Risk Management Lecture PDF

Click to edit Master title style Edit Master text styles Second level Third level Fourth level Fifth level By: Abeer Hassan Mohamed Lect. Of Geriatric Medicine Click OF ILOS to edit THE Master LECTUR...

Click to edit Master title style Edit Master text styles Second level Third level Fourth level Fifth level By: Abeer Hassan Mohamed Lect. Of Geriatric Medicine Click OF ILOS to edit THE Master LECTURE title style definition Edit Master oftext riskstyles management Second risk level perception assessment, Third level policies onFourth needle-stick level injuries. Fifth level effective communications. informed consent and risk management. Weighing up risks and benefits with patients. Willingness to respect and accept patients views and choices  Click to edit Master Risk management title style The Edit process Masteroftextminimizing styles risk to an organization by developing systems to identify Secondandlevelanalyze potential hazards to prevent accidents, injuries, and other adverse Third level occurrences, and by attempting to handle events and Fourth do incidents which level occur in such a manner that their effect and cost are minimized. Fifth level Effective risk management has its greatest benefits in application to insurance in order to avert or minimize financial liability.  Click to edit Master Risk Management title style The world health organization (WHO) conceptual framework for the Edit Masterclassification international text styles for patient safety (ICPS) offers a definition of SRM, Second restricted levelto a healthcare setting: Third level Activities or measures taken by an individual or a health care organization Fourth level to prevent, remedy or mitigate the occurrence or reoccurrence of a real or Fifth level potential (patient) safety event.  None of the definitions presented so far conflict with each other. They all Click to edit Master title style refer to intentional actions, activities and measures: part of an organisational improvement or learning process in a healthcare setting. Editrelevant Other Master textphrasesstyles relating to patient safety are ‘medical error’, ‘near miss’ and Second level event’. Again a leading definition comes from the ICPS: ‘adverse Third level An error is a Fourth failurelevelto carry out a planned action as intended or application of an incorrect plan. Errors may manifest by doing the wrong thing Fifth level (commission) or by failing to do the right thing (omission), at either the planning or execution phase. (WHO, world alliance for patient safety 2009)  Click to edit Master title style Medical errors should be distinguished from negligence or malpractice, insofar as the first Edit Master textisstyles accidental while the second two are deliberate violations of level Second a rule or standard of behaviour. Furthermore, medical errors do not lead to observable injury to the patient Third level in all cases. The Fourthsituations level that did not cause harm to patients, but could have done, are described Fifth level as ‘near miss’. The term ‘adverse event’ is used for incidents in which the person receiving healthcare was harmed.  incident categorization Click type incident to edit Master is a descriptive title term for a style category made up of incidents of a common nature grouped because of shared, agreed features, such as ‘clinical process/procedure’, ‘resources/ organizational management’ or ‘medication/IV Edit fluid’ incident. Master text styles Second Patient level is the impact upon a patient, which is wholly or partially outcome attributable Third to anlevelincident. Patient outcomes can be classified according to type of harm, degree Fourth levelof harm and any social and/or economic impact. Fifth level patient characteristics categorize patient demographics, the original reason for seeking care and the primary diagnosis. Incident characteristics classify the information about the circumstances surrounding the incident, such as where and when in the patient’s journey through the healthcare system the incident occurred, who was involved and who reported it.  Click to edit Master title style Contributing factors/hazards are the circumstances, actions or influences which are thought to have played a part in the origin or development of an Edit Master incident text styles or to increase the risk of an incident. Secondare Examples level human factors such as behaviour, performance or communication; Third system level such as work environment and factors, Fourth level external factors beyond the control of the organization, such as the natural Fifth level environment or legislative policy. More than one contributing factor and/or hazard is typically involved in a single patient safety incident.  Organizational outcomes refer to the impact upon an organization which is wholly or Click to edit Master title style partially attributable to an incident such as an increased use of resources to care for the patient, media attention. System resilience (proactive and reactive risk management) : the degree to which a Editcontinuously system Master textprevents, styles detects, mitigates or ameliorates hazards or incidents so that an organization can ‘bounce back’ to its original ability to provide core functions. Second level Actions taken to reduce risk concentrate on steps taken to prevent the reoccurrence of Third level the same or similar patient safety incident and on improving system resilience. Actions Fourth level taken to reduce risk are those actions taken to reduce, manage or control any future Fifth level harm, or probability of harm, associated with an incident. These actions may be directed toward the patient (provision of adequate care, decision support), toward staff (training, availability of policies/protocols), toward the organization (improved leadership/guidance, proactive risk assessment), and toward therapeutic agents and equipment (regular audits, forcing functions). Detection, mitigating factors and ameliorating actions both influence and inform the actions taken to reduce risk.  