange for phenergan which understanding heaves inside 30 minutes. What do you do next? Day 5

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Nurse visit. Quiet as yet whining of stomach agony and wiped out to stomach. Nurture archives gut sounds in every one of the 4 quadrants. No bounce back delicacy. No indications of umbilical hernia. What do you do next? Day 6

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Day 7 Custody staff report "spitting up chestnut stuff in container". Told by social insurance staff he's been checked and is OK.

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Patient states "not able to pee". UA indicates ketones and slight WBC's. Doctor called, orders CBC and glucose detail. WBC typical aside from slight left move. Glucose typical. Nurture reports to MD white blood tally typical yet does not fax comes about. Versus T 97.4, P 100, BP 116/66 R18. What do you do next? Day 8

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Guards call nursing staff at night since patient still keeps on griping of stomach agony. Informed that everything is okay. Nurture reports to officer that blood work is typical. What do you do next?

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Officers don't beware of detainee as the night progressed. Authority gets medical attendant to discover when he's coming in? (Sat.) Tells nurture he needs to see persistent that day. Officer reports that prisoner has heaved espresso ground material. Nurture reports at twelve. Tolerant crumples and kicks the bucket. Noted to be "icy" by EMT's. Ridiculous regurgitation all over cell. What is the Diagnosis? Where might chance administration have helped for this situation? Day 9

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Where is the Liability and with Whom?

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Inconsistency in Care EMS reports patient was lapsed on landing Nurse reports P 70 R12 MD shows she never observed duplicate of lab work Nurse sorts attendant's notes from home and adds them to the graph as late passage Officers never began CPR Nursing Protocol not took after

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Conclusions Cause of Death Ruptured informative supplement with peritonitis Deliberate lack of concern case recorded Providers imprudent and rash and neglected to follow appropriate norms of care Case settled September 2005

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Scenario 2 Background 17 year old white male mediated to adolescent foundation on 12/28/98. Program has solid accentuation on games. April 5, 1999 after Easter Break youth comes back to adolescent institute and is sick has manifestations of hack, chill, nasal stuffiness, the runs, vexed stomach Mother calls school to illuminate them of child's disease What might you do?

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Juvenile Academy Youth set in hospital Treated by EMT with over the counter medication 4/7/99 Temperature perusing is 104.3 at 6:40 AM EMT puts cool packs on youth's brow and gives OTC drug

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Temperature Chart 4/7-4/8/99

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4/8/99 Youth seen by school doctor Temperature100 degrees F at 8 AM At 4:45 PM temperature 96.2 degrees F Youth is muddled, not able to give MD history of why he was available at wiped out call MD orders patient to go to ER for assessment

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ER Fiasco EMT informs adolescents guardians that young is to go to the ER EMT exhorted administrator that adolescent is to be transported to ER Youth declines to go to ER states he can finally relax. Temperature 97.4 Parents informed that adolescent does not have any desire to go to the ER Youth set in clinic. EMT advises officer to watch youth

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Next Morning April 9, 1999 Youth muddled Officer moved youth out of clinic Youth tumbled to floor while getting up No indispensable signs were taken amid the night Youth urinated and crapped on himself EMS called Transferred to tertiary healing facility craniotomy performed Today tolerant experiences discourse and cerebrum harm

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What Went Wrong

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What were the Problems with this care? Absence of Adequate Assessment No documentations of nuchal inflexibility Incomplete imperative signs no heartbeat or BP (abating of heartbeat demonstrative of expanded intracranial weight No documentations made re migraines, photophobia, peevishness, disquietude, change in LOC, chills or sudden changes in body temperature

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Poor Monitoring of Temperature readings more than 102 degrees No endeavor to contact doctor when temperature achieved 104 degrees Intermittent fever diurnal varieties as often as possible seen in pyrogenic contaminations

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Inadequate Charting OTC pharmaceutical given however we don't know sedate, quality, recurrence or how it influenced temperature Facility was not able discover solution log Physician did not have admittance to restorative record when he analyzed the patient

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Inadequate Staffing and Training Only two EMTs allocated to medicinal unit No preparation in constant or irresistible ailments No nursing oversight EMTS every now and again pulled to perform different assignments e.g. transport, help on field with games and so forth. No restorative staff on the night move

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Failure to take after requests MD surveyed quiet unequipped for noting questions Youth had adjusted therapeutic status, with high fever, and upper respiratory disease Supervisors of Academy made mindful of transport request No correspondence to MD that demonstrates youth not sent to ER Customary routine of foundation to cross out off-site arrangements

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Lack of Autonomy Patient moved out of hospital without warning of medicinal staff No systems set up of affirmation or release of youth to clinic Patient not observed by night move Supervisors are accountable for medicinal unit

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Failure to Communicate Officer shows EMT did not instruct him to screen tolerant EMT demonstrates he advised officer to screen understanding Nothing recorded No unmistakable strategy on correspondence amongst clinician and office organization re medicinal requirements of youth

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Consent EMT unconscious of State Statute re educated assent Supervisor did not illuminate State Statute on assent for medicinal staff What else could have been finished? Could guardians have gone to the ER?

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RISK MANGAMENT DIAGRAM Egg Arrest DIVERT INTAKE SCREEN NURSING SCREEN MEDICAL SCREEN MEDICATION SYSTEM SICK CALL REQUEST HOUSING OFFICER OBSERVATION CUSTODY/HC COMMUNICATION

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Scenario 3 Native American kicked the bucket of seizures in transport van. He was in leg irons and midsection chains when he touched base at the correctional facility.

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Background Patient had been in prison a few circumstances already Known alcoholic Previous charges were aggressive behavior at home Current charge homicide Had earlier therapeutic records demonstrating seizure Had been conveyed to a psychological well-being office not long after capture for a competency hearing

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making a course for Mecca Patient began breathing clever and shaking viciously Transport officers were available in real city Hospital was two pieces away Jail was two hours away Officers called LPN who worked at little correctional facility What did she say to do?

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Prior Medical History Inmate was known to attendant, she showed to officer that he had seizures beforehand Nurse exhorted officer to keep quiet in upright position and if more than 3 seizures happened in 20 minutes to look for restorative help Officer noted bubbly breath of prisoner. What ought to officers do?

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Continuing Sega Officer called other transport officer who was in the Federal Marshals Building Inmate kept on having seizures-his arms and legs got to be distinctly tense, patient was portrayed as lethargic What ought to the delegate do?

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What did the De

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