0555_healthcare risk assessment made easy.pdf

8/12/2019 0555_Healthcare risk assessment made easy.pdf

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March 2007

Healthcare riskassessment made easy


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The purpose of this document is to provide:

1. an easy-to-use risk assessment tool that helpspromote vigilance in identifying risk and the

ways in which risk can be minimised;

2. guidance that will encourage greater

consistency in the way risk assessment

is applied across the NHS.

The tool is intended to encourage greater useat practice level, and increased awareness andunderstanding of risk assessment at all levels.Frontline staff may use the tool to assess any

risk to a patient or patients in their care.This tool is applicable and easily adapted for usein all care settings.

Before you start to assess risks make sure youhave a good understanding of your organisations

risk management policy/strategy.

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What is risk assessment?

A risk assessment seeks to answer four simple,related questions:

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Is there a needfor action?

How bad?

How often?

It is not usually possible to eliminate all risks buthealthcare staff have a duty to protect patientsas far as reasonably practicable. This meansyou must avoid any unnecessary risk. It is best tofocus on the risks that really matter those with

the potential to cause harm. Keep risk assessmentsimple do not use techniques that are overlycomplex for the type of risk being assessed.

What cango wrong?


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In risk assessment we look at:

hazards which are situations with thepotential to cause harm; and

risks which are dened as the probabilitythat a specic adverse event will occur ina specic time period or as a result of aspecic situation.

Riskis the combination of likelihood andconsequence of a hazard being realised.

A clinical risk or healthcare risk is thechance of an adverse outcome resulting

from clinical investigation, treatment orpatient care.

For each hazard identied, it is important todecide whether it is signicant and whetherappropriate and sufcient controls orcontingencies are in place to ensure that

the risk is properly controlled.

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Understanding the difference betweena hazard and a risk an example

A medicine could be described as a hazard if ithas the potential to cause harm. However, therisk of that harm may be very small providedeffective controls/measures are in place. If apatient could suffer harm as a result of taking

the medicine, the chance of the harm occurringat a given severity may be described as a clinicalrisk. If harm resulted from taking the medicineand the harm was not expected this would be apatient safety incident.

It is important that you identify and have a clear

understanding of the signicant risks of eachparticular hazard. To avoid confusion, describeeach risk separately and clearly. For example,when considering the hazard of selecting thewrong drug because of similar (look-alike)packaging, there is risk to the patient, risk to

the staff involved and risk to the organisation.Failure to describe or dene each risk clearlyis a common pitfall that can lead to problemswhen carrying out risk assessment.

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Five steps to easy risk assessment

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Identify the hazards (what can go wrong?)

Decide who might be harmed and how(what can go wrong? who is exposed

to the hazard?)

Evaluate the risks (how bad? how often?)and decide on the precautions (is therea need for further action?)

Record your ndings, proposed actionand identify who will lead on what action.

Record the date of implementation.

Step 1

Step 3

Step 4

Step 5Review your assessment and updateif necessary.

Review

Step 1Identify the hazards

(what can go wrong?)

To prevent harm it is important to understandnot only what is likely to go wrong but also howand why it may go wrong. Consider the activitywithin the context of the physical and emotionalenvironment, and the culture of the organisationand the staff who perform the activity.

Step 2


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Take into account things that have gone wrongin the past and near-miss incidents. Learn fromthe past.

1. Walk around the workplace or clinical areaand talk to patients and staff.

2. Map or describe the activity to be assessed.

3. The risk assessment may require amulti-disciplinary team.

Step 2Decide who might be harmedand how (what can go wrong? who isexposed to the hazard?)

People will make mistakes. It is necessary toanticipate some degree of human error andtry to prevent the error from resulting in harm.

1. Consider the number of patients that mightbe affected over a stated period of time.

When quoting the number of patientsaffected you should always state the lengthof the assessment period.

2. Remember that the most vulnerable patientsare more likely to suffer harm.

3. Think about the complexity of the task.

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Step 3Evaluate the risks (how bad?how often?) and decide on the precautions(is there a need for further action?)

Consider both consequence (how bad?) andlikelihood (how often?). Is there a need foradditional action? The law requires everyoneproviding a service to do everything reasonably

practicable to protect patients from harm.1. Use your organisations risk matrix

(an example risk matrix is on page 10).

2. Decide on the precautions (controls) thatwill most effectively reduce consequence

and/or likelihood.3. Re-evaluate the risks assuming the

precautions (controls) have been taken.

Step 4Record your fndings, proposed actionand identify who will lead on what action.

Record the date of implementation

Risk assessments and action planning shouldbe reviewed and changed when necessary.This is easy only if the assessment is well-recorded and the logic behind the decisionstransparent. An efcient and succinct systemof documentation is essential.