Click to edit Master title style Detection is defined as an action or circumstance that results in the discovery of an incident. For example, an incident could be detected by a change in the patient’s status, or via a monitor, alarm, audit, review or risk assessment. Edit Master Detection text styles mechanisms may be built into the system as official barriers or informally developed. Second level Third Mitigating level are actions or circumstances that prevent or moderate the factors Fourth level progression of an incident toward harming the patient. Mitigating factors are Fifth level designed to minimize the harm to the patient after the error has occurred and triggered damage control mechanisms. If the incident does result in harm, ameliorating actions can be introduced. Ameliorating actions are those actions taken or circumstances altered to make better or to compensate any harm after an incident. Ameliorating actions apply to the patient (clinical management of an injury, apologizing) and to the organization (staff debriefing, culture change and claims management). Click tois edit What risk assessment? Master title style A Edit riskMaster assessment text styles seeks to answer four simple, related questions: Second level Third level Fourth level Fifth level How bad? What can go Is there a need wrong? for action ? How often? Click to edit Master title style It Edit is not Master usuallytextpossible styles to eliminate all risks but healthcare staff have a duty to protect Second level patients as far as ‘reasonably practicable’. This means Third level you must avoid any unnecessary risk. Fourth level It is best to focus on the risks that really matter – those with the Fifth level potential to cause harm. Keep risk assessment simple – do not use techniques that are overly complex for the type of risk being assessed. In Click to editweMaster risk assessment look at: title style hazards – which are situations with the potential to cause harm; and risks – whichtext Edit Master arestyles defined as the probability that a specific adverse event will occur Second in a specific time period or as a result of a specific level situation. Third level Fourth level – Risk is the combination Fifth level of likelihood and consequence of a hazard being realised. – A clinical risk or healthcare risk is the chance of an adverse outcome resulting from clinical investigation, treatment or patient care. For each hazard identified, it is important to decide whether it is significant and whether appropriate and sufficient controls or contingencies are in place to ensure that the risk is properly controlled.  Five steps to easy risk assessment Click to edit Master title style Identify the hazards (what can go wrong?) Step 1 Edit Master text styles Decide Second levelbe harmed and how (what can go wrong? who is exposed to the hazard?) who might Step 2 Third level Fourth level Fifth level Evaluate the risks (how bad? how often?) and decide on the precautions (is there a need for further action?) Step 3 Record your findings, proposed action and identify who will lead on what action. Record the date of implementation. Step 4 Review your assessment and update if necessary. Step 5 Step 1 identify the hazards (what can go wrong?) To prevent harm it is Click to edit Master title style important to understand not only what is likely to go wrong but also how and why it may go wrong. Edit Master Consider text styles the activity within the context of the physical and emotional Second level environment, and the culture of the organisation and the staff who Third level perform the activity. Fourth level Take into account things Fifth level that have gone wrong in the past and near-miss incidents. Learn from the past. Walk around the workplace or clinical area and talk to patients and staff. Map or describe the activity to be assessed. The risk assessment may require a multi-disciplinary team. Step 2 decide who might be harmed and how (what can go wrong? Who Click to is exposed to theedithazard?)Master title style It is necessary to anticipate some degree of human error and try to Edit the prevent errortext Master from resulting in harm. styles Secondthe 1. Consider levelnumber of patients that might be affected over a stated period of time. Third level Fourth level When quoting the number Fifth level of patients affected you should always state the length of the assessment period. 2. Remember that the most vulnerable patients are more likely to suffer harm. 3. Think about the complexity of the task.  Click Step to 3 evaluate edit the risksMaster title (how bad? Howstyle precautions (is there a need for further action?) often?) And decide on the The law requires everyone providing a service to do everything Edit Master text styles reasonably practicable to protect patients from harm. Second level 1. Use your Thirdorganisation’s level risk matrix Fourth level 2. Decide on the precautions (controls) that will most effectively reduce Fifth level consequence and/or likelihood. 3. Re-evaluate the risks assuming the precautions (controls) have been taken.  Click to edit Master title style Step 4 record your findings, proposed action and identify who will lead on what action. Record the date of implementation risk assessments Edit Master and styles text action planning should be reviewed and changed when necessary. This is easy only if the assessment is well recorded and the logic behind Secondtransparent. the decisions level An efficient and succinct system of documentation is essential. Third level Fourth level You need to show that: Fifth level 1. A thorough check was made to identify all the hazards and treat all the significant risks; 2. The precautions are reasonable and the remaining risk is acceptable; 3. The solutions are realistic, sustainable and effective. It may be reasonable to accept some degree of preventable risk, if the benefits to be gained outweigh the risk.  