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

2. 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

3. 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

4. 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.

5. 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

6. ……… 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

7. 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

8. 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

9. 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.

10. 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

11. Hospital at Night Top Level Activity Map
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
Implementation of Planned tests/treatment

12. 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 / Team assessment and resource allocation
Team assessment
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
Team treatment

13. 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

14. 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

15. 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

16. Outcomes of the Risk Assessment
Recommendations to ensure solutions implemented maximise patient safety
Risk assessment plan
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.