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You need to show that:

1. a thorough check was made to identify all thehazards and treat all the signicant risks;

2. the precautions are reasonable and theremaining risk is acceptable;

3. the solutions are realistic, sustainable

and effective.

It may be reasonable to accept some degreeof preventable risk, if the benets to be gainedoutweigh the risk.

Step 5Review your assessment and updateif necessary

Good documentation is important becausethings are always changing. Research and newdevelopments increase the pace of change, andthose changes can alter existing and/or introduce

new hazards.

Review your risk assessment:

1. when you are planning a change;

2. routinely at least on an annual basis;

3. when there has been a signicant change.


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Example risk matrix

Consequence For example catastrophic means

death or debilitating permanent injury and minormeans requiring rst aid.

Likelihood This must be estimated over astated period or related to a given activity.

Frequency

1

Rare

2

Unlikely

3

Possible

4

Likely

5

Almostcertain

How oftenmight ithappen (perprocedure/episode orwithin aspecied

timeframe)?

Cantbelieve thatthis will everhappen orrecur

Do notexpect it tohappen orrecur but it ispossible

Mighthappenor recuroccasionally

Willprobablyhappen orrecur butit is not apersistentissue

Willundoubtedlyhappen orrecur, possiblyfrequently

Catastrophic

Major

Moderate

Minor

Negligible

Yellow

Yellow

Green

Green

Green

Rare

Orange

Orange

Yellow

Yellow

Green

Unlikely

Red

Orange

Orange

Yellow

Green

Possible

Red

Red

Orange

Orange

Yellow

Likely

Red

Red

Red

Orange

Yellow

Almostcertain

Likelihood

Consequence


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For the denitions of adverse event and patient

safety incident see page 13.

Risk scoring The risk scores are not intendedto be precise mathematical measures of risk,but they are useful when prioritising controlmeasures for the treatment of different risks.

Low risk (green) Quick, easy measuresimplemented immediately and further actionplanned for when resources permit.

Moderate risk (yellow) Actions implementedas soon as possible, but no later than the nextnancial year.

High risk (orange) Actions implemented assoon as possible and no later than six months.

Extreme risk (red) Requires urgent action.The trust Board is made aware and it implementsimmediate corrective action.

The above information is not meant to beprescriptive but is intended for guidance. Thetrust Board is responsible for dening the levelof acceptable risk.


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Any signicant residual risk should be recorded inthe organisations risk register. The organisationsrisk register should be subject to regular reviewby the trust Board.

Denitions

Risk managementis assessment, analysis andmanagement of risks. It is simply recognisingwhich events (hazards) may lead to harm inthe future and minimising their likelihood(how often?) and consequence (how bad?).

An adverse eventis any event or circumstance

leading to unintentional harm or suffering.

A patient safety incidentis any unintendedor unexpected incident which could have or didlead to harm for one or more patients receivinghealthcare. It is a specic type of adverse event.


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Inherent clinical riskis the permanent

or currently unavoidable clinical risk that isassociated with a particular clinical investigationor treatment. It is the risk from undergoing aparticular procedure in ideal conditions andperformed by the best staff using the most up-to-date research, equipment and techniques.

The inherent clinical risk can be consideredpermanent or currently unavoidable when usedfor the purpose of risk assessment. The risk thatshould be targeted by clinical risk assessmentis the risk that is added to the inherent risk and

results from, for example, a poor safety culture,poor communication and teamwork, inadequatesupervision of inexperienced staff, unreliableequipment or an unsuitable environment.


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Acknowledgements

This document has been prepared by theNational Patient Safety Agency (NPSA).The following organisations have beenconsulted and/or have assisted in deningand testing the risk assessment:

Guys and St Thomas Hospital NHSFoundation Trust

Mid Yorkshire Hospitals NHS Trust

Health and Safety Executive

NPSA project team

Michael Coultous, Patient Safety ManagerDonna Forsyth, Patient Safety ManagerAly Hume, Patient Safety ManagerJohn Morrison, Patient Safety Manager

FeedbackWe would appreciate your feedback on thisdocument. Please send your comments to:Michael Coultous, Patient Safety Manager,[email protected]


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The National Patient Safety Agency

4-8 Maple Street

London

W1T 5HD

T 020 7927 9500

F 020 7927 9501

Gateway Reference Number: 8083

0555

National Patient Safety Agency 2007. Copyright and other intellectual

property rights in this material belong to the NPSA and all rights are

reserved. The NPSA authorises healthcare organisations to reproduce

this material for educational and non-commercial use.

Reprinted May 2007

www.npsa.nhs.uk

0555_healthcare risk assessment made easy.pdf

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