Click Step to your 5 review editassessment Masterandtitle style update if necessary good documentation is important because things are always changing. Research and new developments increase the pace of change, and those Edit Master text styles changes can alter existing and/or introduce new hazards. Second level Review your risk Third assessment: level Fourth level 1. When you are planning a change; Fifth level 2. Routinely at least on an annual basis; 3. When there has been a significant change  Click toofedit Types risksMaster title style Low risk: quick, easy measures implemented immediately and further action Edit Master planned for when resources text styles permit. Second Moderate levelactions implemented as soon as possible, but no later than risk: the next financial Third level year. Fourth level High risk: actions Fifthimplemented level as soon as possible and no later than six months. Extreme risk: requires urgent action. The trust board is made aware and it implements immediate corrective action.  Clickrequired Action to edit Master in reducing riskstitle style level it is often hard to to an acceptable judge the level of risk that can be tolerated. This is because Edit Master textthe risk is balanced against the benefit and whether there is styles a better alternative Second level to accepting the risk. It is reasonable Third levelto accept a level of risk if the risk from all the other Fourth level alternatives, including doing nothing, is even greater. Fifth level A risk is not acceptable if there is a reasonable alternative that offers the same benefit but avoids the risk. Acceptable risk may become unacceptable over time or because circumstances change. It is best to use your organisation’s approved risk assessment forms.  Risk assessment and needle-sticks Click to edit Master title style When looking at the risks from needle-sticks, it is essential that all the workers who may be harmed are identified. Nurses and other medical staff may be at highest risk, but cleaners, laundry Edit workers, Master and others text such as laboratory technicians and students may also be at risk. Ask styles all workers whether they have come across “sharps” at work. Second Consider level situations, tasks, and equipment that may result in the transmission of all the places, blood-borne pathogens. Third level Even if nurses using syringes in acute medical situations may be at highest risk, do not Fourthforget level all the other potential situations, such as a sharp being caught up in dirty laundry and exposing the laundry worker of an outside contractor to risk. Fifth level While eliminating the risk of transmission of blood-borne pathogens through needlestick injuries is difficult, particularly in health care establishments, there are many measures that can substantially reduce the risk. These measures should consider collective means of prevention first, for example by procurement of syringes with retractable needles. Personal prevention (e.g. gloves) are a last resort when the risk cannot be adequately controlled through other means. Immunisation for hepatitis B virus is an option, but does not prevent the transmission of other blood-borne pathogens.  All measures need to be supported by information provision and training, and consulting those Click to edit Master title style who will have to use the protective measures When putting new measures in place, check that new dangers are not also being created. Be clear who does what and when, and make sure the resources needed are available. A range of measures (e.g. for workplace, work organisation, work equipment, training) is often most Edit Master text styles effective. The employer should also have a plan of action should a needlestick injury occur. This should focus onSecond level of the injured worker through medical care and counselling, but also the well-being prompt a review of preventive measures to learn from the event. There should not be a “blame Third level culture”. Fourth level Measures that can be considered Fifth level include: Procurement of safer medical equipment such as syringes with retractable needles Better control of medical waste Improved working conditions such as lighting Improving work organisation – for example, dealing with fatigue (e.g. from long shifts) which can be a causal factor of worker harm, and improving supervision to ensure compliance with systems of work Personal protective equipment Immunisation for Hepatitis B virus Safe systems of work (no re-capping of needles) Safe disposal of sharps and other clinical waste Training and information  Click to edit Effective communications Master title style ineffective or insufficient communication among team members is a significant Edit Master contributing texttostyles factor adverse events. Second level In the acute care setting, communication failures lead to increases in patient Third level harm, length of stay, and resource use, as well as more intense caregiver Fourth level dissatisfaction and more rapid turnover. Fifth level in multisite studies of intensive care units (icus), poor collaborative communication among nurses and physicians, among other specific factors, contributed to as much as a 1.8-fold increase in patient risk-adjusted mortality and length of stay Analysis of 421 communication events in the operating room found communication failures in approximately 30 percent of team exchanges; one- third of these jeopardized patient safety by increasing cognitive load, interrupting routine, and increasing tension in the OR setting. Click to edit Master title style the Edit researchers Master text found styles that communication problems were relatively straightforward Second level and fell into four categories: Third level (1) communications that were too late to be effective, Fourth level (2) failure to communicate Fifth level with all the relevant individuals on the team, (3) content that was not consistently complete and accurate, and (4) communications whose purposes were not achieved—i.E., Issues were left unresolved until the point of urgency.  