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

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 providing safer care

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

Is there a Need for Action? What is Risk Assessment? What Can Go Wrong? How Often? How Bad? Is there a Need for Action? The process of risk assessment seeks to answer four simple, related questions: What can go wrong? How bad will it be if it does go wrong? How often this may happen? Is there a need for action? For each hazard identify, 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 effectively minimised.

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

……… so what happens next? Others are less predictable and therefore risk assessment must be able to pick up the frequent and infrequent, low and high risk issues. It we look at incident investigation it’s the idiosyncrasies of events that lead to the incident – so one needs to think out of the box to be a good risk assessor You need to consider the unexpected

determine the need for action 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 Frequency/Likelihood/Probability Two dimensions Consequence/impact/severity Likelihood/frequency/ probability How to use Define for a risk its: consequence likelihood Read off the risk level Risk Consequence / Severity / Impact High Risk

Example of a Risk Matrix CONSEQUENCES LIKELIHOOD 1 - Rare 2 - Unlikely 3 - Moderate 4 - Likely 5 - Certain 1 – Minor 1 2 3 4 5 2 - Moderate 6 8 10 3 – Serious 9 12 15 4 - Major 16 20 5 - Critical 25 This is an example of a 5X5 risk matrix, it is only an example to show how risk matrixes work, individuals may want to add their own matrix in here.

How do you identify hazards so you can assess the risks? 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 eight activities Second level – map more complex activities in greater detail

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

Treatment of patients needing unscheduled care Hospital at Night Second Level Activity Map for treatment of patients needing unscheduled care Treatment of patients needing unscheduled care Ward nurse identifies and assesses patient in need of treatment Ward treatment Bleep management / H@N Team assessment and resource allocation H@N Team assessment H@N Team treatment resource allocation Note this slides expands the last box in the previous slide. Treatment of patients needing unscheduled care is the selected activity. Each selected activity needs to be mapped or fully described. Mapping provides a better base to work from than a description. Patient evaluation H@N Team treatment

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 Step 1 - Select activity to assess e.g. Not all relevant staff attend 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. Different shift patterns e.g. Medical emergency e.g. Not seen as important e.g. Failure to understand need for and benefit of handover Step 6 – Assess hazard’s risk and determine the need for action (Record in log sheet columns 6, 7 & 8) e.g. Handover from Day to Night staff 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. Step 2 - Describe activity even better map using eg a timeline (Document in top section of log sheet) Step 7 – Develop recommendations and re-assess risk (Record in log sheet columns 9, 10,11 and 12) Step 3 – Identify relevant hazards (Record in log sheet column 2) Step 8 – next Another hazard? Yes Step 4 – Select relevant hazard to assess e.g. Late handover No Step 9 - Another Activity? Step 5 – Identify causes, patient safety consequences and control (Record in log sheet columns 3, 4 & 5) Yes e.g. Bleep cover No Assessment complete

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) Group work – get the delegates to do the steps. Do the remaining steps and record in log sheet

Record Sheet C= Consequences L= Likelihood Hospital Date of Assessment Activity description: Inputs: Outputs: Resources (people, equipment, etc.): Controls: Activity No. ID What could go wrong? Causes? Consequences? Controls? (already planned or implemented) Risk Ranking Recommendations? C L R Group work: Use the record sheet to record the steps. Quickly go through the record sheet which each participant should have in front of them. C= Consequences L= Likelihood R= Risk combination of likelihood and consequence of hazards being realised R = C x L

Outcomes of the Risk Assessment Recommendations to ensure solutions implemented maximise patient safety Risk assessment plan H@N Assessment Plan Hospital Date of assessment RecNo. Recommendation Priority Lead Start date Due date Completed date Resources required Reporting/ monitoring requirements Progress (including dates) Group work: Use the Assessment Plan to record the recommendations and how they are to be implemented.