Risk Assessment Meeting Introduction Slides --- Your Hospital’s Name --- Hospital at Night Patient Safety Risk Assessment:

What are we here to do? Risk Assessment of Hospital at Night issues and solutions −Identify issues that could compromise patient safety −Design them out of our solution Thereby provide safer care

Risk Assessment Objectives To ensure solutions provide safer care Risk Assessment Scope All accountable activities Activities changed by recommendations/solutions for which others, both within the hospital and external, are accountable Objective and Scope

What Can Go Wrong? How Often? How Bad? Is there a Need for Action? What is Risk Assessment?

Hazard – a situation with the potential to cause harm Risk – the combination of likelihood and consequence of hazards being realised Hazards and Risks

……… so what happens next? You need to consider the unexpected

Assess risk and determine the need for action Risk Matrix This is used for: –Qualitative assessment of the level of risk from an event Commonly used in risk assessments Found in many forms

Example of a Risk Matrix Two dimensions –Consequence/impact/severity –Likelihood/frequency/probabi lity How to use –Define for a risk its: consequence likelihood –Read off the risk level Consequence / Severity / Impact Frequency/Likelihood/Probability Extreme Risk

Example of a Risk Matrix Key Low riskModerate risk High riskExtreme risk Consequence Catastrophic Major Moderate Minor Negligible RareUnlikelyPossibleLikelyAlmost Certain Likelihood Catastrophic Major Moderate Minor Negligible12345 RareUnlikelyPossibleLikelyAlmost Certain Likelihood

Mapping or develop a flow chart of the process/issue is one of the more effective ways to identify hazards It may be useful to have different levels of mapping Top level – limit to no more than 8 activities Second level – map more complex activities in greater detail How do you identify hazards so you can assess the risks?

Team arrival and handover from Day team Planned treatment (e.g. taking blood samples) Acute Admissions Handover to Day team and Team departure Bed Management Treatment of patients needing unscheduled care Risk Assessment of Patients on Wards Implementati on of Planned tests/treatme nt Top Level Activity Map

Ward nurse identifies and assesses patient in need of treatment Ward treatment Bleep management / Team assessment and resource allocation Team assessment Team treatment resource allocation Team treatment Patient evaluation Treatment of patients needing unscheduled care Second Level Activity Map for treatment of patients needing unscheduled care

e.g. Different shift patterns e.g. Medical emergency e.g. Not seen as important e.g. Failure to understand need for and benefit of handover e.g. Not all relevant staff attend handover e.g. Failure to (or insufficient) handover e.g. Late handover e.g. Wrong or incomplete information transferred e.g. Exchange of information related to patient assessed as likely to need additional or extraordinary care during the night. Bed status and workload is also discussed. e.g. Handover from Day to Night staff Step 1 - Select activity to assess Step 4 – Select relevant hazard to assess Step 5 – Identify causes, patient safety consequences and control (Record in log sheet columns 3, 4 & 5) Step 2 - Describe activity even better map using eg a timeline (Document in top section of log sheet) Step 3 – Identify relevant hazards (Record in log sheet column 2) Step 6 – Assess hazard’s risk and determine the need for action (Record in log sheet columns 6, 7 & 8) Step 7 – Develop recommendations and re-assess risk (Record in log sheet columns 9, 10,11 and 12) Assessment complete Step 9 - Another Activity? Yes No Step 8 – next Another hazard? No Yes Assessment Process e.g. Consequence (C) = Medium Likelihood (L) = High Risk Rating (CxL) = HIGH e.g. A register of attendees required at, and attending handover is kept e.g. Pre-defined person updates all who do not attend handover Consequence (C) = Low Likelihood (L) = Low Risk Rating (CxL) = LOW e.g. Late handover e.g. Bleep cover

What Now? Step 1 - Select activity to assess Step 2 - Describe activity or even better, map the activity using a time line. (Document a summary in top section of log sheet) Step 3 – Identify relevant hazards i.e. using your mapping, identify what could go wrong – ask some “what if” questions – what if this happens or does not happen, what if action is taken at wrong time etc. (Record in log sheet column 2) Do the remaining steps and record in log sheet

HospitalDate of Assessment Activity description: Inputs: Outputs: Resources (people, equipment, etc.): Controls: Activity No. IDWhat could go wrong? Causes?Consequences?Controls? (already planned or implemented) Risk Ranking Recommendations?Risk Ranking CLRCLR C= Consequences L= Likelihood R= Risk combination of likelihood and consequence of hazards being realised R = C x L Record Sheet

Outcomes of the Risk Assessment Recommendations to ensure solutions implemented maximise patient safety Risk assessment plan HospitalDate of assessment Rec No. Recommen dation PriorityLeadStart date Due date Completed date Resources required Reporting/ monitoring requirements Progress (including dates) Assessment Plan