Examining the outcomes of communication, other researchers have found associations between Click to edit Master title style better nurse-physician communication and collaboration and more positive patient outcomes, i.e., lower mortality, higher satisfaction, and lower readmission rates. Effective communication among health care professionals is challenging due to a number of interrelated dynamics: Edit Master text styles Health care is complex and unpredictable, with professionals from a variety of disciplines involved Second in providing levelcare at various times throughout the day, often dispersed over several locations, creating spatial gaps with limited opportunities for regular synchronous interaction. Third level Care providers often Fourthhave level their own disciplinary view of what the patient needs, with each provider prioritizing the activities in which he or she acts independently. Fifth level Health care facilities have historically had a hierarchical organizational structure, with significant power distances between physicians and other health care professionals. This frequently leads to a culture of inhibition and restraint in communication, rather than a sense of open, safe communication (psychological safety). Differences in education and training among professions often result in different communication styles and methods that further complicate the scenario and render communications ineffective. Although teamwork and effective communication are crucial for safe patient care, the educational curricula for most health care professions focus primarily on individual technical skills, neglecting teamwork and communication skills.  Click to edit Master title style A cultural barrier can be found in many organizations that can be traced to the belief that quality of care and error-free performance result from Edit Mastertraining professional text styles and effort, ignoring the inherent limitations described Second in human level science. factors Third level in fact, human Fourthfactors level such as cognitive overload; the effects of stress, fatigue, distractions and interruptions; poor interpersonal Fifth level communications; imperfect information processing; and flawed decision making are all known to contribute to errors in health care and other complex environments, such as aviation. failure to recognize and understand these issues can lead to a culture of unrealistic expectations and blame, diverting efforts away from effective team-based error management strategies.  Situational briefing guide: SBAR. A standardized communication format, the SBAR, was Click to edit Master title style utilized as a situational briefing guide for staff and provider communication regarding changes in patient status or needs for nonemergent events, related issues, or for events on the unit, in the lab, or within the health care team. SBAR is an acronym for: Edit Master Situation: what is text goingstyles on with the patient? Secondwhat Background: levelis the clinical background or context? Assessment: Third leveldo i think the problem is? what Fourth level Recommendation: what Fifth leveldo i think needs to be done for the patient? Since sbar provides a standardized means for communicating in patient care situations, it is effective in bridging differences in communication styles and helps to get all team members in the “same movie.” SBAR provides a common and predictable structure for communication, can be used in any clinical domain, and has been applied in obstetrics, rapid response teams, ambulatory care, icus, and other areas. SBAR also presents guidelines for organizing relevant information when preparing to contact another team member, as well as the framework for presenting the information, appropriate assessments, and recommendations.  Informed consent and risk management Click to edit Master title style Informed consent is a general principle of law that imposes a duty on healthcare providers to disclose to patients the information they need to intelligently make healthcare-related decisions. The basisMaster Edit of informedtext consent stylescenters on the principle of autonomy, which recognizes an individual's right to make decisions regarding his/her healthcare. Second Generally, level provider has a duty to disclose what a reasonable, prudent clinician in a healthcare Third the medical or dental level community in the exercise of reasonable care would disclose to a patient. At minimum, this includes: Fourth level Fifth level Diagnosis and purpose of the proposed procedure or treatment A description and explanation of the proposed procedure or treatment Important risks and benefits Alternatives to the proposed procedure or treatment, including no action The healthcare provider should discuss risks that are material or necessary to the patient's informed decision-making. Remote risks generally do not need to be disclosed, although many practitioners do advise patients of the risk of death or serious morbidity. This approach is especially wise if patients' comorbid conditions or life situations make such information more urgent. For example, a surgeon will want to discuss and document in greater detail the risks of a knee procedure if the patient is a professional football player. Additional elements of informed consent may be legally required (such as the patient's signature) and can vary by state. Healthcare providers should be aware of the laws and standards related to informed consent in the states in which they practice.  The scope of informed consent the thoroughness and complexity of the informed consent process will depend on the type of procedure or treatment involved. Click to edit Master title style Minor procedures — such as the removal of a minor skin lesion or the filling of caries — may require only a simple discussion of risks. However, Edit as procedures Master text become more complex or have a greater degree of risk, the styles consent process should be more comprehensive. Second Healthcare level should individually tailor the consent process to each patient and providers his/her specific condition or situation. Third level Patients should Fourth have ample time to ask questions, voice concerns, and clarify level information. Fifth level Additionally, providers should always document the informed consent process in patient health records, regardless of the complexity of the procedure. When determining how to effectively support patient comprehension, practitioners should consider: The patient’s current understanding of his/her condition and the proposed treatment plan The patient’s overall capacity to understand Cultural considerations that might affect the patient’s decision-making Any language barriers that could impede the consent process  The Essentials of Informed Consent Although the information provided during Click to edit Master title style Informed consent should be tailored to each individual patient and his/her clinical condition, some basic elements include: the patient’s name Edit Master the name of thetext styles hospital or healthcare practice Second the level treatment/procedure name (both in medical and layman’s terms) A description of the procedure Third level the names of all practitioners Fourth level performing the treatment/procedure and the significant tasks of each Fifth level A statement that the procedure was explained to the patient (or patient’s guardian) the name and signature of the person who explained the procedure to the patient or guardian the risks and benefits of the proposed treatment/procedure Alternatives to the proposed treatment/procedure, including doing nothing The patient’s signature memorializing understanding and providing consent The date and time consent is obtained A witness signature  Informed consent in cognitively impaired patients Click to edit Master title style In addition to considerations related to informed consent in minors, healthcare organizations should have policies and guidance about Edit Master informed consent textforstyles individuals who have cognitive impairments or other Second disabilities that levelaffect their decision-making capacity (e.g., Patients who have alzheimer’s Third level disease, dementia, certain mental illnesses, or developmental Fourthdisabilities). level Fifth level Key considerations include using best practices and standards for (a) identifying patients who may lack capacity, (b) evaluating capacity, (c) determining competence, and (d) using appropriate alternative consent procedures.  Click to edit Informed refusal Master title style As part of patients’ rights to make informed decisions about their care and treatment, they also Edit Master texthave the right to refuse care, even if the consequences are dire. styles The basis Second of informed level refusal is identical to informed consent. Third This process level that the patient who is refusing the practitioner’s ensures Fourth level recommended treatment Fifth level or procedure is informed about the potential risks and complications that may occur as a result of his/her refusal. Patients also have the right to change their minds and withdraw consent for treatment they have previously authorized, even when the treatment has already been started. When a patient refuses treatment or wants to abandon a treatment plan, the provider should carefully document the decision in the patient’s health record. Documentation should include the following considerations:  Although Click it to is not edit always necessary Master for title the patient style to sign an informed refusal statement, the request forces the patient to acknowledge the seriousness of the untreated condition. Many patients sign; some Edit Master text styles refuse. Second In the eventlevel of refusal, the provider should document that the patient Third level was asked to sign the statement and would not do so Fourth level Some providers like Fifth to have a witness present when a patient refuses level needed care. When an employee has been asked to witness the informed refusal process, he/she should sign the statement and date the signature — whether the patient agrees to sign or not.  Weighing up risks and benefits Click to edit Master title style Every treatment has risks as well as benefits. The best treatment for you may be different from the best treatment for your friend or neighbour. Edit We all Master text styles have individual needs, and different things matter to each of us. Second Research level that if you take part in deciding what treatment you suggests Third level have, you're likely to recover more quickly than if you don't take part in decisions. itFourth is evenlevel more important to play an active role when doctors Fifth level don't know which treatment works best. Doctors should base their treatment recommendations on what the research tells them. This is called practising evidence-based medicine. This is a good way to practise medicine because it means your doctor is using evidence from medical studies that have looked at what happens to many thousands of people with your condition.  Key points to remember when choosing Click to edit Master title style treatments Look into all your treatment options. Edit Master text styles Make sure you understand the risks and benefits of treatments. Second level Make sure youlevel Third understand how the risks and benefits will affect you personally. Fourth Make sure you havelevelenough information to make a choice. Fifth level Make sure you understand the risks and benefits of deciding not to have treatment. You and your doctor should talk about your options for treatment and make a decision together about the best treatment for you. This is called shared decision-making. There are several questions you should ask before deciding on any treatment.  Risk management in elderly patients: Medication Click to edit Master title style issues When prescribing a medication to an elderly patient, physicians should be aware Editthat age-related Master text styles changes may affect a drug's absorption, distribution, Secondmetabolism, level and elimination. As well, the Third elderly level may be more prone to side effects from medications, Fourth level such as dizziness or drowsiness, leading to an increased risk of falls. Fifth level Lastly, the elderly are frequently prescribed multiple medications and are particularly vulnerable to drug interactions. Physicians should also keep in mind that when ordering a medication there are five stages that must be considered: prescribing the appropriate drug and dose, correctly transcribing the prescription, preparing and dispensing the medication, appropriately administering to the correct patient, and monitoring the short- and long-term effects of the drug.  ClickManagement Risk to edit Master fortitle Adult style Day Care Facilities Many families are keeping senior members at home rather than choosing an assisted living or other residential health facility. Editfamilies However, Master need text styles with their daily activities and need assistance caring for their elderly to continue family member during a portion of the day. Adult care facilities provide this service. It is estimated that Second there are currentlylevel more than 4,000 of these facilities in operation and the number keeps growing. part This is due in Thirdtolevel the increased life expectancy and better quality of life of our aging population. Fourthprovide Adult day care facilities level meals and social activities for seniors. Additionally, medical and health services are available. The Fifth facility level also administers medicine and provides necessary therapy. Of course, the variety of services increases the range of risk for both the senior participants and the employees. Common risks associated with adult day care include, but are not limited to: Choking Falling Errors in administering medication Contagious diseases Food poisoning Reports of abuse or neglect  Click toMeasures Preventative edit Master title style A risk management program for adult day care should identify operational Edit risks andMaster specifytexthowstyles those risks can be reduced. Additionally, procedures for Second and emergencies levelcrises must be included. New employee and continuing education Third must level be provided for all staff on the care expectations of the Fourth level center. Fifth level The risk management program should specify that: Only licensed medical personnel should be allowed to administer medications. All foods and food-preparation equipment must meet health standards for cooking and cleaning to prevent food poisoning and food borne illness. Foods should be cut into small, easily swallowed pieces before serving to reduce choking risks.  Click to edit Master title style Avoidance of Abuse and Neglect It takes a special person to work with seniors. Adult care providers who do not receive the proper training may not always be gentle and kind with seniors. Edit Master text styles The adult day carelevel Second facility should take steps to avoid physical abuse. Additionally, security Third levelmeasures should be in place to prevent financial abuse – the accessing of bank accounts or otherlevel Fourth personal financial information. such Psychological abuse, Fifth level as insults, isolation, or humiliation can also be a problem. It is important to have an adequately staffed facility so that patients receive the medical attention and assistance they require. Staff must also receive adequate training on how to meet the needs of the elderly. Malnutrition, sores, and dehydration are some of the results of neglect reported at adult day care facilities.  Click to edit Master title style Preventing Disease Older adults have suppressed immune systems. Therefore, it is important for adult day care workers to wash their hands and observe all appropriate sanitation methods. This includes food preparation. Additionally, staff members should be up-to-date on immunizations to help prevent the transmission of communicable diseases. Edit Master text styles Risk Management Requirements Second level Most states have risk management requirements for adult day care centers. Areas that must be addressed in Third a risklevel management program usually include: Training of staff Fourth level Fifth level Maintenance of facility Food storage, service, and sanitation Storage of chemicals, medications, and supplies Emergency preparedness, including fire and evacuation procedures Transportation (if provided by the facility) Adult day care facilities must do everything possible to reduce risks for elderly participants, their families, and staff members. It is important that adult day care facilities are backed by all the right insurance, including general liability and workers’ compensation.